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

Pandemic (H1N1) 2009 - update 75 - Weekly update

Pandemic (H1N1) 2009 - update 75 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 75

Pandemic (H1N1) 2009 - update 75 - Weekly update

20 November 2009


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

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


Situation update:

The situation remains similar since the last update.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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


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

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 15 November 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.74): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 74): Sri Lanka, Pakistan and Slovenia.


Cumulative total as of 15 November 2009

[Cases* - Deaths]

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

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

-<region cumulative="" totalas="" 15="" november="" 2009="" cases*="" deathswho="" africa="" (afro)="" 14950="" 103who="" americas="" (amro)="" **="" 190765="" 4806who="" eastern="" mediterranean="" (emro)="" 25531="" 151who="" europe="" (euro)**="" 78000="" 350who="" south-east="" asia="" (searo)="" 45844="" 710who="" regional="" office="" for="" western="" pacific="" (wpro)="" 166750="" 613="" over="" 525060="" at="" least="" 6770*given="" that="" countries="" required="" to="" test="" and="" report="" individual="" cases,="" actually="" understates="" the="" real="" cases.="" **the="" total="" number="" of="" cases="" are="" no="" longer="" reported="" from="" these="" regions=""></region>​
<cite cite="http://www.who.int/csr/don/2009_11_20a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 75</cite>
 
Pandemic (H1N1) 2009 - update 76 - Weekly update

Pandemic (H1N1) 2009 - update 76 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 76

Pandemic (H1N1) 2009 - update 76 - Weekly update

27 November 2009


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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


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

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


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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 22 November 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.75): Armenia.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 75): The former Yugoslav Republic of Macedonia, Switzerland, Poland, Tunisia, Morocco and Madagascar.


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

  • WHO Regional Office for Africa (AFRO) 15503 - 104
  • WHO Regional Office for the Americas (AMRO) ** 190765 - 5360
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 38359 - 330
  • WHO Regional Office for Europe (EURO)** over 154000 - at least 650
  • WHO Regional Office for South-East Asia (SEARO) 47059 - 738
  • WHO Regional Office for the Western Pacific (WPRO) 176796 - 644
  • Total over 622482 - at least 7826
*Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases.
**The total number of cases are no longer reported from these regions
-
​
<cite cite="http://www.who.int/csr/don/2009_11_27a/en/index.html">WHO
</cite>
 
Pandemic (H1N1) 2009 - update 77 - Weekly update - 4 December 2009

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

WHO - Pandemic (H1N1) 2009 - update 77

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


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Weekly update (Virological surveillance data)

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


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

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

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

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

The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week.

Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 29 November 2009

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.76): None.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 76): Romania and Slovakia.

[Region - Deaths]

  • WHO Regional Office for Africa (AFRO) 108
  • WHO Regional Office for the Americas (AMRO) 5878
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 392
  • WHO Regional Office for Europe (EURO) at least 918
  • WHO Regional Office for South-East Asia (SEARO) 766
  • WHO Regional Office for the Western Pacific (WPRO) 706
  • Total at least 8768
-
​
<cite cite="http://www.who.int/csr/don/2009_12_04/en/index.html">WHO | Pandemic (H1N1) 2009 - update 77</cite>
 
Pandemic (H1N1) 2009 - update 78 - Weekly update - 11 December 2009

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

WHO - Pandemic (H1N1) 2009 - update 78

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


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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


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

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


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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.77): Democratic Peoples Republic of Korea.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 77): Austria, Lithuania, Latvia, and the United Arab Emirates.


[Region - Deaths]

  • WHO Regional Office for Africa (AFRO) 109
  • WHO Regional Office for the Americas (AMRO) At least 6131
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 452
  • WHO Regional Office for Europe (EURO) At least 1242
  • WHO Regional Office for South-East Asia (SEARO) 814
  • WHO Regional Office for the Western Pacific (WPRO) 848
  • Total At least 9596
-
​
<cite cite="http://www.who.int/csr/don/2009_12_11a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 78</cite>
 
Pandemic (H1N1) 2009 - update 79 - Weekly update

Pandemic (H1N1) 2009 - update 79 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 79

Pandemic (H1N1) 2009 - update 79 - Weekly update

18 December 2009


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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


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

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

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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.78): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 78): Bahamas, Bosnia & Herzegovina, Estonia, Montenegro, Libyan Arab Jamahiriya.

[Region - Deaths**]

  • WHO Regional Office for Africa (AFRO)* 109
  • WHO Regional Office for the Americas (AMRO) At least 6335
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 572
  • WHO Regional Office for Europe (EURO) At least 1654
  • WHO Regional Office for South-East Asia (SEARO) 892
  • WHO Regional Office for the Western Pacific (WPRO) 1020
  • Total** At least 10582
* No update since web update no. 78
** The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2009_12_18a/en/index.html">WHO | Pandemic (H1N1) 2009 - update 79</cite>
 
Pandemic (H1N1) 2009 - update 80 - Weekly update

Pandemic (H1N1) 2009 - update 80 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 80

Pandemic (H1N1) 2009 - update 80 - Weekly update

23 December 2009


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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


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

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.79): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No 79): Georgia and Albania.

[Region - Deaths]*

  • WHO Regional Office for Africa (AFRO) 109
  • WHO Regional Office for the Americas (AMRO) At least 6670
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 663
  • WHO Regional Office for Europe (EURO) At least 2045
  • WHO Regional Office for South-East Asia (SEARO) 990
  • WHO Regional Office for the Western Pacific (WPRO) 1039
  • Total* At least 11516
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2009_12_23/en/index.html">WHO | Pandemic (H1N1) 2009 - update 80</cite>
 
Pandemic (H1N1) 2009 - update 81 - Weekly update

Pandemic (H1N1) 2009 - update 81 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 81

Pandemic (H1N1) 2009 - update 81 - Weekly update

30 December 2009


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)


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

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


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

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


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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline


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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 80): None.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 80): Nepal and Armenia.


[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) 130
  • WHO Regional Office for the Americas (AMRO) At least 6670
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 693
  • WHO Regional Office for Europe (EURO) At least 2422
  • WHO Regional Office for South-East Asia (SEARO) 1056
  • WHO Regional Office for the Western Pacific (WPRO) 1249
  • Total* At least 12220
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2009_12_30/en/index.html">WHO | Pandemic (H1N1) 2009 - update 81</cite>
 
Pandemic (H1N1) 2009 - update 82 - Weekly update

Pandemic (H1N1) 2009 - update 82 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 82

Pandemic (H1N1) 2009 - update 82 - Weekly update

8 January 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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


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

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


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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


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

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 81): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 81): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) 131
  • WHO Regional Office for the Americas (AMRO) At least 6880
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 708
  • WHO Regional Office for Europe (EURO) At least 2554
  • WHO Regional Office for South-East Asia (SEARO) 1165
  • WHO Regional Office for the Western Pacific (WPRO) 1361
  • Total* At least 12799
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_01_08/en/index.html">WHO | Pandemic (H1N1) 2009 - update 82</cite>
 
WHO - Pandemic (H1N1) 2009 - update 83

WHO - Pandemic (H1N1) 2009 - update 83

WHO - Pandemic (H1N1) 2009 - update 83

Pandemic (H1N1) 2009 - update 83 - Weekly update

15 January 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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


Qualitative indicators (Week 29 to Week 53: 13 July - 3 January 2010)

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


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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 3 January 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 82): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 82): Sudan.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) 131
  • WHO Regional Office for the Americas (AMRO) At least 7016
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 883
  • WHO Regional Office for Europe (EURO) At least 2788
  • WHO Regional Office for South-East Asia (SEARO) 1289
  • WHO Regional Office for the Western Pacific (WPRO) 1447
  • Total* At least 13554
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_01_15/en/index.html">WHO | Pandemic (H1N1) 2009 - update 83</cite>
 
WHO - Pandemic (H1N1) 2009 - update 84

WHO - Pandemic (H1N1) 2009 - update 84

WHO - Pandemic (H1N1) 2009 - update 84

Pandemic (H1N1) 2009 - update 84 - Weekly update

22 January 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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


Weekly update (Virological surveillance data)

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

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


Qualitative indicators (Week 29 to Week 1: 13 July 2009 - 10 January 2010)

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


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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 10 January 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 83): Mali.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 83): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) 131
  • WHO Regional Office for the Americas (AMRO) At least 7094
  • WHO Regional Office for the Eastern Mediterranean (EMRO) 941
  • WHO Regional Office for Europe (EURO) At least 3099
  • WHO Regional Office for South-East Asia (SEARO) 1366
  • WHO Regional Office for the Western Pacific (WPRO) 1511
  • Total* At least 14142
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_01_22/en/index.html">WHO | Pandemic (H1N1) 2009 - update 84</cite>
 
WHO - Pandemic (H1N1) 2009 - update 85

WHO - Pandemic (H1N1) 2009 - update 85

WHO - Pandemic (H1N1) 2009 - update 85

Pandemic (H1N1) 2009 - update 85 - Weekly update

29 January 2010


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

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


Situation update:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Weekly update (Virological surveillance data)

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


From the published literature:

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

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


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

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


Qualitative indicators (Week 29 to Week 2: 13 July 2009 - 17 January 2010)

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 24 January 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 84): none.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 84): Cyprus and Nigeria.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 133
  • WHO Regional Office for the Americas (AMRO) - At least 7166
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1002
  • WHO Regional Office for Europe (EURO) - At least 3429
  • WHO Regional Office for South-East Asia (SEARO) - 1426
  • WHO Regional Office for the Western Pacific (WPRO) - 1555
  • Total* - At least 14711
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_01_29/en/index.html">WHO | Pandemic (H1N1) 2009 - update 85</cite>
 
Pandemic (H1N1) 2009 - update 86 - Weekly update

Pandemic (H1N1) 2009 - update 86 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 86

Pandemic (H1N1) 2009 - update 86 - Weekly update

5 February 2010


As of 31 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15174 deaths.

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


Situation update:

In the temperate zone of the northern hemisphere, overall pandemic influenza activity continues to decline or remain low in most regions since peaking during late October and November 2009. Several areas continue to have evidence of active but declining transmission, particularly in North Africa and in limited areas of Eastern Europe and East Asia.

In North Africa, pandemic influenza transmission remains active and geographically widespread but overall activity has been declining since peaking during late December 2009 and early January 2010. During January 2010, a substantial decline in the number of pandemic virus isolations and new cases was observed in Morocco and Egypt, respectively.

In West Asia, pandemic influenza transmission remains geographically widespread to regional, but overall activity remained low.

In South and Southeast Asia, pandemic influenza transmission remains active but geographically localized to regional. The overall intensity of respiratory diseases activity was reported to be low to moderate in most places. In India, influenza activity continued to decline in all regions of the country, however, the most active areas of transmission currently are in the western states. An overall peak in the number of pandemic H1N1 cases was recorded in India during mid December 2009, and the majority of these cases were identified in the northern and western states of India.

In Thailand, overall ILI activity remained low, however focal increase in activity were observed in several central and northern provinces.

In East Asia, pandemic influenza transmission remains active and geographically widespread across the region, however, overall activity continued to decline. In Japan, overall influenza activity continues to decline but transmission remains higher on the southern island of Okinawa than in other places.

In the Republic of Korea (South Korea), rates of ILI continued to decline to near baseline after a substantial wave of activity which peaked during early to mid November 2009. In Mongolia, after a period of sustained elevated ILI activity since early November 2009, levels of ILI have recently fallen to the expected seasonal range.

In northern and southern China, rates of ILI have returned to levels seen during recent seasons; however, approximately 30% of respiratory specimens tested were positive for influenza suggesting that active transmission of influenza viruses persists. Of note in China, in recent weeks the circulation of pandemic influenza H1N1 continued to decline with a concomitant increase in the circulation of seasonal influenza type B viruses (pandemic H1N1 and seasonal Type B viruses accounted for 34% and 66% of all influenza viruses detected, respectively).

Active transmission of pandemic influenza virus also persists in Hong Kong SAR (China), although at significantly lower levels than an earlier peak of activity during September and October 2009.

In Europe, transmission of pandemic influenza virus remains active in a limited number of countries as overall activity remained low in most places. At least seven countries testing more than 20 sentinel respiratory samples reported that >20% of samples had tested positive for influenza (Albania, Bulgaria, the Czech Republic, Georgia, Greece, Luxembourg, and Romania); however, in all seven, rates of illness remained well below earlier peaks of activity. Small increases in ILI/ARI have been reported over the past two reporting weeks in Slovakia, Belarus, and the Russian Federation. The overall rate of sentinel respiratory samples testing positive for influenza fell to 14% after reaching a peak of 45% during early November 2009.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places. In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places.

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

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, East and Southeast Asia and are being detected only sporadically on other continents.

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


Weekly update (Virological surveillance data)

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


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

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


Qualitative indicators (Week 29 to Week 3: 13 July 2009 - 24 January 2010)

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


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

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 31 January 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 85): Mauritania and Chad.

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. 85): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7261
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1014
  • WHO Regional Office for Europe (EURO) - At least 3605
  • WHO Regional Office for South-East Asia (SEARO) - 1474
  • WHO Regional Office for the Western Pacific (WPRO) - 1653
  • Total* - At least 15174
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_02_5/en/index.html">WHO | Pandemic (H1N1) 2009 - update 86</cite>
 
Pandemic (H1N1) 2009 - update 87 - Weekly update

Pandemic (H1N1) 2009 - update 87 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 87

Pandemic (H1N1) 2009 - update 87 - Weekly update

12 February 2010


As of 7 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15292 deaths.

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


Situation update:

In the temperate zone of the northern hemisphere, overall pandemic influenza activity continued to decline in most countries. The most active areas of transmission continue to be in later peaking areas, particularly northern Africa, South Asia, and East Asia. Of note, Senegal became the third country within the past month (and fifth overall) to confirm first cases of pandemic H1N1 2009 in West Africa. There is insufficient evidence at this point to determine if this heralds the beginning of a period of more widespread transmission in West Africa, which heretofore may have been largely spared a significant period of communitywide pandemic influenza virus transmission.

In North Africa, pandemic influenza transmission persists but substantial declines in activity have been observed over the past month across the region. In Morocco, levels of ILI have returned to near baseline, and in Egypt, the number of confirmed cases has declined considerably.

In South and Southeast Asia, pandemic influenza virus continues to circulate widely across the region, however, overall activity continues to decrease or remain low in most places. In India, influenza transmission persist, particularly in western, and to a lesser extent, in northern India, however, overall the numbers of cases have declined substantially. In Thailand, overall activity remains low and unchanged since the previous reporting period, however, focal areas of increased ILI activity were reported in central and northern Thailand.

In East Asia, pandemic influenza transmission persists across the region; however, overall activity has declined substantially in most places. In China, pandemic and seasonal influenza viruses continue to co-circulate, however, over the last several weeks, seasonal influenza type B viruses have been predominant. In Japan, influenza activity continues to decrease towards seasonal baselines, including in Okinawa which is experiencing greater levels of influenza activity than in other parts of the country. In Republic of Korea (S. Korea), levels of ILI have decreased substantially to near baseline levels.

In Europe, although pandemic influenza virus continues to circulate widely, particularly across central, southern, and eastern Europe, the overall intensity of pandemic influenza activity has declined substantially from peaks of activity seen earlier during the winter transmission period. Among 15 countries testing more than 20 sentinel respiratory samples, the proportion of samples testing positive for influenza ranged from 0-14%. Recent slight increases in rates of ARI in Slovakia, Slovenia, and the Russian federation, do not appear to be associated with detections of influenza viruses and may be due to other circulating respiratory viruses.

In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission may be geographically localized in most countries reporting surveillance data to WHO, and the overall intensity of activity may be low.

In the Americas, both in the tropical and northern temperate zones, overall pandemic influenza activity continued to decline or remain low in most places. In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places. A high intensity of respiratory diseases with increasing trend was reported in Guatemala, however, the increased activity does not appear to be associated with increased detections of influenza viruses and may be due to other circulating respiratory viruses.

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

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, East and Southeast Asia and are being detected only sporadically on other continents.

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


Weekly update (Virological surveillance data)

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


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


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

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


(NEW) Map of influenza activity and virus subtypes (Week 4: 24-30 January 2010)

Map of influenza activity and virus subtypes [png 268kb]

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


Qualitative indicators (Week 29 to Week 4: 13 July 2009 - 30 January 2010)

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


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

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 7 February 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 86): Senegal.

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. 86): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7261
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1018
  • WHO Regional Office for Europe (EURO) - At least 3648
  • WHO Regional Office for South-East Asia (SEARO) - 1523
  • WHO Regional Office for the Western Pacific (WPRO) - 1675
  • Total* At least 15292
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_02_12/en/index.html">WHO | Pandemic (H1N1) 2009 - update 87</cite>
 
Pandemic (H1N1) 2009 - update 88 - Weekly update

Pandemic (H1N1) 2009 - update 88 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 88

Pandemic (H1N1) 2009 - update 88 - Weekly update

19 February 2010


As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

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


Situation update:

The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.

In Southeast Asia, several countries reported an increasing trend of respiratory diseases activity but overall intensity remained low. After several months of sporadic influenza activity, Thailand reported increasing respiratory diseases activity marked by increased ILI in 24 provinces; however, the overall intensity of activity nationally remains low. In Myanmar and Indonesia, localized geographic spread of influenza activity, an increasing trend of respiratory diseases, and low overall intensity was reported.

In South Asia, influenza activity persists in the northern and western states of India, however, overall influenza activity continued to decline or remained low in India, Nepal, Bangladesh, and Sri Lanka. In East Asia, transmission of pandemic influenza virus persists but has been steadily declining in most countries of region (China, Japan, and the Republic of Korea), with the exception of DPR Korea, where an increasing trend of respiratory diseases activity was reported.

In West Asia, pandemic influenza virus continues to circulate in many countries, however the overall intensity of current activity remains low in the region.

In North Africa, pandemic influenza transmission persists but substantial declines in activity continue to be reported over the past month. In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission may be sporadic in most areas of the continent. Several countries in West Africa continue to report increases in the numbers of confirmed cases of pandemic influenza, however, currently, no countries in the region are reporting an increasing trend in respiratory diseases activity.

In Europe, pandemic influenza virus continues to circulate across central and southeastern Europe, but the overall intensity of activity remained low in most places; only Greece, Bulgaria, Turkey, Slovakia, the Republic of Moldova, and the Russian Federation reported a moderate intensity of respiratory diseases activity. Several weeks of increases in ARI/ILI were reported in Slovakia and in the Russian Federation, but increased activity in these countries may be associated with other circulating respiratory viruses.

Among 12 countries testing at least twenty sentinel respiratory specimes, only Hungary reported that greater than 20% specimens had tested positive for influenza.

In the Americas, both in the tropical and northern temperate zones, pandemic influenza virus continues to circulate at low levels but overall pandemic influenza activity continued to decline or remain low in most places. In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places. Jamaica reported an increasing trend of respiratory diseases activity but the overall intensity remains low.

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, and Asia.

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


Weekly update (Virological surveillance data)

(NEW) Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses [pdf 21kb]

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


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

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

(NEW) Map of influenza activity and virus subtypes (Week 4: 31 January-06 February 2010)
Map of influenza activity and virus subtypes [png 268kb]

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


Qualitative indicators (Week 29 to Week 5: 13 July 2009 - 6 February 2010)

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


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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 14 February 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 87): 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. 87): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7433
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1018
  • WHO Regional Office for Europe (EURO) - At least 4056
  • WHO Regional Office for South-East Asia (SEARO) - 1562
  • WHO Regional Office for the Western Pacific (WPRO) - 1685
  • Total* - At least 15921
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_02_19/en/index.html">WHO | Pandemic (H1N1) 2009 - update 88</cite>
 
Pandemic (H1N1) 2009 - update 89 - Weekly update

Pandemic (H1N1) 2009 - update 89 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 89

Pandemic (H1N1) 2009 - update 89 - Weekly update

26 February 2010


As of 21 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16226 deaths.

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


Situation update:

In the temperate zone of the northern hemisphere, pandemic influenza virus continues to be detected across many countries, however, overall influenza activity continues to wane in most places. The most active areas of transmission are currently in parts of south and southeast Asia and in limited areas of east and southeastern Europe.

In Southeast Asia, pandemic influenza virus continued to circulate in areas, however, the overall intensity of respiratory diseases activity remained low and unchanged, except in a few countries. In Brunei Darussalam, during February 2009, influenza activity was reported to be geographically widespread and was associated with an increasing trend and high intensity of respiratory diseases. Both Myanmar and Thailand have reported an increasing trend of respiratory diseases associated with geographically regional spread of influenza for the first half of February 2009, however, overall intensity currently remains low in both countries. In Thailand, approximately one third of provinces reported that >5% of medical visits were due to ILI during the most recent reporting week.

In East Asia, virologic surveillance data suggest that pandemic influenza and seasonal influenza type B viruses continue to co-circulate. A recent increase in ILI activity in Mongolia may be due to an increase in the circulation of seasonal influenza type B viruses. Overall influenza activity continues to decline and return to baseline levels in both Japan and the Republic of Korea (S. Korea). In Hong Kong SAR (China) and in Chinese Taipei, pandemic influenza virus continues to circulate at low levels and overall ILI activity is substantially lower than what was observed peaks of activity during the fall months.

In South Asia, overall influenza activity remained low, however, pandemic influenza virus transmission persists in the western part of India.

In Europe, pandemic influenza virus transmission persists across parts of central and southeastern Europe, but overall intensity remained low, except for Greece, Bulgaria, Turkey, Slovakia, the Republic of Moldova, and parts of the Russian Federation which continued to report a moderate intensity respiratory diseases activity. Although an increasing trend of respiratory diseases continued to be reported in Georgia, Slovakia, and parts of the Russian Federation, the increased activity may be due to other circulating respiratory viruses.

Among countries testing at least 20 sentinel respiratory specimens during the past reporting week, none reported that more than 20% of specimens had tested positive for influenza.

In North Africa and West Asia, pandemic influenza virus continues to circulate at low levels as rates of illness in most countries in the region continued to decline or return to baseline. In Afghanistan, an increasing trend of respiratory diseases with moderate healthcare impact was report, however, it is unknown if the recent increase is associated with circulation of influenza virus.

In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission continued to be sporadic in most areas of the continent. Several countries in West Africa continue to report slight increases in the numbers of confirmed cases of pandemic influenza indicating that community transmission is likely beginning in the area; however, data are very limited.

In the Americas, both in the tropical and northern temperate zones, pandemic influenza virus continues to circulate at low levels but overall pandemic influenza activity continued to decline or remain low in most places.

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

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, and Asia.

In summary, pandemic influenza virus continues to circulate widely in the tropical regions and is persisting in some areas of in parts of Europe.

Respiratory disease activity is increasing in many areas of the world due to increasing transmission of influenza type B and Respiratory Syncitial Virus. Seasonal influenza H3N2 continues to be detected in areas of Asia and east Africa.

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


Weekly update (Virological surveillance data)

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

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

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


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

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


(NEW) Map of influenza activity and virus subtypes (Week 6: 07 February-13 February 2010)

Map of influenza activity and virus subtypes [jpg 61kb]

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


Qualitative indicators (Week 29 to Week 6: 13 July 2009 - 13 February 2010)

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


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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 14 February 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 88): Niger.

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. 88): none.

[Region - Deaths]*

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7484
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1018
  • WHO Regional Office for Europe (EURO) - At least 4266
  • WHO Regional Office for South-East Asia (SEARO) - 1601
  • WHO Regional Office for the Western Pacific (WPRO) - 1690
  • Total* - At least 16226
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_02_26/en/index.html">WHO | Pandemic (H1N1) 2009 - update 89</cite>
 
Pandemic (H1N1) 2009 - update 90 - Weekly update

Pandemic (H1N1) 2009 - update 90 - Weekly update

WHO - Pandemic (H1N1) 2009 - update 90

Pandemic (H1N1) 2009 - update 90 - Weekly update

5 March 2010


As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16455 deaths.

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


Situation update:

Summary:

In the temperate zone of the northern hemisphere, transmission of virus persists in some areas of Europe and Asia but influenza activity is declining and at low level in the most areas. The most active areas of transmission are currently observed in parts of Southeast Asia and East and South-eastern Europe. Recently, influenza type B is increasingly reported in Asia.

Pandemic influenza virus continues to circulate in South and Southeast Asian countries. In Thailand, activity has increased and Myanmar continues to report regionally circulating pandemic virus. However, the overall intensity of activity nationally is still low in both countries. Respiratory disease activity is declining in all other countries of the area.

In East Asia, transmission of pandemic influenza virus persists at low levels in most countries including Hong Kong SAR (China) and Chinese Taipei or has returned to baseline levels (Japan and the Republic of Korea). Of note, seasonal influenza B virus activity has been increasing in the area and is now the predominant influenza virus in Mongolia, China, and parts of South East Asia. Japan has also reported clusters of influenza B related cases.

In Australia and New Zealand, overall influenza activity remains low and at the levels experienced at the same time in previous years. No new cases of H1N1 influenza have been reported this week from the island nations of the South Pacific.

Influenza activity is low in Western Europe and has largely returned to baseline levels. However, many countries of Eastern Europe (Russian Federation, Bulgaria, Armenia and Moldova) are still reporting some increased respiratory disease activity compared to their baselines. The percentage of respiratory specimens testing positive for influenza decreased further in week 7 to around 3.5%. The majority of those were positive for pandemic influenza and only a very few seasonal influenza H3N2 and influenza type B viruses were detected.

In the northern temperate zones of the Americas, pandemic influenza virus continues to circulate at very low levels yielding an overall low and declining pattern of pandemic influenza activity. However, in Mexico and Peru, there is a slight increase in respiratory disease activity, though the overall intensity remains low and it is unclear how much is related to pandemic influenza. In Central America and the Caribbean, overall respiratory disease activity remains low in most places.

In North Africa and West Asia, influenza activity is low. However, respiratory tract infections in the north western area of Pakistan and Afghanistan are reportedly increasing. Whether this increased activity is due to circulation of influenza is not known.

In Sub-Saharan Africa, several West African countries are increasingly reporting pandemic influenza cases, though surveillance data from the area is quite limited. Data from the rest of Africa suggests that influenza activity in most countries is low and transmission continues to be sporadic. Some detections of seasonal influenza H1N1, H3N2, and influenza type B are still being reported.

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


Weekly update (Virological surveillance data)

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

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

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


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

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

(NEW) Map of influenza activity and virus subtypes (Week 6: 07 February-13 February 2010)

Map of influenza activity and virus subtypes [png 262kb]

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


Qualitative indicators (Week 29 to Week 7: 13 July 2009 - 20 February 2010)

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

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

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


List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 28 February 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 89): 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. 89): none.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7539
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1018
  • WHO Regional Office for Europe (EURO) - At least 4388
  • WHO Regional Office for South-East Asia (SEARO) - 1633
  • WHO Regional Office for the Western Pacific (WPRO) - 1710
  • Total* - 16455
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
-
​
<cite cite="http://www.who.int/csr/don/2010_03_05/en/index.html">WHO | Pandemic (H1N1) 2009 - update 90</cite>
 
Pandemic (H1N1) 2009 - update 91 - Weekly update (WHO)

Pandemic (H1N1) 2009 - update 91 - Weekly update (WHO)

WHO - Pandemic (H1N1) 2009 - update 91

[Source: World Health Organization, edited: <cite cite="http://www.who.int/csr/don/2010_03_12/en/index.html">WHO | Pandemic (H1N1) 2009 - update 91 ]
</cite>
Pandemic (H1N1) 2009 - update 91 - Weekly update

12 March 2010


As of 7 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16713 deaths.

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


Situation update:

The most active areas of pandemic influenza transmission are currently in Southeast Asia, however, lower levels of pandemic virus circulation persist in other parts of Asia and in Eastern and South-eastern Europe.

In West Africa, limited data suggests that pandemic influenza virus transmission may be increasing in region. Of note, seasonal influenza B viruses have been increasingly detected in Asia and appear to be spreading westward.

In Sub-Saharan Africa, limited data suggests that on-going community transmission of pandemic influenza virus continues to increase in parts of West Africa, without clear evidence of a peak in activity. Increased detections of pandemic influenza virus have been observed among sentinel surveillance sites in several countries, including Senegal and Cote D'Ivoire, however, to date, data is limited regarding the spectrum of clinical severity of cases. Recent increases in influenza activity have also been reported in Rwanda. Much of eastern and southern Africa likely experienced an earlier peak in pandemic influenza activity during November 2009 and late summer 2009, respectively.

In South and Southeast Asia, pandemic influenza virus circulation persist in most countries, however, overall transmission remains most active in Thailand, especially since mid January 2010. Approximately half of all provinces in Thailand reported that greater than 10% of all outpatients sought care for ILI, and approximately 25% of all patients with ILI at sentinel sites tested positive for influenza. The current increase in the number of cases in Thailand remains well below an earlier period of peak transmission during June through September 2009.

In Bangladesh, an increasing trend in respiratory disease was reported, however, overall influenza activity remains low.

In India, influenza virus transmission persist at lower levels in the western region of India, while activity in other regions has largely subsided.

In East Asia, pandemic influenza activity continues to decrease or remain low as levels of ILI return to seasonal baselines in Japan and in the Republic of Korea. In Mongolia, a recent sharp increase in ILI activity was associated predominantly with a resurgence of circulation of seasonal influenza B viruses.

In China, pandemic influenza activity has declined since peaking during November 2009, however, overall influenza activity remains elevated, largely due to an increase in the circulation of seasonal influenza B viruses.

In North Africa and Western Asia, overall pandemic influenza activity remains low in most places, with the exception of Iraq and Afghanistan, both of which reported regional spread of influenza with an increasing trend in respiratory diseases activity. In Afghanistan, a moderate impact on the healthcare system was reported in association with increased respiratory diseases activity. Although overall influenza activity remains low in Iran, all recent influenza virus detection have been due to seasonal influenza B viruses.

In Europe, overall pandemic influenza transmission continued to decline as low levels of pandemic virus continue to circulate in parts of eastern and south-eastern Europe. The overall percentage of sentinel respiratory specimens testing positive for influenza remained low (6.8%) but slightly increased compared to the previous week. Pandemic H1N1 2009 virus continues to be the predominant circulating influenza virus in the European region with the exception of the Russian Federation and Sweden where influenza B was reported as co-dominant or dominant.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continued to circulate at low levels.

In Central America, Nicaragua and Honduras, reported slight increases in respiratory diseases activity, possibly due to an increase in school outbreaks; however, it is unclear to what extent the increases are associated with circulation of pandemic influenza virus.

In Brazil, an increasing trend of respiratory diseases with low overall intensity was reported in association with regional spread of influenza virus.

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

Although pandemic influenza virus continues to be the predominant circulating influenza virus worldwide, circulation of seasonal influenza B viruses continue to increase and spread across Asia, parts of Eastern Europe, and Eastern Africa, but most notably in China, Mongolia, Iran and the Russian Federation.

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

Weekly update (Virological surveillance data)

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

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

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

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

(NEW) Map of influenza activity and virus subtypes (Week 8: 21 February -27 February 2010)

Map of influenza activity and virus subtypes [png 267kb]

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

Qualitative indicators (Week 29 to Week 8: 13 July 2009 - 27 February 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline


Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 7 March 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 90): 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. 90): None.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7576
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1019
  • WHO Regional Office for Europe (EURO) - At least 4571
  • WHO Regional Office for South-East Asia (SEARO) - 1664
  • WHO Regional Office for the Western Pacific (WPRO) - 1716
  • Total* - At least 16713
* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.​
<cite cite="http://www.who.int/csr/don/2010_03_12/en/index.html"></cite>-
------
 
WHO - Pandemic (H1N1) 2009 - update 92: 16,813 deaths cumulative

WHO - Pandemic (H1N1) 2009 - update 92: 16,813 deaths cumulative

WHO - Pandemic (H1N1) 2009 - update 92

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_03_19/en/index.html">WHO | Pandemic (H1N1) 2009 - update 92</cite>. Edited.]

Pandemic (H1N1) 2009 - update 92 - Weekly update

19 March 2010


As of 14 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16813 deaths.

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


Situation update:

The most active areas of pandemic influenza transmission continue to be in Southeast Asia and West Africa. Limited data suggests that pandemic influenza activity may be increasing across parts of Central America and the Caribbean. Low levels of pandemic influenza virus continue to circulate across southern and south-eastern Europe and in East, West, and South Asia.

Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza B viruses are predominate in East Asia, and have been detected at low levels across southeast Asia and eastern Africa.

In south and southeast Asia, the most active areas of pandemic influenza transmission continue to be in Thailand; over the past month approximately 25-30% of sentinel respiratory samples from patients with ILI and 10-35% of sentinel respiratory samples from hospitalized patients with pneumonia tested positive for influenza (predominantly pandemic H1N1, but also small numbers of seasonal B viruses).

Recent pandemic influenza activity in Thailand, while associated with severe and fatal illness, does not appear to exceed activity observed during an earlier period of peak transmission between June and September 2009.

In Myanmar, respiratory disease activity may be declining after a period of increased activity associated with increased detection of pandemic H1N1 cases during February 2010.

In Bangladesh, an increasing trend in respiratory diseases activity was reported for the past two weeks in association with increased numbers of confirmed cases and increased geographical spread of pandemic influenza virus.

In India, low level of pandemic influenza virus continues to circulate in western India.

In East Asia, pandemic influenza activity continued to decline substantially as rates of illness returned to baseline or remained low in Japan, Republic of Korea, Hong Kong (SAR), and Chinese Taipei.

In China, pandemic influenza activity has waned substantially, however, influenza type B viruses continue to circulate.

In Mongolia, a recent sharp increase in ILI activity was associated almost exclusively with increased circulation of influenza B viruses. In addition, increasing but low levels of circulation of seasonal influenza B viruses has been observed across other parts of East and Southeast Asia (Japan, Republic of Korea, Chinese Taipei, the Philippines, Thailand, Vietnam, Indonesia, Bangladesh).

Small numbers of seasonal H3N2 viruses have also been detected in several countries of East and Southeast Asia.

In West Africa, limited data suggest that active transmission of pandemic influenza virus remains sustained across much of the region without clear evidence of a peak in activity.

In Ghana, 38% of respiratory specimens collected during the past week tested positive for influenza, and of these, approximately 70% were pandemic H1N1. Limited sentinel surveillance data from Nigeria suggest that levels of ILI have increased over the past two months in conjunction with increased detections of pandemic influenza H1N1 virus.

Localized outbreaks of pandemic H1N1 influenza have also been recently reported in parts of East Africa, particularly in Rwanda.

Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal H3N2 and seasonal B viruses have also been identified.

In tropical zone of the Americas, particularly in Central America and the Caribbean, limited data suggest that pandemic influenza virus transmission may be active. Geographically regional to widespread pandemic influenza activity was reported across Central America and the Caribbean with mixed trends in the pattern of respiratory diseases activity (increasing activity in Jamaica, Bahamas, Nicaragua, Panama; and decreasing activity in Costa Rica, Guatemala).

Honduras continues to report several outbreaks of respiratory disease in schools with limited laboratory confirmation of pandemic influenza virus infection.

In Brazil, over the past two weeks, an increasing trend of respiratory diseases with low overall intensity was reported in association with regional spread of influenza virus.

In North Africa and Western Asia, limited data suggests that pandemic influenza virus continues to circulate at low levels across the region. An increasing trend of respiratory diseases activity in association with regional spread of influenza was reported for past three weeks in Afghanistan and the past two weeks in Iraq; however, overall intensity of activity remains low to moderate in both countries.

Localized to regional spread of pandemic was also reported in Morocco, Libyan Arab Jamahiriya, Egypt, Jordan, Yemen, and Oman.

In Europe, overall pandemic influenza transmission continued to decline as low levels of pandemic virus continue to circulate in parts of eastern and south-eastern Europe. The overall percentage of sentinel respiratory specimens testing positive for influenza remained low (5.1%). Pandemic H1N1 2009 virus continues to be the predominant circulating influenza virus in the European region, except in Sweden and the Russian Federation, where seasonal influenza B viruses have been reported as co-dominant or dominant.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continued to circulate at low levels.

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

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

Weekly update (Virological surveillance data)

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

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

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

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

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 9: 28 FEBRUARY - 6 MARCH 2010)

Map of influenza activity and virus subtypes [png 264kb]

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

Qualitative indicators (Week 29 to Week 9: 13 July 2009 - 6 March 2010)

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 14 March 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 91): 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. 91): None.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7622
  • WHO Regional Office for the Eastern Mediterranean (EMRO) - 1019
  • WHO Regional Office for Europe (EURO) - At least 4596
  • WHO Regional Office for South-East Asia (SEARO) - 1691
  • WHO Regional Office for the Western Pacific (WPRO) - 1718
  • Total* - At least 16813
*The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.​
<cite cite="http://www.who.int/csr/don/2010_03_19/en/index.html"></cite>-
------
 
WHO - Pandemic (H1N1) 2009 - update 93: At least 16,931 deaths since the beginning of the pandemic

WHO - Pandemic (H1N1) 2009 - update 93: At least 16,931 deaths since the beginning of the pandemic

WHO - Pandemic (H1N1) 2009 - update 93: At least 16,931 deaths since the beginning of the pandemic

[Source: World Health Organization, <cite cite="http://www.who.int/csr/don/2010_03_26/en/index.html">WHO | Pandemic (H1N1) 2009 - update 93</cite>. Edited.]

Pandemic (H1N1) 2009 - update 93 - Weekly update

26 March 2010


As of 21 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 16,931 deaths.

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


Situation update:

The most active areas of pandemic influenza virus transmission currently are in parts of Southeast Asia, West Africa, and in the tropical zone of the Americas. After a period of sustained pandemic influenza transmission in Thailand over the past two months, overall activity now appears to be decreasing. In West Africa, limited data suggests that active transmission of pandemic influenza virus persists without clear evidence of a peak in activity. In Central America and in the tropical zone of South America, an increasing trend of respiratory disease activity associated with circulation of pandemic influenza virus has been reported since early March 2010 in an increasing number of countries.

Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza B viruses are predominate in East Asia, and have been increasingly detected at low levels across southeast and western Asia, eastern Africa, and in parts of Europe.

In Southeast Asia, pandemic influenza virus transmission has remained active and geographically widespread in Thailand since mid February 2010 and has been increasing since early March in Malaysia. In Thailand, the overall intensity of respiratory disease activity was reported to be low to moderate, and activity now appears to decreasing since mid March 2009; 10-22% of sentinel respiratory samples from patients with ILI tested positive for pandemic influenza during the most recent reporting week. In Malaysia, limited data suggests increasing detections of pandemic H1N1 cases over the past two weeks, although the extent and severity of illness is not currently known. Low numbers of seasonal influenza B viruses continue to be isolated in Thailand and in other parts of Southeast Asia.

In South Asia, pandemic influenza virus transmission remains variable across the subcontinent. In Bangladesh, an increasing trend in respiratory disease activity and increasing detections of H1N1 cases has been reported since late February 2010; however, overall intensity of disease activity remains low. In India, although overall pandemic influenza activity remains low, pandemic H1N1 cases continue be reported in Western India.

In East Asia, pandemic influenza virus transmission has declined substantially. Rates of ILI/ARI have returned to near baseline in Japan and Republic of Korea. In China, although overall ILI and pandemic influenza virus circulation has decreased substantially, circulation of seasonal influenza B viruses continues to be active (accounting for ~85% of all influenza viruses isolated during recent weeks). Similarly, in Mongolia, after experiencing a first peak of ILI activity due to circulation of pandemic influenza virus during November 2009, a second recent sharp peak of ILI activity occurred during late February and early March 2010 exclusively as a result circulating seasonal influenza B viruses. Overall influenza activity continues to remain low in Hong Kong SAR (China), Chinese Taipei, and DPR Korea.

In Sub-Saharan Africa, pandemic influenza activity remains variable. Limited data suggest that the most active areas of pandemic influenza virus transmission continue to be in West Africa and in limited areas of East Africa, particularly in Rwanda. Twenty-seven percent of respiratory specimens in Ghana, and 47% of specimens in Rwanda, tested positive for pandemic influenza virus during mid March 2010. In Senegal, a high intensity of respiratory diseases activity was reported in association with increased detections of pandemic influenza virus. Pandemic influenza virus continues to be the predominant influenza virus circulating in West and East Africa, however, small numbers of seasonal influenza H3N2 and seasonal influenza B viruses have also been identified.

In tropical zone of the Americas overall influenza activity remains low, however, active transmission of pandemic influenza virus may be increasing, particularly across Central America and parts of South America. An increasing trend of respiratory diseases activity associated with detections of pandemic influenza virus was reported in Guatemala, Nicaragua, El Salvador, and Panama. In Brazil, three consecutive weeks of increases in respiratory diseases activity have been associated with regional spread of pandemic influenza virus; three states in northern Brazil reported increases in detections of confirmed cases, however, the extent and severity of cases is not yet know. In Mexico, two weeks of increases (11-14% per week) in ILI and SARI were reported during late February and early March 2010, however, the extent to which respiratory disease activity has been due to pandemic influenza virus is not yet known.

In Europe, overall pandemic influenza virus transmission continued to decline or remain low in most countries. Of note, over 20% of sentinel specimens in Germany, Italy, and the Russian Federation tested positive for influenza, however, these increased sentinel detections of influenza virus were not associated with significant increases in overall rates of acute respiratory illness; in Italy and the Russian Federation, seasonal influenza B viruses were either dominant or co-dominant with pandemic H1N1, respectively. In Romania and in Poland, recent increases in rates of ILI or ARI have not been associated with increased detections of pandemic or other influenza viruses.

In North Africa and Western Asia, limited data suggests that pandemic influenza virus continues to circulate at low levels, as overall disease activity remained low across much of the region.

In the northern and the southern temperate zones of the Americas, overall pandemic influenza transmission remained low as influenza virus continues to circulate at low levels.

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

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

Weekly update (Virological surveillance data)

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

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

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

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

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

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

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

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

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

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

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

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

List of definitions of qualitative indicators

Geographic spread of influenza activity
Map timeline

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

Intensity of acute respiratory diseases in the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 21 March 2010

Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 92): 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. 92): None.

[Region - Deaths*]

  • WHO Regional Office for Africa (AFRO) - 167
  • WHO Regional Office for the Americas (AMRO) - At least 7673
  • WHO Regional Office for the Eastern Mediterranean (EMRO) ** - 1019
  • WHO Regional Office for Europe (EURO) - At least 4637
  • WHO Regional Office for South-East Asia (SEARO) - 1709
  • WHO Regional Office for the Western Pacific (WPRO) - 1726
  • Total* - At least 16931
*The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.
**No update since 7 March 2010
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