European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

New influenza A(H1N1) infection - Update 21 May 2009, 17:00 hours CEST - ECDC SITUATION REPORT (Edited)

ECDC SITUATION REPORT


New influenza A(H1N1) infection - Update 21 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]

Main developments since previous update

• 32% increase in confirmed cases reported by Japan in past 24 hours;
• Canada indicates A(H1N1) infections spreading in the communities very much like regular seasonal influenza;
• US media stressing challenges to respond in a balanced way to A(H1N1) infection.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 21 May, 17:00 hours CEST, is presented in Table 1 and Table 2.


Epidemiological update

Since the previous update, ten new cases were confirmed in the EU and EFTA countries, reaching a total of 290 confirmed cases reported from 17 countries (Table 1). The 3 new cases in the UK were all children having travelled and the new case in Germany was returning from the United States.

Outside of the EU and EFTA countries, a total of 10,789 cases are currently reported, including 85 deaths (Table 2). Japan notified 67 new confirmed cases in past 24 hours, representing a 32% increase in cases (Figure 2).

Canada is reporting an additional 223 cases in past 24 hours, resulting in a 44% increase in confirmed cases. However, these newly confirmed cases represent cases reported during the period 16 to 20 May as Canada is now reporting updated cases numbers only three times a week. A news release published yesterday indicates that ?H1N1 has spread in Canadian communities very much like regular seasonal flu, and as such, additional cases are expected to continue to be reported (read more).?


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

The United Kingdoms Health Protection Agency has announced today that from 22 May it will no longer routinely meet flights from Mexico but leaflets and posters will continue to be made available for returning travellers at all ports of entry. Contact tracing of individuals deemed to be at risk of swine flu following a flight will be carried out on the basis of risk, as is the case for all other communicable diseases. Advice in the UK remains that individuals returning from affected areas who become unwell within seven days of their return or contacts of a confirmed or probable case are recommended in the UK to stay at home and contact their doctor (read more).

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Assessment outside the EU

The United States media, in a series of articles, are stressing the challenges for responding to the spread of A(H1N1) in a balanced ways. This is highlighted in New York where there has been a few well-publicised school closures which are being undertaken to prevent more cases in the children in those schools (see http://www.nyc.gov/html/doh/html/pr2009/pr029-09.shtml and http://www.nyc.gov/html/om/pdf/2009/pr219-09_letter.pdf).

A Los-Angeles Times article reports some New-York hospitals experiencing a surge of members of the public (especially children being brought by parents) without symptoms, but fearful of the infection ? so called worried well. The article further mentions the hesitations by some city health authorities in calling for a closure of schools which would affect the educational process and may force parents to take time off work (read article). A New-York Times article stresses the fact that closing schools has seemingly failed to keep school children at home, in an attempt to reduce the spread of the disease (read article).

School closures or class dismissals is not an easy policy area. It is one of the policy issues discussed in ECDC document on Public Health measures in a pandemic (read the document).


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 21 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium ... - 5 - 3
3. Denmark ... - 1 - ...
4. Finland ... - 2 - ...
5. France ... - 16 - ...
6. Germany 1 - 15 - 4
7. Greece ... - 1 - ...
8. Ireland 1 - ...
9. Italy ... - 10 - 1
10. Netherlands ... - 3 - ...
11. Norway ... - 3 - ...
12. Poland ... - 2 - ...
13. Portugal ... - 1 - ...
14. Spain 6 - 113 -30
15. Sweden ... - 3 - ...
16. Switzerland ... - 1 - ...
17. United Kingdom 3 - 112 - 73

• Total 10 - 290 - 111

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 21 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 7 - ...
2. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina ... - 1 - ...
2. Brazil ... - 8 - ...
3. Canada 223 - 719 - 1
4. Chile 12 - 24 - ...
5. Colombia ... - 12 - ...
6. Costa Rica 11 - 20 - 1
7. Cuba ... - 4 - ...
8. El Salvador ... - 6 - ...
9. Ecuador ... - 1 - ...
10. Guatemala ... - 4 - ...
11. Mexico 158 - 3892 - 75
12. Panama ... - 69 - ...
13. Peru ... - 3 - ...
14. USA 241 - 5710** - 8

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 4 - 5 - ...
2. China 1 - 8 - ...
3. Japan 67 - 276 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Republic of Korea ... - 3 - ...
7. Taiwan ... - 1 - ...

• Total 717 - 10789 - 85

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

New influenza A(H1N1) infection - Update 22 May 2009, 17:00 hours CEST (ECDC, Edited)

ECDC SITUATION REPORT

New influenza A(H1N1) infection - Update 22 May 2009, 17:00 hours CEST


Main developments since previous update

• 9% increase in reported confirmed cases in EU/EFTA countries totalling 316 confirmed cases;
• Sentinel surveillance in the EU picks one case of A(H1N1) influenza;
• Japan scaling back measures for handling A(H1N1) influenza.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 22 May, 17:00 hours CEST, is presented in Table 1 and Table 2.


Epidemiological update

Since the previous update, 26 new cases were confirmed in the EU and EFTA countries, reaching a total of 316 confirmed cases reported from 17 countries (Table 1). Eleven of the 13 newly confirmed cases in Spain are students of a military academy.

Recent data from EU influenza surveillance system shows that from calendar week 18 to 19 in 2009, the number of virological specimens submitted under the sentinel system slightly increased from 224 to 238 (Figure 2). The proportion of specimens that were found positive for influenza A(H1N1) virus slightly decreased at around 5%. During this week, 1 samples of new influenza A(H1N1) was identified in the United Kingdom through this surveillance system. By genetic analysis, the new A(H1N1) viruses have been assessed as being sensitive to oseltamivir and zanamivir and resistant to adamantanes.

Outside of the EU and EFTA countries, a total of 11,783 cases are currently reported, including 85 deaths (Table 2). Philippines reported its first confirmed case today. As of today, 43 countries worldwide have reported confirmed cases.


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

Today ECDC published two descriptions and comment on two of the more important papers that have come out on the behaviour of the novel A(H1N1) influenza virus. Firstly a complex study of data from Mexico in Science that estimated the likely transmissibility and case fatality ratio (read more). Secondly, the first description of the infection and disease in the USA that appeared in the New England Journal of Medicine (read more). In the coming months ECDC will be paying special attention to the infection in the USA because it started ahead of that in Europe and is well described by articles like this.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Assessment outside the EU

Media are reporting that Japan is scaling back measures for handling A(H1N1) influenza infections because of the mildness of the disease and the absence of major impact on the country?s economy (read more). Similarly, Mexico City lowered alert level from yellow to green (read more).


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 22 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium 2 - 7 - 3
3. Denmark ... - 1 - ...
4. Finland ... - 2 - ...
5. France ... - 16 - ...
6. Germany 2 - 17 - 4
7. Greece ... - 1 - ...
8. Ireland ... - 1 - ...
9. Italy 4 - 14 - 1
10. Netherlands ... - 3 - ...
11. Norway ... - 3 - ...
12. Poland ... - 2 - ...
13. Portugal ... - 1 - ...
14. Spain 13 - 126 - 30
15. Sweden ... - 3 - ...
16. Switzerland ... - 1 - ...
17. United Kingdom 5 - 117 - 73

• Total 26 - 316 - 111

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 22 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 7 - ...
2. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina ... - 1 - ...
2. Brazil ... - 8 - ...
3. Canada ... - 719 - 1
4. Chile ... - 24 - ...
5. Colombia ... - 12 - ...
6. Costa Rica ... - 20 - 1
7. Cuba ... - 4 - ...
8. El Salvador ... - 6 - ...
9. Ecuador 7 - 8 - ...
10. Guatemala ... - 4 - ...
11. Mexico 116 - 4008 - 75
12. Panama 4 - 73 - ...
13. Peru 2 - 5 - 0
14. USA 842 - 6552** - 8

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia ... - 7 - ...
2. China 1 - 9 - ...
3. Japan 18 - 294 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines 1 - 1
7. Republic of Korea ... - 3 - ...
8. Taiwan 1 - 2 - ...

• Total 992 - 11783 - 85

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 23 May 2009, 17:00 hours CEST (ECDC, Edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 23 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments since previous update

• First case reported from Iceland, Russian Federation and Honduras;
• Media report on more than 500 military in isolation in Spain;
• Study suggests no protective immune response from seasonal influenza vaccination.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 23 May, 17:00 hours CEST, is presented in Table 1 and Table 2.


Epidemiological update

In the past 24 hours, seven new cases were confirmed in the EU and EFTA countries, including the first case from Iceland and the second case from Switzerland (Table 1). In addition, five new cases were confirmed from the United Kingdom, among whom three persons from the same family having travelled to the US. A total of 323 confirmed cases are now reported from 18 countries. In Spain, 61 military are under investigation, including the previously confirmed 11 cases; media report that more than 500 military have been quarantined within the military basis.

Outside of the EU and EFTA countries, a total of 12,110 cases are currently reported, including 91 deaths (Table 2). The first confirmed case was reported from the Russian Federation, in a person who travelled to the US, as well as from Honduras. Media report about two persons with suspected infection in the Democratic Republic of Congo, one of whom is a Chilean citizen who travelled from the Americas; confirmatory test results are still awaited.


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Mortality in Mexico

The ministry of health in Mexico provided additional data on the reported influenza A(H1N1) deaths, representing 2% of the total number of cases and more than half of whom were women (56%). Up to 90% of the deaths occurred in persons having an onset of their symptoms before 23 April, and the majority (77%) occurred in persons between 20 to 54 years of age. Almost a third (29%) of the persons who died had an underlying metabolic disease and 15% had cardio-vascular antecedents. Cough, fever and dyspnoea were the most common symptoms reported. The full report is available from: http://portal.salud.gob.mx/descargas/pdf/influenza/situacion_actual_epidemia_220509.pdf


From the literature

A paper in the Morbidity and Mortality Weekly Record (MMWR) of 22 May suggests that seasonal influenza vaccination from the past four seasons is unlikely to provide cross-reactive immunity against influenza A(H1N1) infection. However, before vaccination, cross-reactive antibodies were detected in 33% of the investigated persons above 60 years of age. Authors suggest this may be explained by previous exposure of this age group to an influenza A(H1N1) virus with genetic and anti-genetic similarities to the current strain.

The full article is available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a1.htm


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 23 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

• Austria ... - 1 - ...
• Belgium ... - 7 - 3
• Denmark ... - 1 - ...
• Finland ... - 2 - ...
• France ... - 16 - ...
• Germany ... - 17 - 4
• Greece ... - 1 - ...
• Iceland 1 - 1 - ...
• Ireland ... - 1 - ...
• Italy ... - 14 - 1
• Netherlands ... - 3 - ...
• Norway ... - 3 - ...
• Poland ... - 2 - ...
• Portugal ... - 1 - ...
• Spain ... - 126 - 30
• Sweden ... - 3 - ...
• Switzerland 1 - 2 - ...
• United Kingdom 5 - 122 - 73
  • Total 7 - 323 -111

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 23 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 7 - ...
2. Russian Federation 1 - 1 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina ... - 1 - ...
2. Brazil 1 - 9 - ...
3. Canada 86 - 805 - 1
4. Chile 20 - 44 - ...
5. Colombia ... - 12 - ...
6. Costa Rica 8 - 28 - 1
7. Cuba ... - 4 - ...
8. Ecuador ... - 8 - ...
9. El Salvador ... - 6 - ...
10. Guatemala ... - 4
11. Honduras 1 - 1 - ...
12. Mexico 166 - 4174 - 80
13. Panama ... - 73 - ...
14. Peru 12 - 17 - ...
15. USA ... - 6552** - 9

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 5 - 12 - ...
2. China ... - 9 - ...
3. Japan 27 - 321 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 1
7. Republic of Korea ... - 3 - ...
8. Taiwan ... - 2 - ...

• Total 327 - 12110 -91

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 24 May 2009, 17:00 hours CEST (ECDC, Edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 24 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 26 new cases reported from EU and EFTA countries;
• Precautionary school closures in Italy.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 24 May, 17:00 hours CEST, is presented in Table 1 and Table 2.


Epidemiological update

In the past 24 hours, 26 new cases were confirmed in the EU and EFTA countries, including seven cases among the military under observation in Spain (Table 1). The latest information from the Spanish ministry of health refers to 81 military currently being under investigation, with a total of 18 confirmed cases in this group of military.

The United Kingdom reports 11 new cases, seven of whom do not have a history of travel but are linked to previously confirmed cases.

A total of 349 confirmed cases are now reported from 18 EU and EFTA countries, 34% of whom are linked to in-country transmission; in the United Kingdom, this proportion is 60%.

Media report on 15 persons being investigated in Bulgaria, from which to date no cases have been confirmed.

In Italy, following confirmed cases among school students having travelled to New York, two schools in Rome were closed as a precautionary measure, and 14 schools are monitored in Sicily.

Outside of the EU and EFTA countries, a total of 12,152 cases are currently reported, including 91 deaths (Table 2). Media report on 18 US military that were confirmed to be infected with influenza A(H1N1) upon their arrival in Kuwait; they have been isolated in the local US military facilities.


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


From the literature

ECDC comments on two previous MMWR papers which highlight potentially important findings for patients sufficiently ill with influenza A(H1N1) as to require hospital care: in the US, an under- representation of older people is observed while young children (under 5 years), pregnant women and especially those with pre-existing medical conditions feature strongly.

This is a situation somewhat different from that for seasonal influenza in Europe. If confirmed, and if this experience is repeated in Europe, these findings could inform strategies for mitigation with anti-viral mediation and specific vaccines.

The World Health Organization?s (WHO) Weekly Epidemiological Record (WER) of 22 May reports on the clinical features of cases of influenza A(H1N1) infection from Mexico and other affected countries.

The WHO guidance document on the clinical management of cases is available from the following link: http://www.who.int/csr/resources/publications/swineflu/clinical_managementH1N1_21_May_2009.pdf.

In addition, the WHO report of a high level consultation, describing key uncertainties, lessons learnt and challenges of the current outbreak of influenza A(H1N1) was published: http://www.who.int/csr/resources/publications/swineflu/High_Level_Consultation_18_May_2009.pdf.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 24 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium ... - 7 - 3
3. Denmark ... - 1 - ...
4. Finland ... - 2 - ...
5. France ... - 16 - ...
6. Germany ... - 17 - 4
7. Greece ... - 1 - ...
8. Iceland ... - 1 - ...
9. Ireland ... - 1 - ...
10. Italy 5 - 19 - 2
11. Netherlands ... - 3 - ...
12. Norway 1 - 4 - ...
13. Poland 1 - 3 - ...
14. Portugal ... - 1 - ...
15. Spain 7 - 133 - 31
16. Sweden ... - 3 - ...
17. Switzerland 1 - 3 - ...
18. United Kingdom 11 - 133 - 80

• Total 26 - 349 - 120

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 24 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 7 - ...
2. Russian Federation ... - 1 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 1 - 2 - ...
2. Brazil ... - 9 - ...
3. Canada ... - 805 - 1
4. Chile ... - 44 - ...
5. Colombia ... - 12 - ...
6. Costa Rica ... - 28 - 1
7. Cuba ... - 4 - ...
8. Ecuador 2 - 10 - ...
9. El Salvador ... - 6 - ...
10. Guatemala ... - 4 - ...
11. Honduras ... - 1 - ...
12. Mexico ... - 4,174 - 80
13. Panama 3 - 76 - ...
14. Peru 4 - 21 - ...
15. USA ... - 6,552** - 9

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 4 - 16 - ...
2. China 6 - 15 - ...
3. Japan 17 - 338 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines 1 - 2 - ...
7. Republic of Korea ... - 3 - ...
8. Taiwan 4 - 6 - ...

• Total 42 - 12,152 - 91

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 25 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 25 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• First confirmed case reported from the Czech Republic;
• More military under observation in Spain;
• First confirmed cases reported from WHO Eastern Mediterranean Region.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 25 May, 17:00 hours CEST, is presented in Table 1 and Table 2.


Epidemiological update

In the past 24 hours, 11 new cases were confirmed in the EU and EFTA countries, including the first confirmed case from the Czech Republic in a person with a history of travel to New York (Table 1).

In Spain, 20 cases have now been confirmed from the academy for military engineers in Hoyo de Manzanares and 74 are still under investigation. In addition, restriction of movement was implemented for 91 more persons in a military base in Le?n, two of whom are being investigated for infection.

A total of 360 confirmed cases are now reported from 19 EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 12,457 cases are currently reported, including 92 deaths (Table 2).

One more death is reported from the US, a 50-year old woman from New York.

The second case reported from the Russian Federation has a history of travel to the Dominican Republic, as had three previously reported cases from Chile. However, no confirmed cases have been reported by the Dominican Republic up to now.

Of the three new cases reported from Taiwan, one was due to household transmission.

Confirmed cases are now also reported from the WHO Eastern Mediterranean Region (EMRO), including the 18 US military in Kuwait referred to in the previous update, and the first case from the United Arab Emirates.

While media report the re-opening of schools in western Japan, Australia asks voluntary home quarantine to students having travelled to affected areas.


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 25 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

• Austria ... - 1 - ...
• Belgium ... - 7 - 3
• Denmark ... - 1 - ...
• Czech Republic 1 - 1 - ...
• Finland ... - 2 - ...
• France 3 - 19 - ...
• Germany ... - 17 -5
• Greece ... - 1 - ...
• Iceland ... - 1 - ...
• Ireland ... - 1 - ...
• Italy ... - 19 - 2
• Netherlands ... - 3 - ...
• Norway ... - 4 - ...
• Poland ... - 3 - ...
• Portugal ... - 1 - ...
• Spain 3 - 136 - 40
• Sweden ... - 3 - ...
• Switzerland ... - 3 - ...
• United Kingdom 4 - 137 -80
  • Total 11 - 360 - 130

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 25 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel 1 - 8 - ...
2. Russian Federation 1 - 2 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 3 - 5 - ...
2. Brazil ... - 9 - ...
3. Canada ... - 805 -1
4. Chile 30 - 74 - ...
5. Colombia ... - 12 - ...
6. Costa Rica ... - 28 - 1
7. Cuba ... - 4 - ...
8. Ecuador ... - 10 - ...
9. El Salvador ... - 6 - ...
10. Guatemala ... - 4 - ...
11. Honduras ... - 1 - ...
12. Mexico ... - 4,174 - 80
13. Panama ... - 76 - ...
14. Peru 4 - 25 - ...
15. USA 212 - 6,764** - 10

• WHO EMRO REGION

1. Kuwait 18 - 18 - ...
2. United Arab Emirates 1 - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 4 - 20 - ...
2. China 3 - 18 - ...
3. Japan 7 - 345 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 2 - ...
7. Republic of Korea 18 - 21 - ...
8. Taiwan 3 - 9 - ...

• Total 305 - 12,457 - 92

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.


(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 26 May 2009, 17:00 hours CEST - (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 26 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 47 new cases in the UK, 44 of which associated with a school outbreak;
• Additional new cases in Ireland (1), Italy (4), Spain (2).

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 26 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 54 new cases were confirmed in the EU and EFTA countries.

The UK reported 47 new confirmed cases, of which 45 are due to in-country transmission. The majority of these (44) are related to a previously confirmed case and the ongoing investigation of a school outbreak in the West Midlands.

The 4 new cases reported from Italy had a travel history to New York, USA. Among them was a school teacher from New York who was already symptomatic on the flight from the USA to Europe (Munich). The second confirmed case from Ireland was a returning traveller from New York, USA.

A total of 414 confirmed cases are now reported from 19 EU and EFTA countries (Table 1), 177 of them (43%) were reported being acquired through in-country transmission.

Outside of the EU and EFTA countries, a total of 13,020 cases are currently reported. Newly confirmed cases were reported from the Americas and from Asia.

A substantial increase in the number of confirmed cases was reported from Argentina (14 new cases to previously 5 cases), Ecuador (14 new confirmed cases to previously 10 confirmed cases) and from Australia (19 new, total 39), respectively.

The death toll increased to 96 globally: Mexico reported 3 more fatal cases. Canada confirmed its second death in a 44 year old male with underlying disease (Table 2).


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


From the literature

ECDC posted on its website a comment concerning an article published in Scienceexpress by Gartner RJ et al.: ?Antigenic and Genetic Characteristics of Swine-Origin 2009 (H1N1) Influenza A Viruses Circulating in Humans.? The opinion of the authors is that the virus was probably circulating for years in pigs before having been detected and the introduction may have been either a single event or multiple events with a similar virus. Read more


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 26 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

• Austria ... - 1 - ...
• Belgium ... - 7 - 3
• Czech Republic ... - 1 - ...
• Denmark ... - 1 - ...
• Finland ... - 2 - ...
• France ... - 19 - ...
• Germany ... - 17 - 5
• Greece ... - 1 - ...
• Iceland ... - 1 - ...
• Ireland 1 - 2 - ...
• Italy 4 - 23 - 2
• Netherlands ... - 3 - ...
• Norway ... - 4 - ...
• Poland ... - 3 - ...
• Portugal ... - 1 - ...
• Spain 2 - 138 - 42
• Sweden ... - 3 - ...
• Switzerland ... - 3 - ...
• United Kingdom 47 -184 - 125
  • Total 54 - 414 -177

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 26 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 8 - ...
2. Russian Federation ... - 2 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 14 - 19 - ...
2. Brazil ... - 9 - ...
3. Canada 116 - 921 - 2
4. Chile 8 - 82 - ...
5. Colombia 4 - 16 - ...
6. Costa Rica 5 - 33 - 1
7. Cuba ... - 4 - ...
8. Ecuador 14 - 24 - ...
9. El Salvador ... - 6 - ...
10. Guatemala ... - 4 - ...
11. Honduras ... - 1 - ...
12. Mexico 367 - 4541 - 83
13. Panama ... - 76 - ...
14. Peru 2 - 27 - ...
15. USA ... - 6764** - 10

• WHO EMRO REGION

1. Kuwait ... - 18 - ...
2. United Arab Emirates ... - 1 - ...

• SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 19 - 39 - ...
2. China 3 - 21 - ...
3. Japan 5 - 350 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 2 - ...
7. Republic of Korea 6 - 27 - ...
8. Taiwan ... - 9 - ...

• Total 563 - 13020 - 96

Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.

*Deaths are included in the cumulative number of confirmed cases
**Cases in the US include both probable and confirmed cases.

(...)

-
-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 27 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 27 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITATO.]


Main developments in past 24 hours

• Two new confirmed cases in Greece with probable exposure in the UK;
• First confirmed case reported from Romania in a traveller returning from New York, USA;
• New cases in returning travellers reported from Ireland, Finland, Poland, Belgium and France (1 each);
• Global increase of cases world-wide mainly in the Southern hemisphere;
• First case reported in Singapore.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 27 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 8 new cases were confirmed in the EU and EFTA countries.

Romania reported its first confirmed case in a returning traveller from New York, USA. The new confirmed cases from Ireland (1), Finland (1) Belgium (1), France (1) and Poland (1) were all in returning travellers from the USA.

Greece reported two new confirmed cases which most likely acquired the infection in Edinburgh, UK. Both of them are students attending the same university in the UK and were close contacts. The first case developed symptoms in the UK, the second one after his return to Greece. This is the first detection of confirmed cases in EU/EFTA countries with probable exposure in another EU/EFTA country.

A total of 422 confirmed cases are now reported from 20 EU and EFTA countries (Table 1).

Outside of the EU and EFTA countries, a total of 13,373 cases are currently reported.

Chile reported 37 new cases and Australia 22. Fourteen of Australia?s 61 confirmed cases were passengers or crew members of a cruise ship. Japan reported 10 additional cases.

Two more deaths were reported from Mexico. The total number of deaths increased to 98 globally (Table 2).


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


From the media

Reuters, 26 May: The World Health Organisation said on Tuesday that nearly 13,000 people have been confirmed infected with the new influenza A(H1N1) strain but the number of countries affected is stable at 46. The WHO said that the airborne virus has now been detected in all regions of the world except for Africa, which has yet to report an influenza A(H1N1) infection. The largest pockets outside of North America so far are in Japan, UK and Spain. http://www.reuters.com/article/companyNewsAndPR/idUSLQ17249020090526

Chicago (Associated Press), 26 May: Authorities in Mexico announced three more swine flu deaths and the United States and Canada one more death each as the world's largest vaccine maker signed a deal with the United States to produce a swine flu vaccine. The World Health Organization says at least 46 countries have confirmed more than 12,950 swine flu cases. The Mexican death toll now stands at 83, and Canada's is two. The U.S. death is the 12th in the country. http://www.google.com/hostednews/ap/article/ALeqM5gzz357patY4-QaJFvo9O95zMM_EQD98DSJEO0

Bloomberg, 26 May: WHO's assistant director-general of health security and environment, Keiji Fukuda, said on 26 May during a conference call with reporters that the agency is considering adjusting its pandemic alert system to account for the severity of an influenza outbreak. Within the next few weeks, the WHO will convene a meeting of scientists to get advice on changing the alert system. Declaring a pandemic for a virus that mostly has mild effects could cause panic and cynicism without providing any public health benefit, which is the goal of the alert system, Fukuda said. In the same article Anne Schuchat, Centers for Disease Control and Prevention interim deputy director is quoted to have said that in the US, the virus ?may have passed its peak?.
http://www.bloomberg.com/apps/news?pid=20601081&sid=ab.YixdwslOo&refer=australia - www.cdc.gov/media/transcripts/2009/t090526.htm

Reuters, 26 May: WHO wants to keep monitoring the spread of H1N1 flu before issuing guidance on the production of pandemic flu vaccines, a top WHO official said on Tuesday. "We are in the process of the most basic development of the vaccine," acting WHO assistant director-general Keiji Fukuda told a news briefing. Work under way on candidate viruses will continue until the end of June or July, after which drug companies can start developing and testing H1N1 vaccines, according to Fukuda. The WHO expects to make recommendations about the best balance between H1N1and seasonal flu vaccine-making "sometime during the summer," he said. "We don't want to make recommendations too early because we are on a daily basis monitoring how the situation is evolving," he said. http://www.reuters.com/article/worldNews/idUSTRE54P42620090526?feedType=RSS&feedName=worldNews

Telegraph.co.uk, 26 May: A school is at the centre of Britain's largest swine flu outbreak after 44 new cases were confirmed there, taking countrywide total to 184. Officials confirmed 47 new cases of the H1N1 swine flu virus in Britain, with the majority centred on one school in the West Midlands. It is thought the school involved is Welford Primary School in Handsworth, Birmingham where last week teachers became aware of a high absence rate due to illness. http://www.telegraph.co.uk/health/swine-flu/5388651/Swine-flu-44-cases-confirmed-in-one-school.html

The Guardian, 26 May: http://www.guardian.co.uk/world/2009/may/26/swine-flu-outbreak-welford-school

Daily Mail, 27 May http://www.dailymail.co.uk/news/art...irmed-cases-jump-Britain-50-184.html?ITO=1490

The Independent, 27 May: 37-year-old man critically ill in hospital probably has swine flu. The man was admitted last week to a hospital in Glasgow with a viral infection. Scotland's Health Secretary, Nicola Sturgeon, said that it was "highly probable" he had the virus, adding: "It is not yet known whether flu was the cause of his illness, or whether it was incidental to it." http://www.independent.co.uk/life-s...alth-news/swine-flu-man-critical-1691226.html

BBC News, 26 May: A third swine flu case has been confirmed in Ireland, health officials have announced. A woman who lives in the east of the country, who had recently returned from New York, tested positive. Her case is unconnected to the second confirmed case in the Republic, also a woman who lives in the east and had just returned from New York. http://news.bbc.co.uk/2/hi/uk_news/northern_ireland/8069374.stm

Reuters, 27 May: An Australian state hit hardest by the H1N1 virus will carry out mass treatment with anti-viral drugs for people suspected of having so-called swine flu as the country's total number of confirmed cases near-doubled to 61. Health authorities in Victoria, where 33 people have been confirmed with H1N1, said they would open special clinics to relieve hospitals and deal with the outbreak, administering anti-viral drugs to anyone with symptoms. We now know that this disease is highly infectious and the community does have to prepare itself for there to be a significant increase in the numbers of cases that are confirmed in coming days," said Australia's national Health Minister Nicola Roxon. http://www.reuters.com/article/asiaCrisis/idUSSYD92693

The Daily Strategic Media Monitoring is a collection of articles of particular interest with regards to the influenza A(H1N1) virus development gathered by the ECDC Health Communication Unit by 9:00 every morning. It does not pretend to be comprehensive.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 27 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium 1 - 8 - 3
3. Czech Republic ... - 1 - ...
4. Denmark ... - 1 - ...
5. Finland 1 - 3 - ...
6. France 1 - 20 - ...
7. Germany ... - 17 - 5
8. Greece 2 - 3 - ...
9. Iceland ... - 1 - ...
10. Ireland 1 - 3 - ...
11. Italy ... - 23 - 2
12. Netherlands ... - 3 - ...
13. Norway ... - 4 - ...
14. Poland 1 - 4 - ...
15. Portugal ... - 1 - ...
16. Romania 1 - 1 - ...
17. Spain ... - 138 - 42
18. Sweden ... - 3 - ...
19. Switzerland ... - 3 - ...
20. United Kingdom ... - 184 - 131

• Total 8 - 422 - 183

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 27 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel 1 - 9 - ...
2. Russian Federation ... - 2 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina ... - 19 - ...
2. Brazil ... - 9 - ...
3. Canada ... - 921 - 2
4. Chile 37 - 119 - ...
5. Colombia ... - 16 - ...
6. Costa Rica ... - 33 - 1
7. Cuba ... - 4 - ...
8. Ecuador 4 - 28 - ...
9. El Salvador 5 - 11 - ...
10. Guatemala 1 - 5 - ...
11. Honduras ... - 1 - ...
12. Mexico 265 - 4806 - 85
13. Panama ... - 76 - ...
14. Peru ... - 27 - ...
15. Puerto Rico 1 - 1 - ...
16. USA** ... - 6764 - 10

• WHO EMRO REGION

1. Bahrain 1 - 1
2. Kuwait ... - 18 - ...
3. United Arab Emirates ... - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 22 - 61 - ...
2. China 1 - 22 - ...
3. Japan 10 - 360 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines 4 - 6 - ...
7. Republic of Korea ... - 27 - ...
8. Singapore 1 - 1 - ...
9. Taiwan ... - 9 - ...

• Total 353 - 13373 - 98
• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases.

(...)

-
------

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 28 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 28 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• Thirty-four new confirmed cases in EU and EFTA countries;
• First confirmed case reported from Slovakia in a traveller returning from USA via Canada;
• First in-country transmission reported from Romania (1);
• First cases reported from the Dominican Republic (2) and Uruguay (2);
• Case count in Australia more than doubled;
• Four more deaths reported from Mexico and one more death from the USA.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 28 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 34 new cases were confirmed in the EU and EFTA countries.

Slovakia reported its first confirmed case in a returning traveller from San Francisco, USA. He was travelling through Toronto, Canada to Vienna.

New confirmed cases from Germany (2), Italy (3), Sweden (1) and UK (1) were in returning travellers from the USA.

Romania reported two more cases, one was the son of the first confirmed case in the country reported yesterday who was travelling to the USA with his mother, and the other one was a household contact of the same family.

UK reported 19 new cases of which 15 were related to in-country transmission.

Within EU and EFTA countries 200 cases were reported as in-country transmissions among 456 cases (44%) with wide variation between countries: Spain (142 confirmed cases, 56 in-country-transmissions, 39%), UK (146 in-country transmissions among 203 cases, 72%), Germany (5 in-country transmissions among 19 cases, 26%), Belgium (3 of 8 cases, 38%) and Italy (2 of 26, 8%) and Romania (1 of 3).

A total of 456 confirmed cases are now reported from 21 EU and EFTA countries (Table 1).

Outside of the EU and EFTA countries, a total of 15,010 cases are currently reported.

More new cases are reported from countries in the tropics and the Southern hemisphere: Uruguay and the Dominican Republic reported their first cases (2 each), Chile (46 new, total 165), Argentina (18 new, total 37), Brazil (1 new, total 10), Ecuador (4 new, total 32) and Panama (3 new, total 79).

The number of cases in Australia increased from 61 to 147 within 24 hours.

The countries where community transmission is ongoing (Mexico, USA and Canada) also reported an increase of the number of cases.

Four more deaths were reported from Mexico and one more from the USA in a person with underlying disease. The total number of deaths increased to 103 globally (Table 2).


Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported. However, two confirmed cases reported by Greece are likely to have been exposed in the UK, meaning that travel-related cases have been confirmed with probable exposure in another EU/EFTA country.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 28 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium ... - 8 - 3
3. Czech Republic ... - 1 - ...
4. Denmark ... - 1 - ...
5. Finland ... - 3 - ...
6. France ... - 20 - ...
7. Germany 2 - 19 - 5
8. Greece ... - 3 - ...
9. Iceland ... - 1 - ...
10. Ireland ... - 3 - ...
11. Italy 3 - 26 - 2
12. Netherlands ... - 3 - ...
13. Norway ... - 4 - ...
14. Poland ... - 4 - ...
15. Portugal ... - 1 - ...
16. Romania 2 - 3 - 1
17. Slovakia 1 - 1 - ...
18. Spain 5 - 143 - 43
19. Sweden 1 - 4 - ...
20. Switzerland 1 - 4 - ...
21. United Kingdom 19 - 203 -146

• Total 34 - 456 -200

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 28 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel 2 - 11 - ...
2. Russian Federation ... - 2 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 18 - 37 - ...
2. Brazil 1 - 10 - ...
3. Canada 197 - 1118 - 2
4. Chile 46 - 165 - ...
5. Colombia ... - 16 - ...
6. Costa Rica ... - 33 - 1
7. Cuba ... - 4 - ...
8. Dominican Republic 2 - 2 - ...
9. Ecuador 4 - 32 - ...
10. El Salvador ... - 11 - ...
11. Guatemala ... - 5 - ...
12. Honduras ... - 1 - ...
13. Mexico 104 - 4910 - 89
14. Panama 3 - 79 - ...
15. Peru ... - 27 - ...
16. Uruguay 2 - 2
17. USA** 1162 - 7928 - 11

• WHO EMRO REGION

1. Bahrain ... - 1
2. Kuwait ... - 18 - ...
3. United Arab Emirates ... - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 86 - 147 - ...
2. China 5 - 27 - ...
3. Japan 4 - 364 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 6 - ...
7. Republic of Korea ... - 27 - ...
8. Singapore ... - 1 - ...
9. Taiwan ... - 9 - ...

• Total 1636 - 15010 - 103

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the USA include confirmed cases from Puerto Rico.

(...)

-
------

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 29 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 29 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• Twenty-four new confirmed cases in EU and EFTA countries;
• Estonia reported its first case in a returning traveller from New York, USA;
• Twelve new cases from the UK of which 11 are related to in-country transmission;
• Two new cases reported from Belgium, six from France, one from Slovakia and Greece each;
• First confirmed cases reported from Bolivia (2), Venezuela (1) and Paraguay (5);
• Six more deaths reported from Mexico.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 29 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 24 new cases were confirmed in the EU and EFTA countries.

Estonia reported its first confirmed case in a returning traveller from New York, USA.

Belgium reported 2 additional cases in returning travellers from the USA.

Slovakia reported today a second confirmed infection affecting a 1 year old child, son of the returning traveller from the USA reported yesterday.

The new confirmed case from Greece is in a returning traveller from New York.

Six more cases were reported from France.

Twelve new confirmed cases are reported from the UK, ten of which related to a previously reported school outbreak and one linked to a previously confirmed case. The source of infection of the remaining new case is under investigation. This brings the total number of confirmed cases in the UK to 205, of which 157 (77%) are related to in-country transmission.

A total of 480 confirmed cases are now reported from 22 EU and EFTA countries (Table 1) and 225 related to in-country transmission (47%).

Outside of the EU and EFTA countries, a total of 15,197 cases are currently reported.

In South America, three more countries reported their first confirmed cases: Bolivia (2), Venezuela (1) and Paraguay (5).

Mexico reported 64 more confirmed cases and 6 more deaths. The total number of deaths increased to 109 globally


Assessment and response in the EU and EFTA countries

There is currently no reported sustained community transmission in the EU and EFTA countries. However, almost half of the cases in the EU and EFTA countries are resulting form in-country secondary transmission. Seventy percent of in-country transmission cases are reported from the UK. Two cases in Greece have been acquired in the UK, representing the first cases of transmission within EU and EFTA countries.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


From the literature

A publication in the MMWR gives the scientific evidence that immunisation with ordinary seasonal vaccines containing conventional A(H1N1) would not give protection against the new influenza A(H1N1). The same report contains some cautious hints that older people may be protected against the new virus, perhaps because of exposure to the virus many years ago (Read more).

At the World Health Assembly there was a call from a number of Member States at a High Level Consultation for more consideration of the severity of a pandemic when considering moving from phase 5 to phase 6, which is not considered in the current WHO guidance (Read more).

A short note was published on the WHO website on ?severity of an influenza pandemic?, followed by an article in the Weekly Epidemiological Record (WER) WHO on ?Considerations for assessing the severity of an influenza pandemic?. This article highlights that monitoring is essential as severity is likely to change over time and may vary from country to country.

In its latest issue on Thursday 28 May, Eurosurveillance has published several peer-reviewed rapid communications on the new influenza A(H1N1) virus:

• An editorial highlights the need for a common name for the virus and the disease it causes to ensure consistency in scientific and other publications (Read editorial).
• A paper on two confirmed cases in Greece of new influenza A(H1N1) virus infection in travellers returning from Scotland without apparent traceable links to an infectious source, discusses potential public health implications of these findings in the light of potential community transmission within the EU (Read article).
• A paper describing the current epidemiology and surveillance activities in France and measures undertaken to slow down the spread of the new virus (Read article).
• A rapid communication about the genetics of the new influenza A(H1N1) strain and the identification of its closest relatives through a cluster analysis approach (Read rapid communication).
• A perspective article on ?The SHIPSAN TRAINET? partnership features actions and options to be implemented, to prevent the spread of influenza infections on board cruise ships and ferries (Read article).

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 29 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium 2 - 10 - 3
3. Czech Republic ... - 1 - ...
4. Denmark ... - 1 - ...
5. Estonia 1 - 1
6. Finland ... - 3 - ...
7. France 6 - 26 - ...
8. Germany 1 - 20 - 5
9. Greece 1 - 4 - ...
10. Iceland ... - 1 - ...
11. Ireland ... - 3 - ...
12. Italy ... - 26 - 2
13. Netherlands ... - 3 - ...
14. Norway ... - 4 - ...
15. Poland ... - 4 - ...
16. Portugal ... - 1 - ...
17. Romania ... - 3 - 1
18. Slovakia 1 - 2 - ...
19. Spain ... - 143 - 57
20. Sweden ... - 4 - ...
21. Switzerland ... - 4 - ...
22. United Kingdom 12 - 215 -157

• Total 24 - 480 - 225

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 29 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 11 - ...
2. Russian Federation ... - 2 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 33 - 70 - ...
2. Bolivia 2 - 2
3. Brazil 4 - 14 - ...
4. Canada ... - 1118 - 2
5. Chile 3 - 168 - ...
6. Colombia 1 - 17 - ...
7. Costa Rica 4 - 37 - 1
8. Cuba ... - 4 - ...
9. Dominican Republic ... - 2 - ...
10. Ecuador 3 - 35 - ...
11. El Salvador ... - 11 - ...
12. Guatemala ... - 5 - ...
13. Honduras ... - 1 - ...
14. Mexico 64 - 4974 - 95
15. Panama 28 - 107 - ...
16. Paraguay 5 - 5
17. Peru 4 - 31 - ...
18. Uruguay ... - 2
19. USA** ... - 7928 - 11
20. Venezuela 1 - 1

• WHO EMRO REGION

1. Bahrain ... - 1
2. Kuwait ... - 18 - ...
3. United Arab Emirates ... - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 21 - 168 - ...
2. China 5 - 29 - ...
3. Japan 3 - 367 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 6 - ...
7. Republic of Korea 6 - 33 - ...
8. Singapore 3 - 4 - ...
9. Taiwan ... - 9 - ...

• Total 190 - 15197 - 109
• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases and include cases from Puerto Rico.

(...)

-
------

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 30 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 30 May 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• Forty-five new confirmed cases in EU and EFTA countries ? the second highest 24-hour increase reported so far;
• First confirmed case reported from Hungary;
• One case reported from Sweden, 2 from Switzerland, 3 from Germany, 14 from the UK, and 24 from Spain:
• Six more deaths worldwide (none in Europe);

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 30 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 45 new cases were confirmed in the EU and EFTA countries. (It should be noted that cut-off time for the ECDC Situation Report is 17:00 hours, and that a large part of these cases were reported already late yesterday, 29 May.)

Hungary reports its first case in a visitor from the Americas.

Sweden reports its fifth case in a 12-year old girl returning from USA on the 23rd May.

Switzerland has 2 more cases, Germany 3, the UK 14 (of which at least 1 in-country transmission), and Spain.

Out of the Spanish cumulative total of 167 cases reported so far, 42 were reported to be linked to an outbreak in a military academy in Madrid, affecting students as well as contacts.

A total of 525 confirmed cases are now reported from 21 EU and EFTA countries (Table 1).

Outside of the EU and EFTA countries, a total of 16,707 cases are currently reported. Major increases are seen in Australia: 86 cases (a 50% increase), Canada 218 (20% increase) and USA 1,047 (13% increase, but USA now only reports every other day).

Two more deaths are reported from Mexico, and 4 from the USA, raising the total number of deaths to 115 globally (Table 2).


Assessment and response in the EU and EFTA countries

22 out of the 31 EU/EFTA countries have now reported cases, but the assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported. However, testing of suspect cases is still to a large extent focused on returning travellers and their contacts, and in the EU case definition one of the criteria that can define the category ?case under investigation? is linked to travel. It would probably be important to more than hitherto make a clear distinction between the case definition for the new influenza A(H1N1) and the algorithm used for screening and case finding. It could also be questioned whether the category ?case under investigation? is still needed ? it does not exist for any of the other diseases under EU surveillance.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


From the literature

According to influenza surveillance data from the EU/EEA member states, the number of specimens submitted by sentinel physicians for virological testing decreased from 238 in week 20 to 188 in week 21 (-21%). One of these specimens, collected in the United Kingdom, tested positive for new influenza A(H1N1) virus.

The surveillance system also captures virus detections in samples from non-sentinel sources where there is no denominator (total number of samples submitted).

Seventy-five such specimens from five countries tested positive for new influenza A(H1N1) virus, three specimens from another two countries tested positive for new influenza A(H1) without neuraminidase subtyping results being reported. All new influenza A(H1N1) viruses tested for antiviral resistance so far proved to be susceptible to oseltamivir and zanamivir and resistant to adamantanes.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 30 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium ... - 10 - 3
3. Czech Republic ... - 1 - ...
4. Denmark ... - 1 - ...
5. Estonia ... - 1 - ...
6. Finland ... - 3 - ...
7. France ... - 26 - ...
8. Germany 3 - 23 - 5
9. Greece ... - 4 - ...
10. Hungary 1 - 1 - ...
11. Iceland ... - 1 - ...
12. Ireland ... - 3 - ...
13. Italy ... - 26 - 2
14. Netherlands ... - 3 - ...
15. Norway ... - 4 - ...
16. Poland ... - 4 - ...
17. Portugal ... - 1 - ...
18. Romania ... - 3 - 1
19. Slovakia ... - 2 - ...
20. Spain 24 - 167 - 57
21. Sweden 1 - 5 - ...
22. Switzerland 2 - 6 - ...
23. United Kingdom 14 - 229 - 158

• Total 45 - 525 - 226

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 30 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel 3 - 14 - ...
2. Russian Federation 1 - 3 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 10 - 80 - ...
2. Bolivia ... - 2 - ...
3. Brazil 1 - 15 - ...
4. Canada 218 - 1336 - 2
5. Chile 56 - 224 - ...
6. Colombia ... - 17 - ...
7. Costa Rica ... - 37 - 1
8. Cuba ... - 4 - ...
9. Dominican Republic ... - 2 - ...
10. Ecuador ... - 35 - ...
11. El Salvador 16 - 27 - ...
12. Guatemala 6 - 11 - ...
13. Honduras 1 - 2 - ...
14. Mexico 55 - 5029 - 97
15. Panama ... - 107 - ...
16. Paraguay ... - 5 - ...
17. Peru 5 - 36 - ...
18. Uruguay ... - 2 - ...
19. USA** 1047 - 8976 - 15
20. Venezuela ... - 1 - ...

• WHO EMRO REGION

1. Bahrain ... - 1 - ...
2. Kuwait ... - 18 - ...
3. United Arab Emirates ... - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand ... - 2 - ...

• WHO WPRO REGION

1. Australia 86 - 254 - ...
2. China ... - 29 - ...
3. Japan 3 - 370 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 6 - ...
7. Republic of Korea ... - 33 - ...
8. Singapore ... - 4 - ...
9. Taiwan ... - 10 - ...

• Total 1508 - 16707 - 115

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the USA include confirmed cases from Puerto Rico.

(...)

-
------

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 31 May 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

[Original Document: LINK. EDITED.]


Influenza A(H1N1) infection - Update 31 May 2009, 17:00 hours CEST


Main developments in past 24 hours

• Thirty-two new confirmed cases in EU and EFTA countries;
• First confirmed case reported from Cyprus;
• One case each reported from Ireland, Finland and Sweden, 2 from Belgium, 5 from Germany, 6 from France, and 15 from the UK.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 30 May, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 32 new cases were confirmed in the EU and EFTA countries.

Cyprus reports its first case: a woman who travelled from New York to Cyprus through London on the 27th of May. She developed influenza-like symptoms (fever, headache, sore throat, cough, muscle pains and malaise) during the leg from London to Cyprus.

In addition to Cyprus, Finland, Ireland and Sweden report 1 new case each, Belgium 2, Germany 5, France 6 and the UK 15. One German case and 8 of the UK cases are reported as in-country transmissions.

A total of 557 confirmed cases are now reported from 24 EU and EFTA countries (Table 1).

Outside of the EU and EFTA countries, a total of 16,838 cases are currently reported. Two countries are reporting their first cases: Bahamas (1) and Lebanon (3). A major increase is seen in Australia, which has almost doubled its case count in the last 48-hour period, from 168 to 298.

No more deaths have been reported today; the total remains at 115 (Table 2).


Assessment and response in the EU and EFTA countries

24 out of the 31 EU/EFTA countries have now reported cases, but the assessment for the EU and EFTA countries does not change: no sustained community transmission has yet been declared.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Transmissibility vs. virulence

The terms transmissibility and virulence are not seldom confused, but they denote two quite different characteristics of a pathogen. Transmissibility measures how efficiently a disease is passed on from an infectious to a susceptible person (another word for this is ?attack rate?). Virulence denotes how severe the infection becomes in a patient, once he/she has become infected. A pathogen may be highly transmissible, but have low virulence (for example common cold), or the reverse (for example Ebola). These terms should not be mixed up when talking about the new influenza A(H1N1) outbreak.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 31 May 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium 2 - 12 - 3
3. Cyprus 1 - 1 - ...
4. Czech Republic ... - 1 - ...
5. Denmark ... - 1 - ...
6. Estonia ... - 1 - ...
7. Finland 1 - 4 - ...
8. France 6 - 32 - ...
9. Germany 5 - 28 - 6
10. Greece ... - 4 - ...
11. Hungary ... - 1 - ...
12. Iceland ... - 1 - ...
13. Ireland 1 - 4 - ...
14. Italy ... - 26 - 2
15. Netherlands ... - 3 - ...
16. Norway ... - 4 - ...
17. Poland ... - 4 - ...
18. Portugal ... - 1 - ...
19. Romania ... - 3 - 1
20. Slovakia ... - 2 - 1
21. Spain ... - 167 - 57
22. Sweden 1 - 6 - ...
23. Switzerland ... - 6 - ...
24. United Kingdom 15 - 244 - 158

• Total 32 - 557 - 228

Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.


Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 31 May 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• WHO EURO REGION

1. Israel ... - 14 - ...
2. Russian Federation ... - 3 - ...
3. Turkey ... - 2 - ...

• WHO AMRO REGION

1. Argentina 20 - 100 - ...
2. Bahamas 1 - 1
3. Bolivia ... - 2 - ...
4. Brazil 1 - 16 - ...
5. Canada ... - 1336 - 2
6. Chile 26 - 250 - ...
7. Colombia 3 - 20 - ...
8. Costa Rica ... - 37 - 1
9. Cuba ... - 4 - ...
10. Dominican Republic ... - 2 - ...
11. Ecuador ... - 35 - ...
12. El Salvador ... - 27 - ...
13. Guatemala ... - 11 - ...
14. Honduras ... - 2 - ...
15. Mexico ... - 5029 - 97
16. Panama ... - 107 - ...
17. Paraguay ... - 5 - ...
18. Peru ... - 36 - ...
19. Uruguay 9 - 11 - ...
20. USA** 1047 - 8976 - 15
21. Venezuela ... - 1 - ...

• WHO EMRO REGION

1. Bahrain ... - 1 - ...
2. Kuwait ... - 18 - ...
3. Lebanon 3 - 3 - ...
4. United Arab Emirates ... - 1 - ...

• WHO SEARO REGION

1. India ... - 1 - ...
2. Thailand 1 - 3 - ...

• WHO WPRO REGION

1. Australia 44 - 298 - ...
2. China 12 - 41 - ...
3. Japan 8 - 378 - ...
4. Malaysia ... - 2 - ...
5. New Zealand ... - 9 - ...
6. Philippines ... - 6 - ...
7. Republic of Korea ... - 33 - ...
8. Singapore 1 - 5 - ...
9. Taiwan 1 - 11 - ...

• Total 131 - 16838 - 115

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(...)

-
-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 01 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 01 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 21 new cases confirmed from EU/EFTA countries in the last 24 hours;
• Bulgaria reports its first confirmed case;
• New non-EU/EFTA countries reporting confirmed cases include Jamaica and Vietnam.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 01 June, 17:00 hours CEST, is presented in Table 1 and Table 2. Please, note that the regional classification of the non-EU and EFTA countries in Table 2 was adapted to the European Commission?s reference (http://ec.europa.eu/world/where/index_en.htm).

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 21 new cases were confirmed in the EU and EFTA countries.

Bulgaria reported its first confirmed case in a man returning from the United States, who reported no contact with known cases of influenza A(H1N1) prior to developing symptoms. The case was not symptomatic during his return flight from New York to
Sofia.

New confirmed cases were also reported by Spain (13), Norway (3), Romania (2), Portugal (1) and Greece (1).

A total of 578 cases are now confirmed from 25 of the 31 EU and EFTA countries (Table 1).

Outside of the EU and EFTA countries, a total of 17,032 cases are currently reported, of which 194 in the last 24 hours.

Two countries are reporting their first cases: Jamaica (2) and Vietnam (1). The total number of reported deaths remains stable at 115 (Table 2).


Assessment and response in the EU and EFTA countries

A total of 25 out of the 31 EU and EFTA countries now report cases, almost half of whom are reported as in-country transmission. However, an epidemiological link can be established for the majority of these cases, including travel history to North America or through institutional outbreaks. Therefore, the assessment for the EU and EFTA countries does not change: no sustained community transmission has yet been declared.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


WHO guidance documents concerning influenza A(H1N1)

The World Health Organization has produced 36 documents related to influenza A(H1N1) guidance. A complete list is available on the WHO website. In the next few days, ECDC will be introducing these documents by areas of speciality, starting today with documents focusing on the clinical management of cases.


Case management of influenza A(H1N1) in air transport, 18 May 2009

This document provides guidance on case management of the new influenza A(H1N1) in air transport, with the objective to reduce human exposure to infectious agents at airports and during air travel. It especially focuses on what to do when suspected cases are detected during a flight. It was developed by WHO in collaboration with experts in aviation medicine, hygiene and sanitation, in occupational health and in infectious disease control.


Clean hands protect against infection, 2 May 2009

This guidance describes the steps to be taken when washing hands, in order to ensure a thorough and effective protection from the influenza A(H1N1) virus. These steps include the use of alcohol-based hand-rub, or the use of soap and water followed by proper drying of hands.


Considerations of influenza A(H1N1) and HIV infection, 1 May 2009

This guidance considers the risks and potential impact of any emerging influenza virus infection in the specific context of HIV/AIDS programmes and services. It also suggests possible adaptations of prevention and treatment plans.


Reducing excess mortality from common illnesses during an influenza pandemic, 28 April 2009

This guidance is mostly applicable to resource poor settings, where a pandemic may lead to increased vulnerability to illnesses like diarrhoea, malaria, pneumonia, malnutrition, HIV/AIDS and tuberculosis. The document suggests strategies to address pandemic influenza within the broader range of health care needs, while at the same time acknowledging resource limitations.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 01 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium ... - 12 - 3
3. Bulgaria 1 - 1 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 1 - ...
6. Denmark ... - 1 - ...
7. Estonia ... - 1 - ...
8. Finland ... - 4 - ...
9. France ... - 32 - ...
10. Germany ... - 28 - 6
11. Greece 1 - 5 - ...
12. Hungary ... - 1 - ...
13. Iceland ... - 1 - ...
14. Ireland ... - 4 - ...
15. Italy ... - 26 - 2
16. Netherlands ... - 3 - ...
17. Norway 3 - 7 - ...
18. Poland ... - 4 - ...
19. Portugal 1 - 2 - ...
20. Romania 2 - 5 - 1
21. Slovakia ... - 2 - 1
22. Spain 13 - 180 - 57
23. Sweden ... - 6 - ...
24. Switzerland ... - 6 - ...
25. United Kingdom ... - 244 - 158

• Total 21 - 578 - 228

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 01 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Israel 5 - 19 - ...
3. Kuwait ... - 18 - ...
4. Lebanon ... - 3 - ...
5. Turkey ... - 2 - ...
6. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 1336 - 2
2. Mexico ... - 5029 - 97
3. USA** ... - 8976 - 15

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Costa Rica ... - 37 - 1
3. Cuba ... - 4 - ...
4. Dominican Republic ... - 2 - ...
5. El Salvador ... - 27 - ...
6. Guatemala 1 - 12 - ...
7. Honduras ... - 2 - ...
8. Jamaica 2 - 2 - ...
9. Panama ... - 107 - ...

• SOUTH AMERICA

1. Argentina 15 - 115 - ...
2. Bolivia 1 - 3 - ...
3. Brazil 4 - 20 - ...
4. Chile 26 - 276 - ...
5. Colombia ... - 20 - ...
6. Ecuador 4 - 39 - ...
7. Paraguay ... - 5 - ...
8. Peru ... - 36 - ...
9. Uruguay ... - 11 - ...
10. Venezuela 1 - 2 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 12 - 33 - ...
2. Hong Kong SAR 3 - 23 - ...
3. India ... - 1 - ...
4. Japan 1 - 379 - ...
5. Korea (South) ... - 33 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 2 - ...
2. Philippines 15 - 21 - ...
3. Singapore ... - 5 - ...
4. Thailand ... - 3 - ...
5. Taiwan 1 - 12 - ...
6. Vietnam ... - 1 - ...

• AUSTRALIA AND PACIFIC

1. Australia 103 - 401 - ...
2. New Zealand ... - 9 - ...

• TOTAL 194 - 17032 - 115

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(...)

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-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 02 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 02 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 27 new cases confirmed from EU and EFTA countries in the past 24 hours;
• Luxembourg confirms its first case;
• 1,522 new cases are reported from non EU and EFTA countries.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 02 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 27 cases were confirmed in the EU and EFTA countries (Table 1).

Luxembourg reported its first confirmed case in a man returning from the United States.

New confirmed cases were also reported from Belgium (1), Germany (3), Ireland (1), Italy (4), the Netherlands (1), Sweden (1), Switzerland (4) and United Kingdom (11).

The newly confirmed case in Belgium represents the fourth in-country transmission and occurred in the 13-year old son of a man who was previously confirmed with influenza A(H1N1) after returning from Costa Rica.

Outside of the EU and EFTA countries, a total of 18,554 cases are currently reported, of which 1,522 in the last 24 hours. The majority of these newly confirmed cases are from Australia, Canada and the United States (Table 2).


Assessment and response in the EU and EFTA countries

A total of 26 out of the 31 EU and EFTA countries now report cases, almost half of whom are reported as in-country transmission. However, an epidemiological link can be established for the majority of these cases, including travel history to North America or through institutional outbreaks. Therefore, the assessment for the EU and EFTA countries does not change: no sustained community transmission has yet been declared.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Scientific background information on influenza A(H1N1)

A comprehensive scientific background presentation, entitled ?Likely evolution of the epidemics/pandemic of new A(H1N1) influenza? is now available on the ECDC website (here). The presentation will be updated at regular intervals in order to include any new evidence and understanding of the situation. ECDC very much welcomes comments and suggestions on this presentation, which should be sent to influenza@ecdc.europa.eu with ?Pandemic PowerPoint? in the subject line.

The presentation discusses evidence from the last three pandemics from the 20th century (1918, 1957 and 1968) regarding age-specific clinical attack and death rates and epidemic curves. This presentation points out that there were large differences between influenza pandemics regarding the shape and duration of outbreaks, the most affected population groups, case severity and case fatality ratios.

The presentation also describes some of the early scientific findings from the initial experiences with the influenza A(H1N1) virus in North America.

This includes evidence that seasonal strains of influenza were found circulating at the same time as this new strain, but outside of the regular influenza season. Also, evidence on severity of disease, affected age groups, and methods for surveillance and control are addressed. Finally, how to determine the severity of a pandemic is discussed, considering the influence of numerous variables such as death ratio, vulnerable groups, media attention etc.

Taking all the above into consideration, the presentation concludes that public health measures cannot be standardized for all pandemics and need to reflect the actual virological and epidemiological situation.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 02 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 1 - ...
2. Belgium 1 - 13 - 4
3. Bulgaria ... - 1 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 1 - ...
6. Denmark ... - 1 - ...
7. Estonia ... - 1 - ...
8. Finland ... - 4 - ...
9. France ... - 32 - ...
10. Germany 3 - 31 - 7
11. Greece ... - 5 - ...
12. Hungary ... - 1 - ...
13. Iceland ... - 1 - ...
14. Ireland 1 - 5 - ...
15. Italy 4 - 30 - 2
16. Luxembourg 1 - 1
17. Netherlands 1 - 4 - ...
18. Norway ... - 7 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania ... - 5 - 1
22. Slovakia ... - 2 - 1
23. Spain ... - 180 - 84
24. Sweden 1 - 7 - ...
25. Switzerland 4 - 10 - ...
26. United Kingdom 11 - 255 - 158

• Total 27 - 605 - 257

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 02 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Israel 14 - 33 - ...
3. Kuwait ... - 18 - ...
4. Lebanon ... - 3 - ...
5. Turkey 2 - 4 - ...
6. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada 194 - 1530 - 2
2. Mexico ... - 5029 - 97
3. USA** 1078 - 10054 - 17

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Costa Rica ... - 37 - 1
3. Cuba ... - 4 - ...
4. Dominican Republic 9 - 11 - ...
5. El Salvador 3 - 30 - ...
6. Guatemala ... - 12 - ...
7. Honduras ... - 2 - ...
8. Jamaica ... - 2 - ...
9. Panama 41 - 148 - ...

• SOUTH AMERICA

1. Argentina 16 - 131 - ...
2. Bolivia ... - 3 - ...
3. Brazil 1 - 21 - ...
4. Chile 37 - 313 - ...
5. Colombia ... - 20 - ...
6. Ecuador ... - 39 - ...
7. Paraguay ... - 5 - ...
8. Peru 5 - 41 - ...
9. Uruguay 4 - 15 - ...
10. Venezuela ... - 2 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 6 - 39 - ...
2. Hong Kong SAR ... - 23 - ...
3. India ... - 1 - ...
4. Japan 6 - 385 - ...
5. Korea (South) ... - 33 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 2 - ...
2. Philippines ... - 21 - ...
3. Singapore 2 - 7 - ...
4. Thailand ... - 3 - ...
5. Taiwan 1 - 13 - ...
6. Vietnam 2 - 3 - ...

• AUSTRALIA AND PACIFIC

1. Australia 100 - 501 - ...
2. New Zealand 1 - 10 - ...

• TOTAL 1522 - 18554 - 117

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(...)

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-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 03 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 03 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 106 new cases confirmed from EU and EFTA countries of which 84 from the UK;
• Nicaragua, Bermuda, Saudi Arabia and Egypt confirmed their first cases today;
• 803 new cases are reported from non EUand EFTAcountries;

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 3 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 106 cases were confirmed in the EU and EFTA countries (Table 1).

New confirmed cases were reported from Austria (1), France (10), Germany (6), Hungary (1), Ireland (2), Romania (1), Slovakia (1) and the United Kingdom (84).

One of the newly confirmed cases in Germany was probably infected in the UK.

Outside of the EU and EFTA countries, a total of 19,357 cases are currently reported, of which 803 in the last 24 hours. The majority of these newly confirmed cases are from Mexico (534), Australia (132) and Chile (47) (Table 2).

New countries reporting confirmed cases include Bermuda (overseas territory of the UK), Egypt, Nicaragua and Saudi Arabia (one each). The confirmed case from Saudi Arabia had recently returned from the Philippines.


Assessment and response in the EU and EFTA countries

Twenty-six of the 31 EU and EFTA countries have reported cases. Media and official national reports are indicating that confirmed cases have been identified in relation with exposure in the EU and EFTA countries. Greece and Germany reported cases which acquired the infection in the UK. Nevertheless, no sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


The rapid evolution of influenza A (H1N1)

Until 2nd June, five of six WHO Regions reported cases. The WHO Region of Africa (AFRO), which does not include Egypt, Libya, Sudan, Morocco and Somalia, has not reported cases so far. The majority of the reported cases worldwide are originating from the Americas (AMRO) as can be seen on figure 1a.

The trend analysis in Figure 1b, using a semi-logarithmic scale, shows a rapid increase in the number of cases in the Americas (AMRO) as well as in the European region (EURO) since end of April 2009.

The increase in the Western Pacific WHO Region (WPRO) was initially less significant but showed a sharp increase in the third week of May, in relation with cases reported from Japan.

The trend in the WPRO Region suggests faster increase in the reported cases in the past 8 days, when compared with the AMRO and EURO Regions, due to the rapid spread of the infection in Australia.

The South East Asian WHO Region (SEARO) reported the first cases three weeks after the alert of WHO on 25 April and the Eastern Mediterranean Region (EMRO, which is including some countries of the African continent) four weeks after the 25 April. The trend in the number of reported cases from SEARO seems to be similar to the one from WPRO during the last week.

[1a: Arithmetic scale 1b: semi-logarithmic scale

Figure 1: Cumulative distribution of cases of influenza A(H1N1) by day of reporting and WHO Region, 28 April ? 2 June 2009 (n = 19,159)
The comparison of trends in reported cases is potentially biased by the sensitivity of surveillance systems, the change in surveillance strategies, the testing strategies and the availability of test-kits. In addition, the case definitions used differ per country, e.g. the USA report the cumulative number of confirmed and probable cases, while other countries report only laboratory confirmed cases.]


Current issues related to pandemic vaccine development

Pandemic influenza prevention includes development of a vaccine based on the current circulating influenza A(H1N1) strain. A number of international public health agencies and regulatory authorities including WHO, ECDC, CDC, EMEA and FDA are now considering the following issues for the development and production of a vaccine:

• Vaccine seed strains
  • Several optional techniques for production of vaccines are available. Wild-type virus isolated from an individual in California is the basis for all these technique developments. During the month of May wild-type influenza A(H1N1) virus was distributed to vaccine manufacturers as the first tool for their coming production. Last week the WHO Collaborating Centres have released vaccine seed strains produced both by the technique reversed genetic and re-assortment. Most manufacturers will choose vaccine seed virus produced by the technique re-assortment. Re-assorted strains carry the recommended hemagglutinin and neuraminidase antigens on the surface of a backbone of a fast growing laboratory influenza strain. These re-assorted strains can be grown in egg- or cell-culture, depending on the preference of the manufacturer.

• Adjuvants
  • Several manufacturers are looking into the possibility of using new adjuvants. Adjuvants are compounds added to the vaccine to increase the immunogenicity of the vaccine. Classically, for decades aluminium hydroxide has been used as adjuvant. New compounds using oil-in-water emulsions stimulate the immune system more effectively. Using an adjuvant may be antigen sparing and may induce a broader immune response to different related influenza strains. Several new adjuvants are present in licensed vaccines on the European market and the experience from these may now be valuable.

• Clinical trials
  • Each new vaccine needs to undergo clinical trials before authorisation. Manufacturers are now planning clinical trials to be performed when the first vaccine lots are available. Immunogenicity and safety will be evaluated in infants, children, teenagers, adults and elderly. The precise data requirements are not yet established and will depend on the severity of the disease as the situation evolves. For example, if influenza A (H1N1) continues to develop into a more severe clinical disease than what is seen now, clinical trials may be accelerated and data requirements for licensure adjusted accordingly.

• Vaccine safety
  • Vaccine safety will be monitored in the initial clinical trials. For more rare adverse event each manufacturer is required by the EMEA document on Risk Management Plans to present how they will follow safety and effectiveness in the post-licensure phase in the general population. Monitoring adverse events in pregnant women will be enhanced.

• Vaccine availability
  • Vaccine availability will be affected by the time needed to produce the pandemic vaccine, the time needed for clinical trials and the time needed for the authorization process.

For further information see: http://www.who.int/csr/disease/swineflu/frequently_asked_questions/vaccine_preparedness/en/


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 03 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria 1 - 2 - ...
2. Belgium ... - 13 - 4
3. Bulgaria ... - 1 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 1 - ...
6. Denmark ... - 1 - ...
7. Estonia ... - 1 - ...
8. Finland ... - 4 - ...
9. France 10 - 42 - 1
10. Germany 6 - 37 - 7
11. Greece ... - 5 - ...
12. Hungary 1 - 2 - ...
13. Iceland ... - 1 - ...
14. Ireland 2 - 7 - ...
15. Italy ... - 30 - 2
16. Luxembourg ... - 1
17. Netherlands ... - 4 - ...
18. Norway ... - 7 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania 1 - 6 - 2
22. Slovakia 1 - 3 - 1
23. Spain ... - 180 - 84
24. Sweden ... - 7 - ...
25. Switzerland ... - 10 - ...
26. United Kingdom 84 - 339 - 158

• Total 106 - 711 - 259

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 03 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt 1 - 1 - ...
3. Israel ... - 33 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia 1 - 1
7. Turkey 1 - 5 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 1530 - 2
2. Mexico 534 - 5563 - 103
3. USA** ... - 10054 - 17

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Bermuda 1 - 1
3. Costa Rica 13 - 50 - 1
4. Cuba ... - 4 - ...
5. Dominican Republic ... - 11 - ...
6. El Salvador 11 - 41 -...
7. Guatemala 2 - 14 - ...
8. Honduras ... - 2 - ...
9. Jamaica ... - 2 - ...
10. Nicaragua 1- 1 - ...
11. Panama 7 - 155 - ...

• SOUTH AMERICA

1. Argentina 13 - 144 - ...
2. Bolivia ... - 3 - ...
3. Brazil 2 - 23 - ...
4. Chile 47 - 360 - 1
5. Colombia ... - 20 - ...
6. Ecuador 2 - 41 - ...
7. Paraguay ... - 5 - ...
8. Peru ... - 41 - ...
9. Uruguay ... - 15 - ...
10. Venezuela 1 - 3 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 10 - 49 - ...
2. Hong Kong SAR 3 - 26 - ...
3. India ... - 1 - ...
4. Japan 9 - 394 - ...
5. Korea (South) 8 - 41 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 2 - ...
2. Philippines ... - 21 - ...
3. Singapore 4 - 11 - ...
4. Taiwan ... - 13 - ...
5. Thailand ... - 3 - ...
6. Vietnam ... - 3 - ...

• AUSTRALIA AND PACIFIC

1. Australia 132 - 633 - ...
2. New Zealand ... - 10 - ...

• TOTAL 803 - 19357 - 124

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 04 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 04 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 116 new cases confirmed from EU and EFTA countries;
• 1,638 new cases are reported from non EU and EFTA countries;
• No new country reported its first confirmed cases.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 4 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 116 cases were confirmed in 14 of the EU and EFTA countries (Table 1). Spain and the UK accounted for the majority of new cases, 38 and 42 respectively.

New cases of in-country transmission were reported in Denmark, Estonia, Romania, Germany, and Ireland.

Outside of the EU and EFTA countries, a total of 20,996 cases are currently reported, of which 1,638 in the last 24 hours. The majority of these newly confirmed cases are from the US (1,000), Canada (265) and Australia (243) (Table 2).


Assessment and response in the EU and EFTA countries

Twenty-six of the 31 EU and EFTA countries have reported cases.

No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

Media reports today include a second case of nosocomial transmission of influenza A(H1N1) to a healthcare worker in the EU. The occurrence involves a nurse who cared for a hospitalised influenza A(H1N1) patient. This event demonstrates that infection control procedures in hospital and healthcare settings continue to be of high importance for healthcare staff dealing with suspected and confirmed cases of this virus.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Recent findings in Chile

Chile reported its first two cases on 18 May with a dramatic increase since then. It is the country with the highest number of reported cases (369 cases as of 4 June 2009) and the first reported death (32 year old male) in South America. On the Ministry of Health website today, Chile reported that seven out of 369 confirmed cases were in severe clinical condition (see here).

In order to cope with the high number of new influenza A(H1N1) infections, the country has changed its case management algorithm for suspected cases (see guidelines) since June 1st. Persons presenting with mild symptoms of influenza-like illness receive antivirals for home treatment, but are not tested for laboratory confirmation. Persons presenting with clinical severe disease (dyspnoea, cyanosis, hypotension, etc.) are now the target group to be laboratory confirmed. This change in laboratory testing strategy will probably result in a higher proportion of severe cases being officially reported in the near future.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 04 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 2 - ...
2. Belgium ... - 13 - 4
3. Bulgaria ... - 1 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic 1 - 2 - ...
6. Denmark 3 - 4 - 1
7. Estonia 2 - 3 - 2
8. Finland ... - 4 - ...
9. France 2 - 44 - 1
10. Germany 6 - 43 - 9
11. Greece ... - 5 - ...
12. Hungary 1 - 3 - ...
13. Iceland ... - 1 - ...
14. Ireland 1 - 8 - 1
15. Italy 8 - 38 - 2
16. Luxembourg ... - 1 - ...
17. Netherlands 2 - 6 - ...
18. Norway 2 - 9 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania 2 - 8 - 4
22. Slovakia ... - 3 - 1
23. Spain 38 - 218 - 84
24. Sweden 6 - 13 - ...
25. Switzerland ... - 10 - ...
26. United Kingdom 42 - 381 - 158

• Total 116 - 827 - 267

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

[Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 04 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area]

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt ... - 1 - ...
3. Israel 6 - 39 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia ... - 1
7. Turkey 2 - 7 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada 265 - 1795 - 3
2. Mexico ... - 5563 - 103
3. USA** 1000 - 11054 - 17

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Bermuda ... - 1
3. Costa Rica ... - 50 - 1
4. Cuba ... - 4 - ...
5. Dominican Republic 12 - 23 - ...
6. El Salvador ... - 41 - ...
7. Guatemala 2 - 16 - ...
8. Honduras 32 - 34 - ...
9. Jamaica ... - 2 - ...
10. Nicaragua ... - 1 - ...
11. Panama 11 - 166 - ...

• SOUTH AMERICA

1. Argentina 3 - 147 - ...
2. Bolivia ... - 3 - ...
3. Brazil 1 - 24 - ...
4. Chile 9 - 369 - 1
5. Colombia 4 - 24 - ...
6. Ecuador 2 - 43 - ...
7. Paraguay ... - 5 - ...
8. Peru 6 - 47 - ...
9. Uruguay ... - 15 - ...
10. Venezuela 1 - 4 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 9 - 58 - ...
2. Hong Kong SAR 1 - 27 - ...
3. India 2 - 3 - ...
4. Japan 15 - 409 - ...
5. Korea (South) ... - 41 - ...

• SOUTH-EAST ASIA

1. Malaysia 1 - 3 - ...
2. Philippines 7 - 29 - ...
3. Singapore ... - 11 - ...
4. Taiwan 1 - 14 - ...
5. Thailand 2 - 5 - ...
6. Vietnam ... - 3 - ...

• AUSTRALIA AND PACIFIC

1. Australia 243 - 876 - ...
2. New Zealand 1 - 11 - ...

• TOTAL 1638 - 20996 - 125

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(...)

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-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 05 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 05 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 144 new cases confirmed from EU and EFTA countries;
• 254 new cases are reported from non EU and EFTA countries;
• First case reported from French Polynesia and Barbados.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 5 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 144 cases were confirmed in nine EU and EFTA countries (Table 1).

Spain and the UK accounted for the majority of new cases, 73 and 47 respectively.

Forty-seven new cases of in-country transmission were reported from five countries (France, Germany, Italy, and Romania - one each) within the last 24 hours, the majority of them from Spain (43).

France reported the first case from French Polynesia, and Barbados reported also its first confirmed case.

Outside of the EU and EFTA countries, a total of 21,250 cases are currently reported, of which 254 in the last 24 hours. The majority of these newly confirmed cases are from the Australia (130) (Table 2).

The total number of reported deaths did not change globally (125).


Assessment and response in the EU and EFTA countries

The number of EU and EFTA countries reporting cases did not change (26 of 31 EU and EFTA countries). No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Summary of influenza meeting at ECDC

The ECDC organised a meeting in Stockholm on the 3-4 June 2009 for influenza expert epidemiologists and virologists from all the EU and EEA countries to discuss the epidemiological and virological surveillance of seasonal influenza and of influenza A(H1N1) in the EU.

The meeting served as a valuable forum to discuss the experiences during the first season of operating the surveillance of influenza under ECDC coordination and to discuss the imminent shift in the reporting platform to the ECDC IT infrastructure using The European Surveillance System (TESSy).

Senior experts from CDC Atlanta and WHO-Europe also presented their reports, focusing mainly on the influenza A (H1N1) situation, while the Community Network of Reference Laboratories for Human influenza (CNRL) discussed in detail the virology laboratory preparedness, difficulties and solutions related to testing this new variant as compared to the seasonal flu virus.

A number of innovative sources of data that may be used as adjuncts to routine surveillance were also presented and discussed. These included the web based Google Flutrends, the Influenzanet project, and the Swedish web queries initiative as well as the mortality monitoring project, EuroMOMO.

The meeting ended with agreeing that a more focused meeting will be organised by ECDC in six weeks time to allow Member States to share their experiences in dealing with influenza A(H1N1) in the EU.


From the literature

In its latest issue on Thursday 4 June, Eurosurveillance has published several peer-reviewed rapid communications on the new influenza A(H1N1) virus:

• A rapid communication estimates the transmission potential of the new influenza A(H1N1) virus and its age-specificity in Japan. In particular, the average number of secondary transmissions involving minors (those under 20 years of age) traced back to infected minors was estimated at 2.8. The authors conclude that minors could sustain transmission even in the absence of adults. (read more)
• Another report provides an update on the epidemiology of new influenza A(H1N1) in the United Kingdom, with data on 252 confirmed cases detected by 31 May. The evidence indicates spread in households, schools and the community with secondary (n=40), tertiary (n=125) and sporadic (n=13) cases. (read more)
• Another paper from the United Kingdom evaluates four real-time PCR assays for detection of influenza A(H1N1) viruses and demonstrates that the concurrent use of primary diagnostic and confirmatory assays provides rapid and accurate assessment of confirmed cases. (read more)
• The origins of the new influenza A(H1N1) virus is the topic of another rapid communication in which the authors from Mexico and the United States state that it is time to take action towards the development of a surveillance system which integrates phylogenetic information on influenza viruses in humans and livestock, specifically pigs. (read more)
• Finally, a communication from Norway gives an example of how public health authorities can assess their communication strategies before and during an outbreak. A survey performed on 29 April indicates that Norwegians agree with their health authorities? strategy to communicate worst case pandemic scenarios. (read more)

The CDC and WHO published this week an update on the outbreak in Mexico, where the global peak of the novel influenza A(H1N1) outbreak has probably passed, but focal outbreaks continue to occur.

The pattern is similar to outbreaks reported in the US and in other countries: person to person transmission occurring outside of the normal flu season, and circulation among school children.

The fact that persons under 60 years old are significantly more affected could be related to cross-protection with previous infections or vaccinations, but the clear extent of protection is unknown. (See more at MMWR and WER)

According to influenza surveillance data from the EU/EEA member states, the number of specimens submitted by sentinel physicians for virological testing stabilised at 211, after 238 in week 20 and 188 in week 21. None of these specimens tested positive for influenza A(H1N1)v virus.

The surveillance system also captures virus detections in samples from non-sentinel sources where there is no denominator (total number of samples submitted). Fifty-three such specimens tested positive for influenza A(H1N1) virus, fifteen specimens tested positive for new influenza A(H1) without neuraminidase sub-typing results being reported.

All new influenza A(H1N1) viruses tested for antiviral resistance so far proved to be susceptible to oseltamivir and zanamivir and resistant to adamantanes (read the report).

The Trust for America?s Health (TFAH), the Center for Biosecurity, and the Robert Wood Johnson Foundation (RWJF) issued early lessons learned from the 2009 influenza A(H1N1) outbreak in the USA and the core areas to be addressed. The main lessons learnt were that pandemic planning paid off, but public health departments and the health care delivery systems were overwhelmed, more coordination is needed between health care providers and the public health system, public health measures (school closures, restrictions of mass gatherings) are problematic in the implementation, and clear information to the public is key to build trust and limit fear. Their recommendations include the need for maintaining stockpiles for treatment, enhancing vaccine development, improve coordination, enhance strategies for public health measures and ensure surge capacity of health care providers (read more)



Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 05 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 2 - ...
2. Belgium ... - 13 - 4
3. Bulgaria 1 - 2 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 2 - ...
6. Denmark ... - 4 - 1
7. Estonia ... - 3 - 2
8. Finland ... - 4 - ...
9. France 12 - 56 - 2
10. Germany 6 - 49 - 10
11. Greece ... - 5 - ...
12. Hungary ... - 3 - ...
13. Iceland ... - 1 - ...
14. Ireland 1 - 9 - 1
15. Italy 2 - 40 - 3
16. Luxembourg ... - 1 - ...
17. Netherlands ... - 6 - ...
18. Norway ... - 9 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania 1 - 9 - 5
22. Slovakia ... - 3 - 1
23. Spain 73 - 291 - 127
24. Sweden 1 - 14 - ...
25. Switzerland ... - 10 - ...
26. United Kingdom 47 - 428 - 158

• Total 144 - 971 - 314

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 05 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt ... - 1 - ...
3. Israel ... - 39 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia ... - 1
7. Turkey 3 - 10 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 1795 - 3
2. Mexico ... - 5563 - 103
3. USA** ... - 11054 - 17

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Barbados 1 - 1 - ...
3. Bermuda ... - 1 - ...
4. Costa Rica 18 - 68 - 1
5. Cuba ... - 4 - ...
6. Dominican Republic 10 - 33 - ...
7. El Salvador 8 - 49 - ...
8. Guatemala 9 - 25 - ...
9. Honduras ... - 34 - ...
10. Jamaica ... - 2 - ...
11. Nicaragua ... - 1 - ...
12. Panama ... - 166 - ...

• SOUTH AMERICA

1. Argentina 16 - 163 - ...
2. Bolivia ... - 3 - ...
3. Brazil 4 - 28 - ...
4. Chile 24 - 393 - 1
5. Colombia ... - 24 - ...
6. Ecuador 8 - 51 - ...
7. Paraguay ... - 5 - ...
8. Peru 2 - 49 - ...
9. Uruguay 2 - 17 - ...
10. Venezuela ... - 4 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 3 - 61 - ...
2. Hong Kong SAR 3 - 30 - ...
3. India 1 - 4 - ...
4. Japan 1 - 410 - ...
5. Korea (South) ... - 41 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 3 - ...
2. Philippines 4 - 33 - ...
3. Singapore 1 - 12 - ...
4. Taiwan 2 - 16 - ...
5. Thailand ... - 5 - ...
6. Vietnam 2 - 5 - ...

• AUSTRALIA AND PACIFIC

1. Australia 130 - 1006 - ...
2. ***French Polynesia 1 - 1 - ...
3. New Zealand 1 - 12 - ...

• TOTAL 254 - 21250 - 125

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.
• (***) The case from French Polynesia was reported by French authorities

(...)

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-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 06 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 06 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 63 new cases confirmed from EU and EFTA countries;
• 2296 new cases are reported from non EU and EFTA countries;
• First case reported from Cayman Islands;
• First death reported in the Dominican Republic in a pregnant woman with underlying disease;
• ECDC publishes its interim guidance on Delaying (Containment) vs Mitigation Strategies on the web;
• A preliminary analysis of case-based reports for 21 EU and EEA/EFTA countries is attached.

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 6 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.

The WHO Emergency Committee convened for this Public Health Emergency to advise the Director General (DG) under the International Health Regulations met again on June 5th. After WHO issued a brief report: http://www.who.int/csr/disease/swineflu/3rd_meeting_ihr/en/print.html .

On this occasion it seems the DG asked the Committee to look at the issue of severity and to comment on the parameters that WHO has produced.

These have been recently described by WHO in the Weekly Epidemiological Record WHO Considerations for assessing the severity of an influenza pandemic WER 29 May 2009; vol. 84: (22)197?202 http://www.who.int/wer/2009/wer8422.pdf .

There is no mention of the Emergency Committee being asked to consider whether any phase change from Five to Six was justified by the evidence. Rather they were asked to approve including statements on severity in future phase changes, which they did.


Epidemiological update

In the past 24 hours, 63 cases were confirmed in three EU and EFTA countries (Table 1). The UK accounted for the majority of new cases, 58, followed by The Netherlands, with 4, and Belgium, 1.

The new case of Belgium and the 4 new cases in The Netherlands had returned from travelling abroad (3 persons from the United States and one person from the Dominican Republic).

In the UK the information about transmission (in-country or abroad) may be limited, due to the fact that since Monday 1 June, the confirmation is done at regional laboratories and the report may reach earlier the central level, but with less epidemiological detail.

Outside of the EU and EFTA countries, a total of 23,992 cases are currently reported, of which 2296 in the last 24 hours (Table 2).

The majority of these newly confirmed cases are from the US (1713): this covers a period of 2 days, since the previous report of Wednesday.

Cayman Islands reported their first confirmed case.

The total number of reported deaths has reached 139, with one from Dominican Republic in a pregnant woman with underlying disease, and 10 new deaths in the US.


Assessment and response in the EU and EFTA countries

The number of EU and EFTA countries reporting cases did not change (26 of 31 EU and EFTA countries). No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Interim ECDC guidance on Delaying (Containment) vs Mitigation Strategies

ECDC has today published its interim guidance on Delaying (Containment) vs Mitigation Strategies. This is in relation to approaches to case finding and contact tracing of people who may be infected with the new influenza A(H1N1) in Europe. It has been produced following a formal request to ECDC by a Member State and has benefitted from a discussion with ECDC?s Advisory Forum. As befits ECDC?s mandate it presents the evidence and arguments for and against the different approaches rather than making firm recommendations. Read more


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 06 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 2 - ...
2. Belgium 1 - 14 - 4
3. Bulgaria ... - 2 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 2 - ...
6. Denmark ... - 4 - 1
7. Estonia ... - 3 - 2
8. Finland ... - 4 - ...
9. France ... - 56 - 2
10. Germany ... - 49 - 10
11. Greece ... - 5 - ...
12. Hungary ... - 3 - ...
13. Iceland ... - 1 - ...
14. Ireland ... - 9 - 1
15. Italy ... - 40 - 3
16. Luxembourg ... - 1 - ...
17. Netherlands 4 - 10 - ...
18. Norway ... - 9 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania ... - 9 - 5
22. Slovakia ... - 3 - 1
23. Spain ... - 291 - 127
24. Sweden ... - 14 - ...
25. Switzerland ... - 10 - ...
26. United Kingdom 58 - 486 - 158

• Total 63 - 1034 - 314

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 06 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt ... - 1 - ...
3. Israel ... - 39 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia ... - 1
7. Turkey ... - 10 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

• Canada 320 - 2115 - 3
• Mexico 154 - 5717 - 106
• USA** 1713 - 13217 - 27

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Barbados ... - 1 - ...
3. Bermuda ... - 1 - ...
4. Cayman Islands 1 - 1 - ...
5. Costa Rica 15 - 83 - 1
6. Cuba ... - 4 - ...
7. Dominican Republic 11 - 44 - 1
8. El Salvador ... - 49 - ...
9. Guatemala 5 - 30 - ...
10. Honduras ... - 34 - ...
11. Jamaica ... - 2 - ...
12. Nicaragua 17 - 18 - ...
13. Panama 13 - 179 - ...

• SOUTH AMERICA

1. Argentina 11 - 174 - ...
2. Bolivia ... - 3 - ...
3. Brazil 3 - 31 - ...
4. Chile ... - 393 - 1
5. Colombia ... - 24 - ...
6. Ecuador ... - 51 - ...
7. Paraguay ... - 5 - ...
8. Peru ... - 49 - ...
9. Uruguay 4 - 21 - ...
10. Venezuela ... - 4 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 6 - 67 - ...
2. Hong Kong SAR ... - 30 - ...
3. India ... - 4 - ...
4. Japan ... - 410 - ...
5. Korea (South) 5 - 46 - ...

• SOUTH-EAST ASIA

1. Malaysia 4 - 7 - ...
2. Philippines ... - 33 - ...
3. Singapore 2 - 14 - ...
4. Taiwan 1 - 17 - ...
5. Thailand 3 - 8 - ...
6. Vietnam ... - 5 - ...

• AUSTRALIA AND PACIFIC

1. Australia 6 - 1009 - ...
2. ***French Polynesia ... - 1 - ...
3. New Zealand 1 - 13 - ...

• TOTAL 2296 - 23992 - 139

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.
• (***) The case from French Polynesia was reported by France

Appendix: Preliminary analysis of case-based reports of new influenza A(H1N1) reported by 21 EU and EEA/EFTA countries, 03/06/2009

These data were provided by the national contact points for surveillance and the Early Warning Reporting System contact points of the EU and EEA/EFTA countries. ECDC wishes to acknowledge the serious commitment and effort of all these individuals and their teams in ensuring the timely reporting of valid case based data from their respective countries.


Number of cases, travel-association and hospital admission

As published in the ECDC situation report of 3 June, a cumulative number of 711 confirmed cases of new Influenza A(H1N1) have been reported by 26 EU and EFTA countries.

A total of 415 cases (413 confirmed, two probable cases were reported by Germany) of new influenza A(H1N1) have been reported to ECDC as case-based data in the Early Warning Response System by 21 EU, EEA/EFTA countries, out of the 25 known to have cases through epidemic intelligence, from 5 May through 3 June 2009 (Table 1).

The number of travel-related cases (having been outside the country of notification during the incubation period) is 232 (56%) overall.

The information on travel association was reported as unknown or missing for 47 cases (11%).

One hundred and thirty-three of these 232 cases (57%) had returned from Mexico, 90 (39%) had travelled from the USA in the week preceding the date of onset and four had travelled in both Mexico and USA.

One case reported in Germany has travelled to the United Kingdom.

Information was missing for four cases.

The information on hospital admission is available for 301 cases reported in 20 countries (data from Spain will be provided retrospectively).

Among these 301 cases, 138 (46%) have not been admitted to hospital, 91 (30%) have been reported as unknown and 72 (24%) have been admitted in hospital.

As some hospitalisations were done for isolation purposes, the proportion of patients admitted to hospital is not an indicator for severity of disease.


Table 1: Reported number of cases of influenza A(H1N1), travel association and hospital admission, as of 3 June 2009

[Country - Cumulative number of confirmed cases, aggregated data (1) - Number of cases, individual data (2) - Number of travel-related cases (2) - Number of hospitalised patients(2, 3)]

1. Austria 2 - 2 - 2 - 2
2. Belgium 13 - ... - ... - ...
3. Bulgaria 1 - ... - ... - ...
4. Cyprus 1 - 1 - 1 - 1
5. Czech Republic 1 - 1 - 1 - 0
6. Denmark 1 - 1 - 1 - 1
7. Estonia 1 - 1 - 1 - 1
8. Finland 4 - 3 - 3 - 0
9. France 42 - 18 - 18 - 17
10. Germany 37 - 39 - 31 - 22
11. Greece 5 - ... - ... - ...
12. Hungary 2 - 2 - 2 - 0
13. Iceland 1 - ... - ... - ...
14. Ireland 7 - 7 - 7 - 0
15. Italy 30 - 26 - 23 - 11
16. Luxembourg 1 - 1 - 1 - 0
17. Netherlands 4 - 3 - 3 - 0
18. Norway 7 - 8 - 8 - 0
19. Poland 4 - 2 - 2 - 2
20. Portugal 2 - 2 - 2 - 1
21. Romania 6 - 6 - 3 - 6
22. Slovakia 3 - 3 - 2 - 3
23. Spain 180 - 113 - 74 - ...
24. Sweden 7 - 7 - 7 - 1
25. Switzerland 10 - ... - ... - ...
26. United Kingdom 339 - 169 - 40 - 4

• Total 711 - 415 - 232 (4) - 72 (5)

1. daily reported through epidemic intelligence
2. reported as case-based data
3. some hospitalisations were for isolation purposes. For the United Kingdom, data on hospitalisation will be completed retrospectively.
4. Information is unknown for 45 cases(n=415)
5. Information not available from Spain, unknown for 91 patients (n=301)

Epidemic curve

The distribution of new influenza A(H1N1) virus infection by date of onset from 16 April to 2 June has peaked twice with one month interval, on 27th April (24 cases) and 27th May (13 cases) respectively (Figure 1).

Data in the most recent two weeks should be considered to be an underestimate because of reporting delays (delay from the date that an illness starts to the date the case is reported to the EWRS by the public health authorities).

The proportion of non travel-related cases appears to remain constant over time.
(...)


Age and gender distribution

As shown in table 2, information on age and gender of new influenza virus infection is available for 409 cases, reported by 21 EU, EEA and EFTA countries.

The male-to-female sex ratio is 1.1 (216 males and 193 females).

Six infants less than two years old are reported.

142 children and young adults are between 2 and 20 years old representing 35% of the total number of cases.

One hundred and ninety-five cases (48%) are aged between 20 and 39 and 56 cases are aged between 40 and 59 (14%).

The number of cases aged sixty and above is 10 (2%). The gender ratio does not vary significantly with the age distribution (Figure 3).


Table 2: Age and gender distribution of cases of new influenza A(H1N1) reported by 21 EU, EEA and EFTA countries from 16 April through 2 June 2009

[Female - Male - Total]

• <2: 2 - 4 - 6
• 2_9: 28 - 26 - 54
• 10_19: 42 - 46 - 88
• 20_29: 74 - 83 - 157
• 30_39: 12 - 26 - 38
• 40_49: 21 - 12 - 33
• 50_59: 10 - 13 - 23
• />=60: 4 - 6 - 10
• Total: 193 - 216 - 409

Table 3: Age distribution among travel-related (and not travel-related) cases of new influenza A(H1N1) reported by 21 EU, EEA and EFTA countries from 16 April through 2 June 2009

[Not travel-related - Travel-related - Total]

• <2: 1 - 3 - 4
• 2_9: 33 - 6 - 39
• 10_19: 51 - 27 - 78
• 20_29: 25 - 128 - 153
• 30_39: 4 - 31 - 35
• 40_49: 12 - 18 - 30
• 50_59: 7 - 15 - 22
• />=60: 4 - 7 - 11
• Total: 137 - 235 - 372

(...)


Clinical presentation

The frequency of symptoms reported by the patients is described in table 4.

Data from Spain were not included in this analysis because some re-coding issues still need to be solved for this variable.

For each symptom the denominator is the total number of cases reported in case-based reports of 20 countries (302) and therefore includes asymptomatic cases.

Some symptoms not originally defined in the EWRS dataset were commonly reported in the data from the United Kingdom namely malaise, chills and anorexia.

Therefore they were recoded to ?other? when the data from the United Kingdom were imported to the EWRS.

This partly explains that 25% of the patients were reported with other symptoms.

Some of the symptoms listed in the category ?other? that were less suggestive of ILI or ARI were: abdominal Pain, asthma, confusion for one night, rash, hives towards end of illness, back ache, mouth ulcers, tingling in fingers, cystitis, blurred vision, hallucinations with fever.


[Table 4: Frequency of symptoms (n=302) - Number of cases - %]

• Generalised
  • Fever or history of fever - 263 - 87%
  • Headache - 125 - 41%
  • Muscle pain - 116 - 38%
  • Joint pain - 68 - 23%
• Respiratory
  • Dry cough - 148 - 49%
  • Productive cough - 50 - 17%
  • Sore throat - 149 - 49%
  • Runny nose - 100 - 33%
  • Sneezing - 63 - 21%
  • Shortness of breath - 29 - 10%
• Gastro-intestinal
  • Diarrhoea - 35 - 12%
  • Vomiting - 47 - 16%
  • Nausea - 52 - 17%
• Other
  • Conjunctivitis - 17 - 6%
  • Nose bleed - 7 - 2%
  • Altered consciousness - 1 - 0%
  • Other (various) - 101 - 25%

Treatment and prophylaxis

The number of patients who have been treated with oseltamivir is 205 (49%). One patient received zanamivir and 2 patients received other treatments. No treatment was administered in 29 (7%) patients. The use of an antiviral drug for treatment is unknown in 81 (20%) patients. The information on antiviral treatment was missing for 97 patients (23%).

This information was available for 302 patients.

Only 10 patients have used an antiviral (oseltamivir for 9 and zanamivir for one) drug in the 14 days before onset of illness. No prophylaxis was given to 145 patients (48%).

The information on prophylaxis was unknown in 112 (37%) patients and the number of missing records was 35 (12%).


Pre-existing conditions and complication diagnosis

Information on pre-existing condition was available for 21 patients (missing or unknown for 294 cases). Among these 21 patients, the pre-existing conditions reported were:

• Heart disease for four patients
• HIV for three patients,
• Lung disease for three patients,
• Seizure for two patients,
• Other for nine patients (information available for 8 patients): lodine sensitivity, septicaemia, asthma, beta thalassaemia, high blood pressure, laparotomy, right kidney removed (pre-existing tumor), skin graft.

Information on influenza complications was available from 260 cases (20 countries).

Two hundred and forty-one patients (93%) had no complication.

Three patients (1%) had pneumonia.

Two patients reported an ?other? complication - ?elevated transaminase? and ?use of non-steroidal anti-inflammatory?. The information was unknown in 14 patients (5%).


Vaccination

The information on the vaccination status for seasonal influenza in the previous season is available for 360 cases.

Only 13 patients (4%) were reported to have been vaccinated during the last season. 187 cases (52%) received no vaccination. The vaccination status for seasonal influenza is unknown in 160 (44%) patients.


Transmission and occupational exposure

The information on transmission was reported for 399 cases. The suspected mode of transmission was reported as a contact with a confirmed case within the last seven days in 52 cases (13%).

Two hundred and nine persons (52%) are reported to have been in an area with laboratory confirmed cases of new influenza A(H1N1) virus infection.

The information was unknown in 138 cases (35%).

The information on occupational exposure was supposed to answer the question :?did the person get infected because of his/her occupation?? E.g. was the person exposed as a health care worker?

This information is available for 269 cases.

Twelve patients (4%) are health care workers.

No occupational exposure has been reported in 109 cases (41%).

One hundred and nineteen patients (44%) have been reported with an occupation ?other? (various, including air hostess, employee in an airport duty free shop, pilot).

Among these 119 patients, 106 are reported by the United Kingdom where the data on occupation was designed only to identify health care workers in the light of SARS experience and the possibility of transmission in this group affecting acute services. For cases reported by the United Kingdom, there is not therefore further information available for "other occupation". This variable is currently being reviewed following discussion with the ECDC Advisory Forum.


Laboratory variables

The laboratory method for case confirmation was reported as PCR for 321 cases, culture for two cases, other method for two cases and not available for 90 cases. All cases, but one were reported with the subtype A(H1N1), the exception was reported simply as influenza A.

(...)

-
-----

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 07 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 07 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 26 new cases confirmed from EU and EFTA countries;
• 595 new cases are reported from non EU and EFTA countries;
• Trinidad &Tobago reported yesterday their first 2 cases;
• A set of presentations to support the MS in their communication to policy makers

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 6 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 26 cases were confirmed in six EU and EFTA countries (Table 1).

Germany accounted for the majority of new cases, 14; Austria reported 4 new cases (with one in-country transmission), Denmark 1 case, France 1 case, Ireland 2 cases and The Netherlands 4 cases.

Outside of the EU and EFTA countries, a total of 24,587 cases are currently reported, of which 595 in the last 24 hours (Table 2).

The majority of these newly confirmed cases are from Chile (497: these are delayed reports coming from private clinics)

The total number of reported deaths, 139, has not changed from yesterday.


Assessment and response in the EU and EFTA countries

The number of EU and EFTA countries reporting cases did not change (26 of 31 EU and EFTA countries).

No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


ECDC risk communication aid

ECDC has produced as a resource for Member States a set of materials concerning the new influenza A(H1N1).

They are primarily intended for people who have to explain the developing situation to policy makers and others.

A recent slide-show on this subject is downloadable from the ECDC web-site at http://ecdc.europa.eu/en/Health_top...mics_pandemic_new_A-H1N1_influenza_090602.ppt

More documents will be added to and frequently updated.

Comments are most welcome and encouraged. ECDC would welcome receiving copies of any translations that are made by Member States.

Enquiries, comments and translations should be sent to influenza@ecdc.europa.eu


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 07 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria 4 - 6 - 1
2. Belgium ... - 14 - 4
3. Bulgaria ... - 2 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 2 - ...
6. Denmark 1 - 5 - 1
7. Estonia ... - 3 - 2
8. Finland ... - 4 - ...
9. France 1 - 57 - 2
10. Germany 14 - 63 - 10
11. Greece ... - 5 - ...
12. Hungary ... - 3 - ...
13. Iceland ... - 1 - ...
14. Ireland 2 - 11 - 1
15. Italy ... - 40 - 3
16. Luxembourg ... - 1 - ...
17. Netherlands 4 - 10 - ...
18. Norway ... - 9 - ...
19. Poland ... - 4 - ...
20. Portugal ... - 2 - ...
21. Romania ... - 9 - 5
22. Slovakia ... - 3 - 1
23. Spain ... - 291 - 127
24. Sweden ... - 14 - ...
25. Switzerland ... - 10 - ...
26. United Kingdom ... - 486 - 158

• Total 26 - 1056 - 315

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 06 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt ... - 1 - ...
3. Israel 2 - 41 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia ... - 1
7. Turkey ... - 10 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 2115 - 3
2. Mexico ... - 5717 - 106
3. USA** ... - 13217 - 27

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Barbados ... - 1 - ...
3. Bermuda ... - 1 - ...
4. Cayman Islands ... - 1 - ...
5. Costa Rica ... - 83 - 1
6. Cuba ... - 4 - ...
7. Dominican Republic ... - 44 - 1
8. El Salvador ... - 49 - ...
9. Guatemala ... - 30 - ...
10. Honduras ... - 34 - ...
11. Jamaica ... - 2 - ...
12. Nicaragua ... - 18 - ...
13. Panama ... - 179 - ...
14. Trinidad-Tobago 2 - 2

• SOUTH AMERICA

1. Argentina 28 - 202 - ...
2. Bolivia ... - 3 - ...
3. Brazil 4 - 35 - ...
4. ****Chile 497 - 890 - 1
5. Colombia ... - 24 - ...
6. Ecuador ... - 51 - ...
7. Paraguay ... - 5 - ...
8. Peru ... - 49 - ...
9. Uruguay ... - 21 - ...
10. Venezuela ... - 4 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 5 - 72 - ...
2. Hong Kong SAR 3 - 33 - ...
3. India ... - 4 - ...
4. Japan 10 - 420 - ...
5. Korea (South) ... - 46 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 7 - ...
2. Philippines ... - 33 - ...
3. Singapore 1 - 15 - ...
4. Taiwan ... - 17 - ...
5. Thailand ... - 8 - ...
6. Vietnam ... - 5 - ...

• AUSTRALIA AND PACIFIC

1. Australia 42 - 1051 - ...
2. ***French Polynesia ... - 1 - ...
3. New Zealand 1 - 14 - ...

• TOTAL 595 - 24587 - 139

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.
• (***) The case from French Polynesia was reported by France
• (****) 479 of the new cases reported by Chile correspond to delayed reports from private health sector

(...)

-
------

 

[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 08 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 08 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 108 new cases confirmed from EU and EFTA countries;
• 284 new cases are reported from non EU and EFTA countries;
• The first cases were reported by Martinique (overseas territory France) and Dominica;

This report is based on official information provided by the national public health websites, or through ot he official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 8 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 108 cases were confirmed in nine EU and EFTA countries (Table 1). The majority of the newly reported cases were from the UK (71). Cases were also reported from Italy (10), the Netherlands (10), Switzerland (6), Germany (5), Sweden (2), Denmark (2) and Estonia (1). The first cases of in-country transmission was reported from the Netherlands in two persons who had contact with previously confirmed cases with travel history to the United States.

Outside of the EU and EFTA countries, a total of 24,871 cases are currently reported, of which 284 in the last 24 hours (Table 2). Two new islands in the Caribbean region confirmed their first cases, Martinique and Dominica.


Assessment and response in the EU and EFTA countries

The number of EU and EFTA countries reporting cases did not change (26 of 31 EU and EFTA countries). No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Update on situation in Victoria State, Australia

The new influenza A(H1N1) is now affecting parts of Australia which being in the Southern Hemisphere is approaching its seasonal influenza season. The Australian Pandemic Plan has a distinct series of phases with a formal Delay, Contain, Sustain and Control Phases.

The ?control phase? would be initiated when a pandemic vaccine is available.

Australia has a strong federal structure and health care is organised by State with a coordinating Commonwealth system.

The most affected State is that of Victoria where another 137 cases have been reported during the weekend bringing the total number of cases to 1011, 84% of the total cases in Australia.

With this transmission pattern, the State can pass from Contain into what it calls a modified Sustain Phase of the Australian plan consistent with sustained community outbreaks and transmission. The other Australian states are still in the ?contain? phase. But the authorities there are no longer requiring extensive testing for the new influenza A(H1N1) before offering antivirals.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 08 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 6 - 1
2. Belgium ... - 14 - 4
3. Bulgaria ... - 2 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 2 - ...
6. Denmark 2 - 7 - 1
7. Estonia 1 - 4 - 2
8. Finland ... - 4 - ...
9. France ... - 57 - 2
10. Germany 5 - 68 - 10
11. Greece ... - 5 - ...
12. Hungary ... - 3 - ...
13. Iceland ... - 1 - ...
14. Ireland ... - 11 - 1
15. Italy 10 - 50 - 3
16. Luxembourg ... - 1 - ...
17. Netherlands 10 - 20 - 2
18. Norway ... - 9 - ...
19. Poland 1 - 5 - ...
20. Portugal ... - 2 - ...
21. Romania ... - 9 - 5
22. Slovakia ... - 3 - 1
23. Spain ... - 291 - 127
24. Sweden 2 - 16 - ...
25. Switzerland 6 - 16 - ...
26. United Kingdom 71 - 557 - 158

• Total 108 - 1164 - 314

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 08 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt ... - 1 - ...
3. Israel 13 - 54 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia 1 - 2 - ...
7. Turkey ... - 10 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 2115 - 3
2. Mexico ... - 5717 - 106
3. **USA ... - 13217 - 27

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Barbados 1 - 2 - ...
3. Bermuda ... - 1 - ...
4. Cayman Islands ... - 1 - ...
5. Costa Rica ... - 83 - 1
6. Cuba 1 - 5 - ...
7. Dominica 1 - 1 - ...
8. Dominican Republic ... - 44 - 1
9. El Salvador 20 - 69 - ...
10. Guatemala ... - 30 - ...
11. Honduras ... - 34 - ...
12. Jamaica 2 - 4 - ...
13. Martinique 1 - 1 - ...
14. Nicaragua ... - 18 - ...
15. Panama ... - 179 - ...
16. Trinidad-Tobago ... - 2 - ...

• SOUTH AMERICA

1. Argentina 13 - 215 - ...
2. Bolivia ... - 3 - ...
3. Brazil 1 - 36 - ...
4. ****Chile ... - 890 - 1
5. Colombia 1 - 25 - ...
6. Ecuador 9 - 60 - ...
7. Paraguay ... - 5 - ...
8. Peru 12 - 61 - ...
9. Uruguay 3 - 24 - ...
10. Venezuela ... - 4 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 8 - 80 - ...
2. Hong Kong SAR 5 - 38 - ...
3. India ... - 4 - ...
4. Japan 12 - 432 - ...
5. Korea (South) 1 - 47 - ...
6. Taiwan 2 - 19 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 7 - ...
2. Philippines 13 - 46 - ...
3. Singapore ... - 15 - ...
4. Thailand 1 - 9 - ...
5. Vietnam 4 - 9 - ...

• AUSTRALIA AND PACIFIC

1. Australia 156 - 1207 - ...
2. ***French Polynesia ... - 1 - ...
3. New Zealand 3 - 17 - ...

• TOTAL 284 - 24871 - 139

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.
• (***) The case from French Polynesia was reported by France
• (****) 479 of the new cases reported by Chile correspond to delayed reports from private health sector

(...)

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[Giuseppe]

Re: European Centre of Diseases Control and Prevention (ECDC), Updates, Statements, News

Influenza A(H1N1) infection - Update 09 June 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1) infection - Update 09 June 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 184 new cases confirmed from EU and EFTA countries;
• 527 new cases are reported from non EU and EFTA countries;
• No new country reported its first confirmed cases;

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 9 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

In the past 24 hours, 184 cases were confirmed in eight EU and EFTA countries (Table 1).

The majority of the newly reported cases were from the UK (118).

Cases were also reported from Spain (40), France (11), Germany (10), Norway (2), Denmark (1), Iceland (1) and Poland (1).

Outside of the EU and EFTA countries, a total of 25,396 cases are currently reported, of which 527 in the last 24 hours (Table 2).


Assessment and response in the EU and EFTA countries

The number of EU and EFTA countries reporting cases did not change (26 of 31 EU and EFTA countries).

No sustained community transmission has yet been declared from EU and EFTA countries and the assessment for the EU and EFTA countries does not change.

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.


Global epidemiological investigations

There is an increasing need to learn more on the epidemiology of the novel influenza A (H1N1) virus as this will affect decisions on various aspects of clinical management, community mitigation, and vaccination strategies. A international Epidemiology working group on new A(H1N1) was convened by WHO and a first teleconference was held today.

The main objective was to facilitate the conduction of epidemiological investigations worldwide and to allow rapid sharing of findings as the epidemic evolves. In order to achieve these objectives a common online platform will be developed where both information from the epidemiological investigations and investigation tools such us study protocols can be shared.

The group is composed by national and international public health agencies including ECDC and will operate through regular teleconferences and face-to-face meetings.


Table 1: Reported cumulative number of confirmed cases and of in-country transmission of influenza A(H1N1) as of 09 June 2009, 17:00 hours (CEST) in EU and EFTA countries

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

1. Austria ... - 6 - 1
2. Belgium ... - 14 - 4
3. Bulgaria ... - 2 - ...
4. Cyprus ... - 1 - ...
5. Czech Republic ... - 2 - ...
6. Denmark 1 - 8 - 2
7. Estonia ... - 4 - 2
8. Finland ... - 4 - ...
9. France 11 - 68 - 8
10. Germany 10 - 78 - 10
11. Greece ... - 5 - ...
12. Hungary ... - 3 - ...
13. Iceland 1 - 2 - ...
14. Ireland ... - 11 - 1
15. Italy ... - 50 - 3
16. Luxembourg ... - 1 - ...
17. Netherlands ... - 20 - 2
18. Norway 2 - 11 - ...
19. Poland 1 - 6 - ...
20. Portugal ... - 2 - ...
21. Romania ... - 9 - 5
22. Slovakia ... - 3 - 1
23. Spain 40 - 331 - 127
24. Sweden ... - 16 - ...
25. Switzerland ... - 16 - ...
26. United Kingdom 118 - 675 - 291

• Total 184 - 1348 - 457

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1) as of 09 June 2009, 17:00 hours (CEST) outside of the EU and EFTA area

[Country - Confirmed cases reported in the last 24h - Cumulative number of confirmed cases - Deaths among confirmed cases*]

• EASTERN EUROPE AND CENTRAL ASIA

1. Russian Federation ... - 3 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Bahrain ... - 1 - ...
2. Egypt 2 - 3 - ...
3. Israel ... - 54 - ...
4. Kuwait ... - 18 - ...
5. Lebanon ... - 3 - ...
6. Saudi Arabia ... - 2 - ...
7. Turkey ... - 10 - ...
8. United Arab Emirates ... - 1 - ...

• NORTH AMERICA

1. Canada 331 - 2446 - 4
2. Mexico ... - 5717 - 106
3. **USA ... - 13217 - 27

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 1 - ...
2. Barbados ... - 2 - ...
3. Bermuda ... - 1 - ...
4. Cayman Islands ... - 1 - ...
5. Costa Rica 10 - 93 - 1
6. Cuba ... - 5 - ...
7. Dominica 1 - 1 - ...
8. Dominican Republic 28 - 72 - 1
9. El Salvador ... - 69 - ...
10. Guatemala 20 - 50 - ...
11. Honduras ... - 34 - ...
12. Jamaica 3 - 7 - ...
13. Martinique 1 - 1 - ...
14. Nicaragua 8 - 26 - ...
15. Panama 21 - 200 - ...
16. Trinidad-Tobago ... - 2 - ...

• SOUTH AMERICA

1. Argentina 20 - 235 - ...
2. Bolivia ... - 3 - ...
3. Brazil ... - 36 - ...
4. ****Chile ... - 890 - 1
5. Colombia ... - 25 - ...
6. Ecuador ... - 60 - ...
7. Paraguay ... - 5 - ...
8. Peru ... - 61 - ...
9. Uruguay 3 - 27 - ...
10. Venezuela 8 - 12 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 9 - 89 - ...
2. Hong Kong SAR 3 - 41 - ...
3. India ... - 4 - ...
4. Japan 25 - 457 - ...
5. Korea (South) 1 - 48 - ...
6. Taiwan 2 - 21 - ...

• SOUTH-EAST ASIA

1. Malaysia ... - 7 - ...
2. Philippines 8 - 54 - ...
3. Singapore 2 - 17 - ...
4. Thailand ... - 9 - ...
5. Vietnam 2 - 11 - ...

• AUSTRALIA AND PACIFIC

1. Australia 17 - 1224 - ...
2. ***French Polynesia ... - 1 - ...
3. New Zealand 2 - 19 - ...

• TOTAL 527 - 25396 - 140

• Note: cases reported in non-EU and EFTA countries correspond to cases published on Ministry of Health websites, or through WHO, or through credible media source quoting national authorities. Therefore, some of these cases may be taken out at a later stage if not validated.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.
• (***) The case from French Polynesia was reported by France
• (****) 479 of the new cases reported by Chile correspond to delayed reports from private health sector

(...)

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