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

[Giuseppe]

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 55 new cases were reported in EU and EFTA countries;
• 1,401 new cases were reported from non-EU and EFTA countries;
• The total number of fatal cases worldwide is 324;
• 4 new fatal cases have been reported from non-EU and EFTA countries: Australia (2), Thailand (1) and Brazil (1);
• Denmark health authorities are reporting today an isolated case of oseltamivir resistance.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 29 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

The number of EU and EFTA countries reporting cases is 29 out of 31. In the past 24 hours, 55 new cases were confirmed in 11 EU and EFTA countries (Table1).

• The cumulative number of cases in the EU and EFTA countries is now 6,173, including two deaths.

Denmark health authorities have reported today one case of oseltamivir-resistant A(H1N1)v influenza virus (29. juni 2009 - Resistens hos pandemisk influenza A H1N1v p?vist i Danmark).

This is an isolated case, part of a cluster of cases investigated. No additional cases have been identified through extensive contact tracing.

Outside of the EU and EFTA countries, a total of 66,980 cases, including 322 deaths, have been reported, representing an increase of 1,401 from yesterday (Table 2).

There were 4 new deaths since the last report.


WHO guidance documents

Pandemic preparedness and response

• Pandemic influenza preparedness and mitigation in refugee and displaced populations - WHO guidelines for humanitarian agencies, 28 April 2009
  • The impact of a novel pandemic influenza virus on refugee and displaced populations is expected to be severe. This document provides background information on pandemic influenza, describes WHO pandemic phases and strategies to deal with a pandemic according to phase, and outlines preparedness activities needed during the pre-pandemic period. These practical field-based guidelines are intended for use by humanitarian agencies, e.g. non-governmental organizations (NGOs), UN organizations coordinating these services, and donor agencies providing financial support for the populations concerned.

• Reducing excess mortality from common illnesses during an influenza pandemic, 28 April 2009
  • This document aims to provide strategies for prevention and treatment, at the community and household levels, of the most likely contributors to mortality from common illnesses during an influenza pandemic. It also tries to provide recommendations to support a minimum level of continuity for priority public health programmes during a pandemic. These guidelines are designed primarily for community-level programming in resource-poor settings (urban, semi-urban and rural) but are applicable to a wide range of situations.

• Pandemic influenza preparedness and response, 25 April 2009
  • Since 2005, there have been advances in many areas of preparedness and response planning. For example, stockpiles of antiviral drugs are now a reality and a WHO guideline has been developed to attempt to stop or delay pandemic influenza at its initial emergence. There is increased understanding of past pandemics, strengthened outbreak communications, greater insight on disease spread and approaches to control, and increasingly sophisticated statistical modelling of various aspects of influenza. Extensive practical experience has been gained from responding to outbreaks of highly pathogenic avian influenza A (H5N1) virus infection in poultry and humans, and from conducting pandemic preparedness and response exercises in many countries. There is greater understanding that pandemic preparedness requires the involvement of not only the health sector, but the whole of society. In 2007, the International Health Regulations (2005) (IHR, 2005) entered into force providing the international community with a framework to address international public health concerns. In light of these developments, WHO decided to update its guidance to enable countries to be better prepared for the a new pandemic, which now it will prove to be useful for the current influenza A(H1N1)v virus pandemic.

WHO Meeting reports

• Summary report of a High-Level Consultation: new influenza A (H1N1), 22 May 2009
  • The Director-General of the World Health Organization convened a high level consultation for all Member States at the start of the sixty-second World Health Assembly, in view of the threat posed by the current outbreak of influenza A (H1N1)v virus. The consultation provided an opportunity for Member States to share experiences, to discuss lessons learnt, and to highlight the challenges that now confront the world community.

• Recommendations of the Strategic Advisory Group of Experts (SAGE) on Influenza A (H1N1) vaccines, 19 May 2009
  • The SAGE Working Group met by telephone conference on 14 May 2009 to in order to review current evidence on influenza A (H1N1)v virus infection and potential vaccine options; to review the current status of seasonal vaccine production and potential A (H1N1)v production capacity; and to discuss timing of a potential recommendation to initiate commercial scale production of A (H1N1)v vaccine.

• WHO Technical Consultation on the Severity of Disease Caused by the new influenza A (H1N1) virus infections 6 May 2009
  • On 5 May 2009, WHO convened a technical consultation via teleconference to assess current knowledge about the severity of disease caused by influenza A(H1N1)v infection and the implications this might have. WHO also sought data on the clinical spectrum and patterns of the disease and how this compares with what is seen during epidemics of seasonal influenza. Information was provided by epidemiologists, clinicians, and virologists from Canada, Mexico, Spain, the United Kingdom and the US. In addition, international experts advised WHO during the consultation.

• WHO ad hoc scientific teleconference on the current influenza A(H1N1) situation, 4 May 2009
  • On 29 April 2009, WHO hosted a teleconference that included more than one hundred participants from all of the WHO Regions. The objectives of the teleconference were to gain a better understanding of the situation in affected countries; to update and share preliminary epidemiological, clinical and virological information; and to identify key knowledge gaps needed to address immediate public health questions.

Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 29 June 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 12 - ...
2. Belgium 2 - 43 - ...
3. Bulgaria 3 - 10 - ...
4. Cyprus 5 - 25 - ...
5. Czech Republic ... - 9 - ...
6. Denmark ... - 44 - ...
7. Estonia ... - 13 - ...
8. Finland ... - 27 - ...
9. France ... - 239 - ...
10. Germany 22 - 388 - ...
11. Greece 15 - 88 - ...
12. Hungary ... - 8 - ...
13. Iceland ... - 4 - ...
14. Ireland 2 - 39 - ...
15. Italy ... - 102 - ...
16. Latvia ... - 1
17. Lithuania ... - 1
18. Luxembourg 1 - 4 - ...
19. Netherlands ... - 118 - ...
20. Norway 1 - 25 - ...
21. ***Poland ... - 14 - ...
22. Portugal 2 - 13 - ...
23. Romania 1 - 25 - ...
24. Slovakia ... - 9 - ...
25. Slovenia ... - 4 - ...
26. Spain ... - 541 - ...
27. Sweden 1 - 68 - ...
28. Switzerland ... - 49 - ...
29. United Kingdom ... - 4250 - 2

• Total 55 - 6173 - 2

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 28 June 17:00 hours and 29 June 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) This case patient is an USA citizen who was confirmed and hospitalized while travelling in Poland

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

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

• EASTERN EUROPE AND CENTRAL ASIA

1. Montenegro ... - 1 - ...
2. Serbia ... - 5
3. Russian Federation ... - 3 - ...
4. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 2 - ...
2. Bahrain ... - 15 - ...
3. Egypt 11 - 61 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 10 - ...
6. Israel 79 - 454 - ...
7. Jordan 3 - 18 - ...
8. Kuwait ... - 26 - ...
9. Lebanon ... - 25 - ...
10. Morocco ... - 9 - ...
11. Occupied Palestinian Territory ... - 9 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia 7 - 69 - ...
15. Tunisia ... - 2
16. Turkey ... - 26 -...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 6 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 2
3. Ivory Coast ... - 2
4. South Africa ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 7775 - 21
2. Mexico ... - 8617 - 116
3. **USA ... - 27717 - 127

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2
2. Bahamas ... - 4
3. Barbados ... - 10 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 1 - ...
6. Cayman Islands ... - 9 - ...
7. Costa Rica ... - 222 - 1
8. Cuba ... - 46 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 226 - ...
12. Guatemala ... - 262 - 2
13. Honduras ... - 119 - 1
14. Jamaica ... - 19 - ...
15. ***Martinique ... - 2 - ...
16. ****Netherlands Antilles ... - 4 - ...
17. Nicaragua ... - 277 - ...
18. Panama ... - 403 - ...
19. Suriname ... - 11 - ...
20. Trinidad-Tobago ... - 25 - ...

• SOUTH AMERICA

1. Argentina ... - 1587 - 26
2. Bolivia ... - 59 - ...
3. Brazil ... - 591 - 1
4. Chile ... - 6211 - 12
5. Colombia 7 - 80 - 2
6. Ecuador ... - 125 - ...
7. Paraguay ... - 79 - ...
8. Peru ... - 506 - ...
9. Uruguay ... - 195 - ...
10. Venezuela .. - 153 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 7 - ...
2. China 159 - 729 - ...
3. Hong Kong SAR 130 - 726 - ...
4. India ... - 80 - ...
5. Japan ... - 1049 - ...
6. Korea (South) 60 - 202 - ...
7. Macao 5 - 18 - ...
8. Sri Lanka ... - 8 - ...
9. Taiwan ... - 61 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 18 - 29 - ...
2. Cambodia 1 - 6
3. Indonesia 6 - 8
4. Laos PDR ... - 3
5. Malaysia 343 - 411 - ...
6. Myanmar ... - 1
7. Philippines ... - 861 - 1
8. Singapore 234 - 599 - ...
9. Thailand ... - 1209 - 3
10. Vietnam 54 - 117 - ...

• AUSTRALIA AND PACIFIC

1. *****Australia 210 - 4031 - 7
2. Fiji 8 - 10
3. ***French Polynesia ... - 2 - ...
4. New Zealand 66 - 589 - ...
5. Papua New Guinea ... - 1 - ...
6. Samoa ... - 1 - ...
7. Vanuatu ... - 2

• TOTAL 1401 - 66980 - 322

• 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.
• (a) Cases reported between 28 June 17:00 hours and 29 June 17:00 hours
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico.
• (***) The cases in Martinique and French Polynesia were reported by France
• (****) Three of the cases are reported to occur in a cruise ship in Curacao.
• (*****) One Australian case reported from a cruise ship.

(...)

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[Giuseppe]

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 2,006 new cases were reported in EU and EFTA countries, including 1,687 reported by UK;
• 990 new cases were reported from non-EU and EFTA countries;
• The total number of fatal cases worldwide is 330;
• First fatal case in Spain;
• 5 new fatal cases have been reported from non-EU and EFTA countries: Canada (4), Uruguay (1);
• ECDC prepared an assessment of the oseltamivir resistance identified in Denmark yesterday.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 30 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

The number of EU and EFTA countries reporting cases is 29 out of 31. In the past 24 hours, 2,006 new cases were confirmed in 18 EU and EFTA countries (Table1).

The cumulative number of cases in the EU and EFTA countries is now 8,179.

Spain reported first death: 20 years old pregnant woman from Morocco with the history of asthma died after delivering a baby. The baby is in good condition.

The cumulative number of fatal cases in the EU and EFTA countries is now 3.

Outside of the EU and EFTA countries, a total of 68,050 cases, including 327 deaths, have been reported, representing an increase of 990 from yesterday (Table 2). There were 5 new deaths since the last report.


ECDC prepared and assessment of the public health risk associated with the identification of a secondary resistance to oseltamivir, identified in Denmark yesterday. The document is annexed to this situation report.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 30 June 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 3 - 15 - ...
2. Belgium 1 - 44 - ...
3. Bulgaria ... - 10 - ...
4. Cyprus 23 - 48 - ...
5. Czech Republic ... - 9 - ...
6. Denmark 3 - 47 - ...
7. Estonia ... - 13 - ...
8. Finland 9 - 36 - ...
9. France 49 - 288 - ...
10. Germany 29 - 417 - ...
11. Greece 4 - 92 - ...
12. Hungary 2 - 10 - ...
13. Iceland ... - 4 - ...
14. Ireland 2 - 41 - ...
15. Italy ... - 102 - ...
16. Latvia ... - 1
17. Lithuania ... - 1
18. Luxembourg ... - 4 - ...
19. Netherlands ... - 118 - ...
20. Norway ... - 25 - ...
21. ***Poland 1 - 15 - ...
22. Portugal 4 - 17 - ...
23. Romania 3 - 28 - ...
24. Slovakia 4 - 13 - ...
25. Slovenia ... - 4 - ...
26. Spain 176 - 717 - 1
27. Sweden 1 - 69 - ...
28. Switzerland 5 - 54 - ...
29. ****United Kingdom 1,687 - 5,937 - 2

• Total 2,006 - 8,179 - 3

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 29 June 17:00 hours and 30 June 17:00 hours.
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) This case patient is an USA citizen who was confirmed and hospitalized while travelling in Poland
• (***) Cases confirmed between 27th and 29th of June

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

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

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Monaco 1 - 1 - ...
2. Montenegro ... - 1
3. Serbia ... - 5 - ...
4. Russian Federation ... - 3 - ...
5. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria 3 - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 61 - ...
4. Iran ... - 1 - ...
5. Iraq 1 - 11 - ...
6. Israel ... - 454 - ...
7. Jordan 2 - 20 - ...
8. Kuwait 7 - 33 - ...
9. Lebanon 14 - 39 - ...
10. Morocco 7 - 16 - ...
11. Occupied Palestinian Territory 4 - 13 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia 6 - 75 - ...
15. Tunisia ... - 2
16. Turkey ... - 26 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 6 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 2
3. Ivory Coast ... - 2
4. South Africa ... - 1 - ...

• NORTH AMERICA

1. Canada 208 - 7,983 - 25
2. Mexico ... - 8,617 - 116
3. **USA 8 - 27,725 - 127

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2
2. Bahamas ... - 4
3. Barbados ... - 10 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 1 - ...
6. Cayman Islands ... - 9 - ...
7. Costa Rica 33 - 255 - 1
8. Cuba ... - 46 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 226 - ...
12. Guatemala ... - 262 - 2
13. Honduras ... - 119 - 1
14. Jamaica 13 - 32 - ...
15. ***Martinique ... - 2 - ...
16. ****Netherlands Antilles 3 - 7 - ...
17. Nicaragua ... - 277 - ...
18. Panama ... - 403 - ...
19. Saint Lucia 1 - 1
20. Suriname ... - 11 - ...
21. Trinidad-Tobago 28 - 53 - ...

• SOUTH AMERICA

1. Argentina ... - 1587 - 26
2. Bolivia 67 - 126 - ...
3. Brazil 36 - 627 - 1
4. Chile ... - 6,211 - 12
5. Colombia 8 - 88 - 2
6. Ecuador 15 - 140 - ...
7. Paraguay 17 - 96 - ...
8. Peru 43 - 549 - ...
9. Uruguay ... - 195 - 1
10. Venezuela 40 - 193 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 7 - ...
2. China 37 - 766 - ...
3. Hong Kong SAR ... - 726 - ...
4. India ... - 80 - ...
5. Japan 158 - 1,287 - ...
6. Korea (South) ... - 202 - ...
7. Macao 2 - 20 - ...
8. Nepal 3 - 3
9. Sri Lanka ... - 8 - ...
10. Taiwan ... - 61 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 29 - ...
2. Cambodia ... - 6
3. Indonesia ... - 8
4. Laos PDR ... - 3
5. Malaysia ... - 411- ...
6. Myanmar ... - 1
7. Philippines ... - 861 - 1
8. Singapore 102 - 701 - ...
9. Thailand ... - 1,209 - 3
10. Vietnam ... - 117 - ...

• AUSTRALIA AND PACIFIC

1. *****Australia 59 - 4,090 - 7
2. Fiji ... - 10
3. ***French Polynesia ... - 2 - ...
4. New Zealand 64 - 653 - ...
5. Papua New Guinea ... - 1 - ...
6. Samoa ... - 1 - ...
7. Vanuatu ... - 2

• TOTAL 990 - 68,050 - 327

• 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.
• (a) Cases reported between 29 June 17:00 hours and 30 June 17:00 hours
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico and American Samoa
• (***) The cases in Martinique and French Polynesia were reported by France
• (****) Three of the cases are reported to occur in a cruise ship in Curacao.
• (*****) One Australian case reported from a cruise ship.

(...)


ECDC Threat Assessment

First isolation of a secondary oseltamivir - resistant A(H1N1)v strain in Denmark, 29 June, 2009

SOURCE: Internal request following a EWRS message from Denmark health authorities
PUBLIC HEALTH ISSUE: Isolation of a mutant A(H1N1)v virus containing a genetic marker of resistance to oseltamivir.
CONSULTED EXPERTS: Internal experts

EVENT BACKGROUND INFORMATION:

Event reported by Danish EWRS Focal point on 29 July 2009 :

In the context of tracing contacts of a cluster of 3 imported cases in Denmark, a female contact who initially tested negative on PCR, was given prophylaxis with oseltamivir (75 mg per day). Five days later, despite reportedly having complied with treatment, she developed flu-like symptoms and was tested positive for A(H1N1)v. Sequencing of the virus showed a single mutation H275Y (H274Y in N2 nomenclature) in the neuraminidase gene. The presence of the resistance marker and the phenotypic (in vitro) resistance was confirmed by a WHO collaborating Centre. The virus is not a re-assortant and is presumed to remain susceptible to zanamivir (another neuraminidase inhibitor). All other virus isolated as part of this cluster investigation, including the presumed source patient, did not show the mutation.


ECDC THREAT ASSESSMENT FOR THE EU

The A(H1N1)v virus related to the ongoing pandemic has always be found sensitive to oseltamivir and zanamivir and resistant to adamantanes (M2 blockers). This is the first observation of a genetic marker of resistance to oseltamivir in a A(H1N1)v virus.

The mutation consists of the substitution of histidine to tyrosine at amino acid position 275 in the neuraminidase segment gene (position 274 in N2 nomenclature). This mutation has been described in the past, associated with secondary resistance to oseltamivir acquired during treatment. This was documented some years back in children in Japan where the drug was used more commonly than in Europe(1). The mutation was detected in up to 16% of oseltamivir-treated children in Japan, perhaps associated with under-dosing(2). Studies have shown that the virus containing this mutation is unfit in terms of transmissibility(3) and possibly also in terms of pathogenicity(4) as demonstrated in animal studies. Therefore, such mutation is of limited public health concern since it has not resulted in the past in a virus that demonstrated sustained person-to-person transmission.

According to the available epidemiological and virological data, this reported event in Denmark is almost certainly secondary resistance acquired during post-exposure prophylaxis. This is supported by the time sequence and the absence of similar genotypic markers in viruses isolated in the other cases of the cluster.

There is no evidence in this case that the isolated resistant virus has transmitted to other persons, meaning that the risk of spread of a resistant virus is nearly zero. It is however likely that such mutation will be observed again in the future. This observation does highlight the increased likelihood of such event arising from widespread use of anti-virals especially in prophylaxis.

Secondary resistance, arising due to treatment, must not be confused with more complex mutations including the H274Y substitution resulting from primary resistance. Such primary resistance was first observed in seasonal A(H1N1) influenza virus in the 2007-2008. It spread worldwide generally displacing other seasonal A(H1N1) viruses (98% resistance in EU in 2008-2009)(5). Following that phenomenon some EU countries have diversified their anti-virals stockpiles adding zanamivir to oseltamivir.

There is always a theoretical risk of re-assortment of A(H1N1)v with primary resistant seasonal viruses notably the seasonal influenza virus A(H1N1) containing the H274Y mutation.


CONCLUSIONS AND RECOMMENDATIONS

The emergence of secondary resistance while on antiviral treatment is a well recognised phenomenon in influenza viruses. As in the past, there is no evidence the mutation has led to a virus capable of transmitting from person to person. Therefore, though resistant viruses are always a concern, the emergence of A(H1N1)v resistant to oseltamivir does not represent a public health threat. It can be expected to happen again.

Surveillance of genetic resistance for detecting early primary resistance is of particular importance for the future course of the pandemic

CONTACT: support@ecdc.europa.eu


References

(1) Whitley RJ, Hayden FG, Reisinger K, Young N, Dutkowski R, Ipe D, et al. Oral oseltamivir treatment of influenza in children. Ped Infect Dis J 2001; 20(2):127-33.
(2) Ward P, Small I, Smith J, Suter P, Dutkowski R. Oseltamivir (Tamiflu(R)) and its potential for use in the event of an influenza pandemic. J Antimicrob Chemother 2005; 55(suppl_1): i5-21.
(3) Compromised transmission: Herlocher ML, Truscon R, Elias S; et al. Influenza viruses resistant to the antiviral drug oseltamivir: transmission studies in ferrets. J Infect Dis. 2004;190(9):1627-30
(4) Attenuated pathogenicity: Ives JA, Carr JA, Mendel DB; et al. The H274Y mutation in the influenza A/H1N1 neuraminidase active site following oseltamivir phosphate treatment leave virus severely compromised both in vitro and in vivo. Antiviral Res. 2002; 55(2): 307-17
(5) Meijer A, Lackenby A, Hungnes O, Lina B, van der Werf S, Schweiger B, et al. Oseltamivir-resistant influenza A (H1N1) virus, Europe, 2007?08 season. Emerg Infect Dis. 2009; 15(4):552-60

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[german-docter]

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

ECDC INTERIM GUIDANCE
Public health use of influenza antivirals
during influenza pandemics

Stockholm, June 2009 [release July 1, 2009]

full text:
http://www.ecdc.europa.eu/en/files/...enza_Antivirals_during_Influenza_Pandemic.pdf

(?)

This evidence indicates that certain antiviral drugs, particularly the neuraminidase inhibitors (oseltamivir and zanamivir), offer some treatment benefits by reducing the duration of illness from influenza usually by 1?2 days and also reducing complications and the need for antibiotics in infected individuals. This effect is limited by the need for the drugs to be given early (within 48 hours of the start of symptoms). There is also some weak evidence from observational studies that the drugs might reduce morbidity and even mortality in sicker patients even if given later than the 48 hours.
Trials in healthy adults suggest infection can be prevented with prophylaxis treatment with a 70% to 90% effectiveness rate provided the drug is taken as prescribed.
(?)

Currently the antiviral stockpiles in European countries seem to vary from coverage of a few per cent of the population to more than 50% of the population. However, even with stockpiles in place it is almost inevitable that demand for antiviral drugs will outweigh supply in a pandemic. Because of this, it is important that advanced strategic and logistical planning is carried out to optimise the usefulness of existing stockpiles. An important general principle is that having stockpiles is of limited use without the agreed objectives, protocols, administration and delivery systems to go with them.

(?)

Based on the available evidence ECDC suggests the following prioritisation strategy for antiviral use:

1 People with more severe disease. The first priority is to treat people with more severe influenza illness even if they are beyond the 48hour ?window? following the start of symptoms when it is considered that antivirals are effective. However, for these patients it is even more important that there are adequate supplies of appropriate antibiotics available to treat secondary infections, and other essential drugs.

2 People most at risk of severe disease. Among these, priority could be given to those most at risk of developing severe disease. For seasonal influenza these are those for whom seasonal influenza vaccination is recommended: older people, those with pre-existing chronic conditions, and healthcare workers with direct patient contact. However, this may need to be modified during a pandemic to reflect those most at risk from the pandemic strain*. When both pandemic and seasonal viruses are circulating the seasonal and pandemic higher-risk groups will need to be combined. Some countries may want to consider giving prophylaxis in households containing people at higher risk though this would be a complicated policy to implement.

3 All people just starting an illness. After the more severe cases antivirals could be prioritised for people just starting their illness (within 48 hours of the first symptoms) because that is when these drugs are most effective.
4 Use for prophylaxis. Countries with larger stocks of antivirals can consider giving them also for prophylaxis. Candidate groups are: close contacts of cases, family contacts, and key workers for business continuity purposes. Home stockpiles are not recommended as supplies are limited though inevitably some people can be expected to request these from their doctors as they did with bird flu.

5 Healthcare workers with direct patient contact are a special case. They need to have reasonable protection with personal protective equipment. Should they become sick they need to receive antivirals promptly and to stay home from work. Countries with larger stocks may consider prophylaxis for certain groups of these workers.

Even greater challenges are posed by the organisational aspects of antiviral delivery. Namely the evidence indicating that antiviral treatment may only deliver its limited benefits if it is given within the first 48 hours following the start of symptoms. This will be particularly critical during a pandemic. Hence, for antivirals to be effective in treating infection, resources should also be put in place to develop protocols and systems to ensure their rapid delivery and administration. (...)

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 2 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 2 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 563 new cases were reported in EU and EFTA countries, including 391 reported by UK;
• 3632 new cases were reported from non-EU and EFTA countries;
• Three countries report cases for the first time: Malta, Palau and Bosnia and Herzegovina;
• The total number of fatal cases worldwide is 343;
• The latest analysis of individual case reports in the EU/EEA countries is now available;
• The UK adapts its response strategy, acknowledging that containment of the virus is no longer possible.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 2 July, 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

With Malta reporting its first confirmed cases of influenza A(H1N1)v, 30 out of the 31 EU and EFTA countries are now reporting cases. In the past 24 hours, 563 new cases were confirmed in 20 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 9453, including 4 deaths.

Malta confirmed the first two cases in the country. According to media reports, both have a history of travel to Spain.

Outside of the EU and EFTA countries, a total of 3632 new cases, including 7 deaths, have been reported, reaching a total of 81,700 cases (Table 2). This includes both Bosnia and Herzegovina and Palau, which reported their first case each in the past 24 hours.

The UK announced that the country has changed its response strategy, acknowledging that containment of the virus is no longer possible. The change implies that treatment will no longer be given to the close contacts of those infected. Moreover, laboratory testing will no longer be done to confirm all cases, relieving the pressure on the health system. Patients with uncomplicated symptoms will be asked to stay at home.

The analysis of influenza A(H1N1)v individual case reports in the EU and EEA countries has been updated as of 29 June. The results can be found at the end of this report, as well as on ECDC?s website: http://www.ecdc.europa.eu/en/Health_topics/novel_influenza_virus/2009_Outbreak/


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 02 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 15 - ...
2. Belgium 2 - 49 - ...
3. Bulgaria ... - 10 - ...
4. Cyprus ... - 58 - ...
5. Czech Republic 5 - 15 - ...
6. Denmark 2 - 57 - ...
7. Estonia ... - 13 - ...
8. Finland 4 - 43 - ...
9. France 23 - 311 - ...
10. Germany 41 - 470 - ...
11. Greece 11 - 109 - ...
12. Hungary ... - 11 - ...
13. Iceland ... - 4 - ...
14. Ireland 8 - 49 - ...
15. Italy 7 - 130 - ...
16. Latvia ... - 1 - ...
17. Lithuania 2 - 3 - ...
18. Luxemburg ... - 4 - ...
19. Malta 2 - 2 - ...
20. Netherlands 4 - 134 - ...
21. Norway 1 - 41 - ...
22. Poland 4 - 19 - ...
23. Portugal 5 - 23 - ...
24. Romania ... - 36 - ...
25. Slovakia 4 - 18 - ...
26. Slovenia ... - 4 - ...
27. Spain 39 - 756 - 1
28. Sweden 1 - 74 - ...
29. Switzerland 7 - 65 - ...
30. United Kingdom 391 - 6929 - 3

• Total 563 - 9453 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 1 July 17:00 hours and 2 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 02 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina 1 - 1 - ...
2. Channel Islands ... - 13 - ...
3. Island of Man ... - 1 - ...
4. Monaco ... - 1 - ...
5. Montenegro 5 - 9 - ...
6. Russian Federation ... - 3 - ...
7. Serbia 1 - 13 - ...
8. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 67 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 11 - ...
6. Israel 36 - 542 - ...
7. Jordan 2 - 22 - ...
8. Kuwait ... - 34 - ...
9. Lebanon 8 - 47 - ...
10. Morocco ... - 17 - ...
11. Occupied Palestinian Territory 17 - 30 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia ... - 81 - ...
15. Tunisia ... - 3 - ...
16. Turkey 5 - 37 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 7 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 2 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 1 - ...
5. Mauritius ... - 7 - ...
6. South Africa 10 - 11 - ...

• NORTH AMERICA

1. Canada ... - 7983 - 25
2. Mexico 348 - 9028 - 119
3. ***USA ... - 27725 - 127

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Bahamas ... - 6 - ...
3. Barbados ... - 10 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 1 - ...
6. Cayman Islands ... - 13 - ...
7. Costa Rica ... - 279 - 2
8. Cuba ... - 46 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 226 - ...
12. Guatemala ... - 262 - 2
13. Honduras 4 - 123 - 1
14. Jamaica ... - 32 - ...
15. Martinique ... - 2 - ...
16. Netherlands Antilles ... - 14 - ...
17. Nicaragua ... - 310 - ...
18. Panama ... - 417 - ...
19. Suriname ... - 11 - ...
20. Trinidad-Tobago ... - 53 - ...

• SOUTH AMERICA

1. Argentina ... - 1587 - 26
2. Bolivia ... - 205 - ...
3. Brazil ... - 680 - 1
4. Chile 1165 - 7376 - 14
5. Colombia ... - 93 - 2
6. Ecuador ... - 163 - ...
7. Paraguay 4 - 100 - ...
8. Peru ... - 549 - ...
9. Uruguay ... - 196 - 1
10. Venezuela ... - 194 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 7 - ...
2. China (mainland) 57 - 867 - ...
3. Hong Kong SAR China 43 - 828 - ...
4. India ... - 104 - ...
5. Japan 70 - 1354 - ...
6. Macao SAR China 8 - 34 - ...
7. Nepal ... - 3 - ...
8. South Korea ... - 210
9. Sri Lanka ... - 15 - ...
10. Taiwan 11 - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 23 - 66 - ...
2. Cambodia ... - 6 - ...
3. Indonesia ... - 8 - ...
4. Laos Peoples Democratic Republic ... - 3 - ...
5. Malaysia ... - 411 - ...
6. Myanmar ... - 1 - ...
7. Philippines 848 - 1709 - 1
8. Singapore 82 - 783 - ...
9. Thailand ... - 1414 - 3
10. Vietnam 8 - 131 - ...

• AUSTRALIA AND PACIFIC

1. Australia 198 - 4568 - 9
2. Fiji ... - 10 - ...
3. French New Caledonia ... - 6 - ...
4. French Polynesia 2 - ...
5. New Zealand 114 - 825 - ...
6. Papua New Guinea ... - 1 - ...
7. Republic of Palau 1 - 1 - ...
8. Samoa ... - 1 - ...
9. Vanuatu ... - 2 - ...

• TOTAL 3069 - 72,247 - 335

• 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.
• (*) Cases reported between 1 July 17:00 hours and 2 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico and American Samoa.

(...)
-
-----

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 3 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 3 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• More than 10,000 cases reported from the EU and EFTA countries, with 641 new cases reported in the past 24 hours;
• 8586 new cases are reported from non-EU and EFTA countries;
• Two countries report cases for the first time: Uganda and Aruba;
• A total of 45 new fatal cases are reported;
• Japan and Hong Kong announce one case of resistance to oseltamivir each.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 3 July, 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

A total of 30 out of the 31 EU and EFTA countries are now reporting cases. In the past 24 hours, 641 new cases were confirmed in 17 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 10,094, including 4 deaths.

Outside of the EU and EFTA countries, a total of 8568 new cases, including 45 new fatal ones, have been reported. The latest reported deaths due to influenza A(H1N1)v came from the USA, which reported 43 deaths in the last week, Australia (1) and Brunei (1).

A total of 80,758 cases are reported outside of the EU and EFTA countries, including 380 deaths (Table 2). Uganda and Aruba reported their first cases.

Following the change in response strategy in the UK from ?containment? to ?treatment?, following the announcement of an estimated 100,000 new cases per week at the expected peak of the outbreak towards the end of August, guidance on the practical implementation of the new strategy is provided, using the following link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_102019.

In addition to the isolated case of oseltamivir resistance reported earlier this week by Denmark, Japan and Hong Kong announced two more cases. The patient from Japan had received oseltamivir as a preventive measure, being a close contact from a confirmed case. In Hong Kong, the person was identified being infected after entry screening procedures at the airport. Further laboratory testing identified the resistant strain. This case refused any treatment with oseltamivir after the diagnosis of influenza A(H1N1)v.


European influenza surveillance network ? update week 26

The weekly bulletin of the European influenza surveillance network is published on the ECDC website: http://ecdc.europa.eu/en/Activities...sletter/SUN_EISN_INFL_Bulletin_2009week26.pdf

The update of week 26 states that the influenza activity in the EU remains at, or below, baseline levels, apart from the UK, which reports medium activity. A total of 204 influenza A(H1N1)v infections were detected during the reporting period (22-28 June). Influenza A(H1N1)v was the dominant type reported in Denmark, Greece, Hungary, Ireland, and the UK (England).


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 03 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 1 - 16 - ...
2. Belgium ... - 49 - ...
3. Bulgaria ... - 10 - ...
4. Cyprus 25 - 83 - ...
5. Czech Republic ... - 15 - ...
6. Denmark 6 - 63 - ...
7. Estonia ... - 13 - ...
8. Finland ... - 43 - ...
9. France 7 - 318 - ...
10. Germany 35 - 505 - ...
11. Greece ... - 109 - ...
12. Hungary 1 - 12 - ...
13. Iceland ... - 4 - ...
14. Ireland 2 - 51 - ...
15. Italy ... - 130 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 3 - ...
18. Luxemburg 2 - 6 - ...
19. Malta ... - 2 - ...
20. Netherlands 1 - 135 - ...
21. Norway ... - 41 - ...
22. Poland 1 - 20 - ...
23. Portugal 5 - 28 - ...
24. Romania 5 - 41 - ...
25. Slovakia ... - 18 - ...
26. Slovenia 3 - 7 - ...
27. Spain 20 - 776 - 1
28. Sweden 2 - 76 - ...
29. Switzerland 7 - 72 - ...
30. United Kingdom 518 - 7447 - 3

• Total 641 - 10094 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 2 July 17:00 hours and 3 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 03 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 1 - ...
2. Channel Islands 3 - 16 - ...
3. Island of Man ... - 1 - ...
4. Monaco ... - 1 - ...
5. Montenegro ... - 9 - ...
6. Russian Federation ... - 3 - ...
7. Serbia 2 - 15 - ...
8. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 67 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 11 - ...
6. Israel 35 - 577 - ...
7. Jordan ... - 22 - ...
8. Kuwait 1 - 35 - ...
9. Lebanon ... - 47 - ...
10. Morocco ... - 17 - ...
11. Occupied Palestinian Territory ... - 30 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia 8 - 89 - ...
15. Tunisia ... - 3 - ...
16. Turkey 3 - 40 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 7 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia 1 - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya 11 - 12 - ...
5. Mauritius ... - 1 - ...
6. South Africa 1 - 12 - ...
7. Uganda 1 - 1 - ...

• NORTH AMERICA

1. Canada ... - 7983 - 25
2. Mexico 1234 - 10262 - 119
3. ***USA 6177 - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba 5 - 5 - ...
3. Bahamas ... - 6 - ...
4. Barbados 2 - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands 1 - 2 - ...
7. Cayman Islands 1 - 14 - ...
8. Costa Rica ... - 227 - 2
9. Cuba 27 - 73 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador 50 - 276 - ...
13. Guatemala ... - 262 - 2
14. Honduras ... - 123 - 1
15. Jamaica ... - 32 - ...
16. Martinique ... - 2 - ...
17. Netherlands Antilles 1 - 15 - ...
18. Nicaragua ... - 310 - ...
19. Panama ... - 417 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 53 - ...
22. Saint Lucia ... - 1 - ...

• SOUTH AMERICA

1. Argentina ... - 1587 - 26
2. Bolivia 78 - 283 - ...
3. Brazil 57 - 737 - 1
4. Chile ... - 7376 - 14
5. Colombia 8 - 101 - 2
6. Ecuador ... - 163 - ...
7. Paraguay 3 - 103 - ...
8. Peru ... - 549 - ...
9. Uruguay ... - 196 - 1
10. Venezuela 10 - 204 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh 5 - 12 - ...
2. China (mainland) 49 - 916 - ...
3. Hong Kong SAR China 29 - 857 - ...
4. India ... - 104 - ...
5. Japan 148 - 1502 - ...
6. Macao SAR China 13 - 47 - ...
7. Nepal 2 - 5 - ...
8. South Korea ... - 210 - ...
9. Sri Lanka 2 - 17 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 27 - 93 - 1
2. Cambodia 1 - 7 - ...
3. Indonesia ... - 8 - ...
4. Laos Peoples Democratic Republic ... - 3 - ...
5. Malaysia ... - 411 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore 95 - 878 - ...
9. Thailand ... - 1414 - 3
10. Vietnam ... - 131 - ...

• AUSTRALIA AND PACIFIC

1. Australia 390 - 4958 - 10
2. Fiji ... - 10 - ...
3. French New Caledonia ... - 6 - ...
4. French Polynesia ... - 2 - ...
5. New Zealand 87 - 912 - ...
6. Papua New Guinea ... - 1 - ...
7. Republic of Palau ... - 1 - ...
8. Samoa ... - 1 - ...
9. Vanuatu ... - 2 - ...

• TOTAL 8568 - 80758 - 380

• 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.
• (*) Cases reported between 2 July 17:00 hours and 3 July 17:00 hours
• (**) 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)v infection Update 4 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection Update 4 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 10,203 cases reported from the EU and EFTA countries, with 109 new cases reported in the past 24 hours;
• 2,766 new cases are reported from non-EU and EFTA countries;
• The Cook Islands reported its first confirmed case;
• New Zealand reported its first 3 fatal cases;
• 28 new fatal 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. An update on the number of confirmed cases as of 4 July, 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

A total of 30 out of the 31 EU and EFTA countries are now reporting cases. In the past 24 hours, 109 new cases were confirmed in 11 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 10,203, including 4 deaths.

Outside of the EU and EFTA countries, a total of 2,766 new cases have been reported from 15 countries, including 28 new fatal cases. The latest reported deaths due to influenza A(H1N1)v came from Argentina (18), Canada (4), Costa Rica (1), Chile (2) and the first 3 fatal cases were reported from New Zealand. A total of 83,524 cases are reported outside of the EU and EFTA countries, including 408 deaths (Table 2). The Cook Islands reported their first case.


Pathogenicity and transmissibility of the pandemic virus A(H1N1)v in animal models

Two important studies were published this week in the Journal Science. They are confirming the observation in humans that the pandemic virus is of comparable or somewhat higher transmissibility in ferrets (the most commonly used animal model for human influenza) compared to seasonal influenza A(H1N1). They also confirmed that the pandemic strain transmits in ferrets and the theoretical opportunity for reassortment of viruses in human respiratory tracts. An extended summary of the two studies and ECDC comment is available at http://ecdc.europa.eu/en/health_content/sciadv/090704_sciadv.aspx.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 04 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 16 - ...
2. Belgium 3 - 52 - ...
3. Bulgaria ... - 10 - ...
4. Cyprus 12 - 95 - ...
5. Czech Republic ... - 15 - ...
6. Denmark ... - 63 - ...
7. Estonia ... - 13 - ...
8. Finland ... - 43 - ...
9. France ... - 318 - ...
10. Germany ... - 505 - ...
11. Greece 25 - 134 - ...
12. Hungary ... - 12 - ...
13. Iceland ... - 4 - ...
14. Ireland 12 - 63 - ...
15. Italy 16 - 146 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 3 - ...
18. Luxemburg ... - 6 - ...
19. Malta 9 - 11 - ...
20. Netherlands ... - 135 - ...
21. Norway ... - 41 - ...
22. Poland 5 - 25 - ...
23. Portugal 10 - 38 - ...
24. Romania ... - 41 - ...
25. Slovakia ... - 18 - ...
26. Slovenia 5 - 12 - ...
27. Spain ... - 776 - 1
28. Sweden 8 - 84 - ...
29. Switzerland 4 - 76 - ...
30. United Kingdom ... - 7447 - 3

• Total 109 - 10,203 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

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

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

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 1 - ...
2. Channel Islands ... - 16 - ...
3. Island of Man ... - 1 - ...
4. Monaco ... - 1 - ...
5. Montenegro ... - 9 - ...
6. Russian Federation ... - 3 - ...
7. Serbia ... - 15 - ...
8. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 67 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 11 - ...
6. Israel ... - 577 - ...
7. Jordan ... - 22 - ...
8. Kuwait ... - 35 - ...
9. Lebanon ... - 47 - ...
10. Morocco ... - 17 - ...
11. Occupied Palestinian Territory ... - 30 - ...
12. Oman ... - 3 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia ... - 89 - ...
15. Tunisia ... - 3 - ...
16. Turkey ... - 40 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 7 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 12 - ...
5. Mauritius ... - 1 - ...
6. South Africa 1 - 13 - ...
7. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada 900 - 8883 - 29
2. Mexico ... - 10262 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 5 - ...
3. Bahamas ... - 6 - ...
4. Barbados ... - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica 50 - 277 - 3
9. Cuba 12 - 85 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador 1 - 277 - ...
13. Guatemala ... - 262 - 2
14. Honduras ... - 123 - 1
15. Jamaica ... - 32 - ...
16. Martinique ... - 2 - ...
17. Netherlands Antilles 15 - ...
18. Nicaragua 11 - 321 - ...
19. Panama ... - 417 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago 12 - 65 - ...
22. Saint Lucia ... - 1 - ...
23. Argentina 496 - 2083 - 44
24. Bolivia ... - 283
25. Brazil 19 - 756 - 1
26. Chile 784 - 8160 - 16
27. Colombia ... - 101 - 2
28. Ecuador ...- 163 - ...
29. Paraguay ... - 103 - ...
30. Peru ... - 549 - ...
31. Uruguay ... - 196 - 1
32. Venezuela ... - 204 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh 12 - ...
2. China (mainland) ... - 916 - ...
3. Hong Kong SAR China 44 - 901 - ...
4. India ... - 104 - ...
5. Japan 15 - 1517 - ...
6. Macao SAR China ... - 47 - ...
7. Nepal ... - 5 - ...
8. South Korea ... - 210 - ...
9. Sri Lanka ... - 17 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 93 - 1
2. Cambodia ... - 7 - ...
3. Indonesia ... - 8 - ...
4. Laos Peoples Democratic Republic ... - 3 - ...
5. Malaysia ... - 411 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore 91 - 969 - ...
9. Thailand ... - 1414 - 3
10. Vietnam ... - 131 - ...

• AUSTRALIA AND PACIFIC

1. Australia 296 - 5254 - 10
2. Cook Islands 1 - 1 - ...
3. Fiji ... - 10 - ...
4. French New Caledonia ... - 6 - ...
5. French Polynesia ... - 2 - ...
6. New Zealand 33 - 945 - 3
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 2 - ...

• TOTAL 2,766 - 83,524 - 408

• 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.
• (*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
-
-----

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 5 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 5 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 10,260 cases reported from the EU and EFTA countries, with 57 new cases reported in the past 24 hours;
• 1,465 new cases are reported from non-EU and EFTA countries;
• FYROM reported its first two confirmed case;
• Thirteen new fatal 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. An update on the number of confirmed cases as of 5 July, 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

A total of 30 out of the 31 EU and EFTA countries are now reporting cases.

In the past 24 hours, 57 new cases were confirmed in 10 EU and EFTA countries (Table1). The cumulative number of cases in the EU and EFTA countries is now 10,260, including 4 deaths.

Outside of the EU and EFTA countries, a total of 1,465 new cases have been reported from 17 countries within the last 24 hours, including 13 new fatal cases. The latest reported deaths due to influenza A(H1N1)v came from Argentina (11) and Thailand (2). A total of 84,989 cases are reported outside of the EU and EFTA countries, including 421 deaths (Table 2).

The global number of confirmed cases is 95,249 and 425 deaths.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 05 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 3 - 19 - ...
2. Belgium 2 - 54 - ...
3. Bulgaria ... - 10 - ...
4. Cyprus 14 - 109 - ...
5. Czech Republic ... - 15 - ...
6. Denmark 2 - 65 - ...
7. Estonia ... - 13 - ...
8. Finland 12 - 55 - ...
9. France ... - 318 - ...
10. Germany ... - 505 - ...
11. Greece 6 - 140 - ...
12. Hungary ... - 12 - ...
13. Iceland ... - 4 - ...
14. Ireland 5 - 68 - ...
15. Italy ... - 146 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 3 - ...
18. Luxemburg ... - 6 - ...
19. Malta 5 - 16 - ...
20. Netherlands ... - 135 - ...
21. Norway ... - 41 - ...
22. Poland ... - 25 - ...
23. Portugal 4 - 42 - ...
24. Romania 3 - 44 - ...
25. Slovakia ... - 18 - ...
26. Slovenia 1 - 13 - ...
27. Spain ... - 776 - 1
28. Sweden ... - 84 - ...
29. Switzerland ... - 76 - ...
30. United Kingdom ... - 7447 - 3

• Total 57 - 10,260 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

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

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

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 1 - ...
2. Channel Islands ... - 16 - ...
3. Former Yugoslav Republic of Macedonia 2 - 2 - ...
4. Island of Man ... - 1 - ...
5. Monaco ... - 1 - ...
6. Montenegro ... - 9 - ...
7. Russian Federation ... - 3 - ...
8. Serbia ... - 15 - ...
9. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 67 - ...
4. Iran ... - 1 - ...
5. Iraq 1 - 12 - ...
6. Israel ... - 577 - ...
7. Jordan ... - 22 - ...
8. Kuwait 1 - 36 - ...
9. Lebanon 2 - 49 - ...
10. Morocco ... - 17 - ...
11. Occupied Palestinian Territory 18 - 48 - ...
12. Oman 1 - 4 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia 20 - 109 - ...
15. Tunisia 1 - 4 - ...
16. Turkey ... - 40 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen 1 - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 12 - ...
5. Mauritius ... - 1 - ...
6. South Africa ... - 13 - ...
7. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 8883 - 29
2. Mexico ... - 10262 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 5 - ...
3. Bahamas ... - 6 - ...
4. Barbados ... - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba ... - 85 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 277 - ...
13. Guatemala 24 - 286 - 2
14. Honduras ... - 123 - 1
15. Jamaica ... - 32 - ...
16. Martinique ... - 2 - ...
17. Netherlands Antilles ... - 15 - ...
18. Nicaragua ... - 321 - ...
19. Panama ... - 417 - ...
20. Saint Lucia ... - 1 - ...
21. Suriname ... - 11 - ...
22. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina 326 - 2409 - 55
2. Bolivia ... - 283 - ...
3. Brazil ... - 756 - 1
4. Chile ... - 8160 - 16
5. Colombia ... - 101 - 2
6. Ecuador ... - 163 - ...
7. Paraguay ... - 103 - ...
8. Peru 367 - 916 - ...
9. Uruguay ... - 196 - 1
10. Venezuela ... - 204 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 12 - ...
2. China (mainland) ... - 916 - ...
3. Hong Kong SAR China ... - 901 - ...
4. India ... - 104 - ...
5. Japan ... - 1517 - ...
6. Macao SAR China ... - 47 - ...
7. Nepal ... - 5 - ...
8. South Korea ... - 210 - ...
9. Sri Lanka ... - 17 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 93 - 1
2. Cambodia ... - 7 - ...
3. Indonesia 12 - 20 - ...
4. Laos Peoples Democratic Republic ... - 3 - ...
5. Malaysia ... - 411 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore 34 - 1003 - ...
9. Thailand 595 - 2009 - 5
10. Vietnam ... - 131 - ...

• AUSTRALIA AND PACIFIC

1. Australia 44 - 5298 - 10
2. Cook Islands ... - 1 - ...
3. Fiji ... - 10 - ...
4. French New Caledonia ... - 6 - ...
5. French Polynesia ... - 2 - ...
6. New Zealand 16 - 961 - 3
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 2 - ...

• TOTAL 1,465 - 84,989 - 421

• 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.
• (*) Cases reported between 3 July 17:00 hours and 4 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 6 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 6 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 82 new confirmed cases reported from the EU and EFTA countries, reaching a total of 10,342;
• 493 new cases reported from non-EU and EFTA countries, reaching a total of 85,482;
• Croatia confirmed its first case;
• Denmark announces changing its response strategy to ?mitigation?.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 6 July, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 10,342 confirmed cases, including four deaths. This count includes the 82 latest cases, reported in the past 24 hours (Table1).

Denmark announced that it will change its response strategy from ?containment? to ?mitigation?. This means that laboratory testing and the use of anti-viral treatment and prophylaxis will be limited to persons considered at higher risk. More information is available from the following link: http://www.sst.dk/Nyhedscenter/Nyheder/2009/Aendret strategi.aspx.

Outside of the EU and EFTA countries, a total of 493 new cases have been reported from 5 countries within the last 24 hours, including 6 new fatal cases: five from Argentina and 1 from Australia. A total of 85,406 cases are reported outside of the EU and EFTA countries, including 427 deaths (Table 2).The global number of confirmed cases is 95,824 and 431 deaths.

On 2?3 July 2009, the EU Swedish Presidency organised an expert meeting of the Member States to discuss pandemic influenza preparedness ? lessons learned and next steps. The EU Member States, the World Health Organisation, the European Commission and others were gathered to exchange experience and discuss future areas of cooperation regarding preparedness for the coming influenza season.

The presentations of the expert meeting, including lessons learned from affected countries like the UK, Spain and France, as well situation updates by ECDC and WHO, are available using the following link: http://www.se2009.eu/en/meetings_ne...the_eu_s_fight_against_the_influenza_pandemic.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 06 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 19 - ...
2. Belgium ... - 54 - ...
3. Bulgaria 3 - 13 - ...
4. Cyprus 8 - 117 - ...
5. Czech Republic ... - 15 - ...
6. Denmark 1 - 66 - ...
7. Estonia ... - 13 - ...
8. Finland 7 - 62 - ...
9. France ... - 318 - ...
10. Germany 22 - 527 - ...
11. Greece 11 - 151 - ...
12. Hungary 9 - 21 - ...
13. Iceland ... - 4 - ...
14. Ireland 6 - 74 - ...
15. Italy ... - 146 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 3 - ...
18. Luxemburg ... - 6 - ...
19. Malta ... - 16 - ...
20. Netherlands 7 - 142 - ...
21. Norway ... - 41 - ...
22. Poland ... - 25 - ...
23. Portugal 3 - 45 - ...
24. Romania ... - 44 - ...
25. Slovakia 1 - 19 - ...
26. Slovenia 1 - 14 - ...
27. Spain ... - 776 - 1
28. Sweden 3 - 87 - ...
29. Switzerland ... - 76 - ...
30. United Kingdom ... - 7447 - 3

• Total 82 - 10,342 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 5 July 17:00 hours and 6 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 06 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 1 - ...
2. Channel Islands ... - 16 - ...
3. Croatia 1 - 1 - ...
4. Former Yugoslav Republic of Macedonia ... - 2 - ...
5. Island of Man ... - 1 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 9 - ...
8. Russian Federation ... - 3 - ...
9. Serbia ... - 15 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 5 - ...
2. Bahrain ... - 15 - ...
3. Egypt ... - 67 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 12 - ...
6. Israel ... - 577 - ...
7. Jordan ... - 22 - ...
8. Kuwait ... - 36 - ...
9. Lebanon ... - 49 - ...
10. Morocco ... - 17 - ...
11. Occupied Palestinian Territory ... - 48 - ...
12. Oman ... - 4 - ...
13. Qatar ... - 10 - ...
14. Saudi Arabia ... - 109 - ...
15. Tunisia ... - 4 - ...
16. Turkey ... - 40 - ...
17. United Arab Emirates ... - 8 - ...
18. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 12 - ...
5. Mauritius ... - 1 - ...
6. South Africa ... - 13 - ...
7. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 8883 - 29
2. Mexico ... - 10262 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 5 - ...
3. Bahamas ... - 6 - ...
4. Barbados ... - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba ... - 85 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 277 - ...
13. Guatemala ... - 286 - 2
14. Honduras ... - 123 - 1
15. Jamaica ... - 32 - ...
16. Martinique ... - 2 - ...
17. Netherlands Antilles ... - 15 - ...
18. Nicaragua ... - 321 - ...
19. Panama ... - 417 - ...
20. Saint Lucia ... - 1 - ...
21. Suriname ... - 11 - ...
22. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina 76 - 2485 - 60
2. Bolivia ... - 283 - ...
3. Brazil 129 - 885 - 1
4. Chile ... - 8160 - 16
5. Colombia ... - 101 - 2
6. Ecuador ... - 163 - ...
7. Paraguay ... - 103 - ...
8. Peru ... - 916 - ...
9. Uruguay ... - 196 - 1
10. Venezuela ... - 204 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh ... - 12 - ...
2. China (mainland) ... - 916 - ...
3. Hong Kong SAR China 20 - 921 - ...
4. India ... - 104 - ...
5. Japan 267 - 1784 - ...
6. Macao SAR China ... - 47 - ...
7. Nepal ... - 5 - ...
8. South Korea ... - 210 - ...
9. Sri Lanka ... - 17 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 93 - 1
2. Cambodia ... - 7 - ...
3. Indonesia ... - 20 - ...
4. Laos Peoples Democratic Republic ... - 3 - ...
5. Malaysia ... - 411 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1003 - ...
9. Thailand ... - 2009 - 5
10. Vietnam ... - 131 - ...

• AUSTRALIA AND PACIFIC

1. Australia ... - 5298 - 11
2. Cook Islands ... - 1 - ...
3. Fiji ... - 10 - ...
4. French New Caledonia ... - 6 - ...
5. French Polynesia ... - 2 - ...
6. New Zealand ... - 961 - 3
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 2 - ...

• TOTAL 493 - 85482 -427

• 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.
• (*) Cases reported between 5 July 17:00 hours and 6 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 7 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 7 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 228 new confirmed cases reported from the EU and EFTA countries, reaching a total of 10,582;
• 3158 new cases reported from non-EU and EFTA countries, reaching a total of 88,640;
• Libya and Syria confirmed their first case.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 7 July, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 10,582 confirmed cases, including four deaths. This count includes the 228 latest cases, reported in the past 24 hours (Table1).

Media report on a total of 7 deaths in the UK, four more than currently reported; confirmation from official sources is awaited before further updates are made.

Outside of the EU and EFTA countries, a total of 3158 new cases have been reported within the last 24 hours, including five new fatal cases: two from Australia and three from Uruguay. Libya and Syria are the two latest countries to report their first cases.

A total of 88,640 cases are reported outside of the EU and EFTA countries, including 432 deaths (Table 2).The global number of confirmed cases is 99,222 and 436 deaths.


Pandemic meetings organised by EU Swedish Presidency

There have been two important meetings organised by the Swedish Presidency in the past week concerning the 2009-2010 Pandemic of influenza A(H1N1)v.

The first meeting on July 2-3rd was a technical workshop chaired by Dr Didier Houssin, the Chief Medical Officer for France, which focused on the case for moving to mitigation and treatment, vaccines, public health measures and cross-sectoral work in EU countries.

The presentations from that workshop and the conclusions of the meeting are available on the Swedish Presidency Web-site. In summary, the EU Member States, ECDC, WHO and the European Commission discussed on how to collaborate on improving preparedness for pandemic spread of influenza A(H1N1)v by analyzing and sharing their experiences on pandemic planning and outbreak reporting.

On July 6-7th, following the technical workshop, the Health Ministers of the EU Member States discussed their experience to date with the pandemic and future areas of cooperation to improve preparedness for the pandemic.

The Ministers received presentations from ECDC, the European Medicines Agency (EMEA) and they were addressed by video-link by Dr Margaret Chan, Director General of WHO. It was reported that the development of a common strategy will continue, in order to be decided upon by the health ministers in the autumn.

The Swedish Presidency announced that an extra formal EPSCO (Employment, Social Policy, Health and Consumer Affairs Council) meeting would be planned for the beginning of October and that the continued work would be carried out in close cooperation with the WHO.

The ministers discussed the importance of ensuring that all those living in the EU know how best to protect themselves and their family from influenza. It was emphasised that possible measures should be based on each Member State taking responsibility for planning and taking measures for its own population.

An important starting point is also the ambition of each Member State to contribute to solidarity within the EU and globally.

Influenza and its effects should quickly be integrated into all the EU?s policy areas so as to take charge of the multi-sectoral dimension. The Member States will continue to look into ways in which the EU can support the international community in dealing with a pandemic.

The Presidency noted that the cooperation will encompass different measures regarding vaccines, antiviral drugs and other public health measures. In this context, it is important to develop strategies to protect people in different risk groups. The Member States also discussed the transition from attempting to delay or contain the pandemic to minimising the effects of the pandemic (mitigation). It was noted that such a transition must, however, occur at a point in time that is appropriate for the respective Member State. It was felt that at an EU level, it should be possible to reach agreement on how to communicate this in the best way to the Member States? citizens.

More information is available using the following link: http://www.eu2009.se/en/meetings_ne...ards_an_eu_strategy_for_pandemic_preparedness


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 7 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 19 - ...
2. Belgium 5 - 59 - ...
3. Bulgaria 1 - 14 - ...
4. Cyprus 18 - 135 - ...
5. Czech Republic 2 - 17 - ...
6. Denmark 3 - 69 - ...
7. Estonia ... - 13 - ...
8. Finland 5 - 67 - ...
9. France 41 - 371 - ...
10. Germany 21 - 548 - ...
11. Greece 11 - 162 - ...
12. Hungary 1 - 22 - ...
13. Iceland ... - 4 - ...
14. Ireland 7 - 81 - ...
15. Italy ... - 146 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 3 - ...
18. Luxemburg 1 - 7 - ...
19. Malta ... - 16 - ...
20. Netherlands 1 - 143 - ...
21. Norway 6 - 47 - ...
22. Poland 2 - 27 - ...
23. Portugal 12 - 57 - ...
24. Romania 3 - 47 - ...
25. Slovakia 3 - 22 - ...
26. Slovenia ... - 14 - ...
27. Spain 72 - 848 - 1
28. Sweden 13 - 100 - ...
29. Switzerland ... - 76 - ...
30. United Kingdom ... - 7447 - 3

• Total 228 - 10,582 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 6 July 17:00 hours and 7 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 7 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina 1 - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 1 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man ... - 2 - ...
6. Monaco ... - 1 - ...
7. Montenegro 1 - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 6 - 21 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria 2 - 7 - ...
2. Bahrain 4 - 19 - ...
3. Egypt 11 - 78 - ...
4. Iran ... - 1 - ...
5. Iraq 4 - 16 - ...
6. Israel 150 - 727 - ...
7. Jordan 1 - 23 - ...
8. Kuwait ... - 36 - ...
9. Lebanon 4 - 53 - ...
10. Libya 1 - 1 - ...
11. Morocco ... - 17 - ...
12. Occupied Palestinian Territory 56 - 104 - ...
13. Oman ... - 4 - ...
14. Qatar ... - 10 - ...
15. Saudi Arabia 16 - 125 - ...
16. Syria 1 - 1 - ...
17. Tunisia 1 - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 12 - ...
5. Mauritius ... - 1 - ...
6. South Africa 17 - 30 - ...
7. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 8883 - 29
2. Mexico ... - 10262 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba 8 - 13 - ...
3. Bahamas 1 - 7 - ...
4. Barbados ... - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba ... - 85 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador 42 - 319 - ...
13. Guatemala ... - 286 - 2
14. Honduras ... - 123 - 1
15. Jamaica ... - 32 - ...
16. Martinique 1 - 3 - ...
17. Netherlands Antilles 1 - 16 - ...
18. Nicaragua ... - 321 - ...
19. Panama ... - 417 - ...
20. Saint Lucia ... - 1 - ...
21. Suriname ... - 11 - ...
22. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2485 - 60
2. Bolivia 133 - 416 - ...
3. Brazil 20 - 905 - 1
4. Chile 334 - 8494 - 16
5. Colombia 17 - 118 - 2
6. Ecuador ... - 163 - ...
7. Paraguay 3 - 106 - ...
8. Peru 154 - 1070 - ...
9. Uruguay ... - 196 - 4
10. Venezuela 2 - 206 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh 6 - 18 - ...
2. China (mainland) 181 - 1097 - ...
3. Hong Kong SAR China 52 - 973 - ...
4. India 25 - 129 - ...
5. Japan 83 - 1867 - ...
6. Macao SAR China 13 - 60 - ...
7. Nepal ... - 5 - ...
8. South Korea ... - 210 - ...
9. Sri Lanka 2 - 19 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 71 - 164 - 1
2. Cambodia ... - 7 - ...
3. Indonesia ... - 20 - ...
4. Laos Peoples Democratic Republic 2 - 5 - ...
5. Malaysia 57 - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore 214 - 1217 - ...
9. Thailand 67 - 2076 - 5
10. Vietnam 95 - 226 - ...

• AUSTRALIA AND PACIFIC

1. Australia 1055 - 6353 - 13
2. Cook Islands ... - 1 - ...
3. Fiji ... - 10 - ...
4. French New Caledonia 6 - 12 - ...
5. French Polynesia 2 - 4 - ...
6. New Zealand 234 - 1195 - 3
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu 1 - 3 - ...

• TOTAL 3158 - 88,640 - 432

• 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.
• (*) Cases reported between 6 July 17:00 hours and 7 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 8 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 8 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 238 new confirmed cases reported from the EU and EFTA countries, reaching a total of 10,820;
• 1254 new cases reported from non-EU and EFTA countries, reaching a total of 89,894;
• WHO communication on oseltamivir resistance.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 8 July, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 10,820 confirmed cases, including four deaths. In the past 24 hours, 238 new cases were confirmed from the EU and EFTA countries (Table1).

Media report on a total of 7 deaths in the UK, four more than currently reported; confirmation from official sources is awaited before further updates are made.

Outside of the EU and EFTA countries, a total of 1254 new cases have been reported within the last 24 hours, including five new fatal cases: four from Thailand and one from Jamaica.

A total of 89,894 cases are reported outside of the EU and EFTA countries, including 437 deaths (Table 2).

The global number of confirmed cases is 100,714 and 441 deaths.

Media report on 14 cases of pandemic influenza A(H1N1)v among US citizens on the main US military base in Afghanistan. As the media report states, p to now no cases have been detected among Afghans.

Following the identification of three sporadic cases of oseltamivir resistance, reported by Denmark, Japan and Hong Kong, WHO confirms that there is no evidence indicating the development of widespread antiviral resistance among pandemic influenza A(H1N1)v: http://www.who.int/csr/disease/swineflu/newsbriefs/h1n1_antiviral_resistance_20090708/en/index.html.

Unrelated to the current pandemic, the government of Canada reports on a new strain of influenza that was detected in two workers on a hog farm in Saskatchewan province. The new strain is the result of a re-assortment of human seasonal influenza and swine influenza viruses.

The Canadian health minister states that the preliminary results indicate that the risk for public health is low.

More information is available from the following link: http://www.phac-aspc.gc.ca/media/nr-rp/2009/2009_0707-eng.php.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 8 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 19 - ...
2. Belgium 1 - 60 - ...
3. Bulgaria ... - 14 - ...
4. Cyprus ... - 135 - ...
5. Czech Republic ... - 17 - ...
6. Denmark ... - 69 - ...
7. Estonia 1 - 14 - ...
8. Finland 6 - 73 - ...
9. France 32 - 403 - ...
10. Germany 43 - 591 - ...
11. Greece 25 - 187 - ...
12. Hungary ... - 22 - ...
13. Iceland ... - 4 - ...
14. Ireland 3 - 84 - ...
15. Italy 28 - 174 - ...
16. Latvia ... - 1 - ...
17. Lithuania 2 - 5 - ...
18. Luxemburg ... - 7 - ...
19. Malta 32 - 48 - ...
20. Netherlands ... - 143 - ...
21. Norway ... - 47 - ...
22. Poland ... - 27 - ...
23. Portugal 4 - 61 - ...
24. Romania 2 - 49 - ...
25. Slovakia ... - 22 - ...
26. Slovenia ... - 14 - ...
27. Spain 22 - 870 - 1
28. Sweden 9 - 109 - ...
29. Switzerland 28 - 104 - ...
30. United Kingdom ... - 7447 - 3

• Total 238 - 10,820 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 7 July 17:00 hours and 8 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 8 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia 2 - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 2 - ...
5. Island of Man ... - 1 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 9 - 30 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 19 - ...
3. Egypt 1 - 79 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan 2 - 25 - ...
8. Kuwait 3 - 39 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco 3 - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman 1 - 5 - ...
14. Qatar 13 - 23 - ...
15. Saudi Arabia 12 - 137 - ...
16. Syria ... - 1 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya 3 - 15 - ...
5. Mauritius ... - 1 - ...
6. South Africa 1 - 31 - ...
7. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 8883 - 29
2. Mexico ... - 10262 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 13 - ...
3. Bahamas ... - 7 - ...
4. Barbados ... - 12 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba ... - 85 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 319 - ...
13. Guatemala ... - 286 - 2
14. Honduras ... - 123 - 1
15. Jamaica 1 - 33 - 1
16. Martinique ... - 3 - ...
17. Netherlands Antilles ... - 16 - ...
18. Nicaragua ... - 321 - ...
19. Panama ... - 417 - ...
20. Saint Lucia ... - 1 - ...
21. Suriname ... - 11 - ...
22. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2485 - 60
2. Bolivia ... - 416 - ...
3. Brazil ... - 905 - 1
4. Chile ... - 8494 - 16
5. Colombia ... - 118 - 2
6. Ecuador ... - 163 - ...
7. Paraguay ... - 106 - ...
8. Peru ... - 1070 - ...
9. Uruguay ... - 196 - 4
10. Venezuela ... - 206 - ...

• NORTH-EAST AND SOUTH ASIA

1. Bangladesh 1 - 19 - ...
2. China (mainland) 21 - 1118 - ...
3. Hong Kong SAR China 41 - 1014 - ...
4. India 24 - 153 - ...
5. Japan 151 - 2018 - ...
6. Macao SAR China 2 - 62 - ...
7. Nepal 1 - 6 - ...
8. South Korea 76 - 286 - ...
9. Sri Lanka 3 - 22 - ...
10. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 10 - 174 - 1
2. Cambodia ... - 7 - ...
3. Indonesia 8 - 28 - ...
4. Laos Peoples Democratic Republic ... - 5 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand 352 - 2428 - 9
10. Vietnam 22 - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 414 - 6767 - 13
2. Cook Islands ... - 1 - ...
3. Fiji ... - 10 - ...
4. French New Caledonia ... - 12 - ...
5. French Polynesia ... - 4 - ...
6. New Zealand 77 - 1272 - 3
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 3 - ...

• TOTAL 1254 - 89,894 - 437

• 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.
• (*) Cases reported between 7 July 17:00 hours and 8 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 9 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 9 July 2009, 17:00 hours CEST

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 200 new confirmed cases reported from the EU and EFTA countries, reaching a total of 11,020;
• 3718 new cases reported from non-EU and EFTA countries, reaching a total of 93,612;
• Three new countries report cases: Guyana, Seychelles and Afghanistan;
• Mexican conference on lessons learned and preparing for the future;
• WHO checklist on clinical patient care.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 9 July, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 11,020 confirmed cases, including four deaths. In the past 24 hours, 200 new cases were confirmed from the EU and EFTA countries (Table1).

Outside of the EU and EFTA countries, a total of 3718 new cases have been reported within the last 24 hours, including 29 new fatal cases: Canada (8), Australia (5), New Zealand (3), Chile (3), Paraguay (3), Colombia (2), Peru (2), Uruguay (2) and El Salvador (1).

A total of 93,612 cases are reported outside of the EU and EFTA countries, including 466 deaths (Table 2).

The global number of confirmed cases is 104,632 and 470 deaths.

The 14 cases among US citizens on a US military base in Afghanistan are confirmed and appear in table 2 as cases from Afghanistan. Media report on one confirmed and one suspected case in Zimbabwe, but official confirmation is awaited.

Upon the initiative of the Mexican Government, and with the support of the US and Canada, the Ministries of Health and public health officials of 43 countries met in Cancun on July 1-3 to evaluate the pandemic influenza A(H1N1)v situation and exchange information and experiences on the international response generated after the emergence of the new virus. Lessons learned from highly affected countries were presented, and an epidemiological update was provided. Presentations of this conference are available from the following link: http://www.encuentroh1n1.org/index.php?ln=sp&ident=ponencias.

The World Health Organization published a clinical patient care checklist, intended for hospital staff treating patients with suspected influenza infection. The checklist addresses both clinical management of individual patients and infection control measures. More details are available from: http://www.who.int/patientsafety/activities/ah1n1_checklist/en/index.html.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 9 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 19 - ...
2. Belgium 7 - 67 - ...
3. Bulgaria ... - 14 - ...
4. Cyprus 66 - 201 - ...
5. Czech Republic ... - 17 - ...
6. Denmark ... - 69 - ...
7. Estonia ... - 14 - ...
8. Finland 6 - 79 - ...
9. France ... - 403 - ...
10. Germany 50 - 641 - ...
11. Greece 14 - 201 - ...
12. Hungary 2 - 24 - ...
13. Iceland ... - 4 - ...
14. Ireland 9 - 93 - ...
15. Italy 6 - 180 - ...
16. Latvia ... - 1 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 7 - ...
19. Malta ... - 48 - ...
20. Netherlands ... - 143 - ...
21. Norway 6 - 53 - ...
22. Poland 1 - 28 - ...
23. Portugal 10 - 71 - ...
24. Romania 1 - 50 - ...
25. Slovakia 1 - 23 - ...
26. Slovenia 1 - 15 - ...
27. Spain ... - 870 - 1
28. Sweden 9 - 118 - ...
29. Switzerland 11 - 115 - ...
30. United Kingdom ... - 7447 - 3

• Total 200 - 11,020 - 4

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 8 July 17:00 hours and 9 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 9 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man ... - 2 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 4 - 34 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 19 - ...
3. Egypt ... - 79 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan ... - 25 - ...
8. Kuwait ... - 39 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman ... - 5 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia 12 - 149 - ...
16. Syria ... - 1 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya 6 - 21 - ...
5. Mauritius ... - 1 - ...
6. Seychelles 1 - 1
7. South Africa ... - 31 - ...
8. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada 546 - 9429 - 37
2. Mexico 1009 - 11271 - 119
3. ***USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 13 - ...
3. Bahamas 3 - 10 - ...
4. Barbados 5 - 17 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba 24 - 109 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 319 - 1
13. Guatemala 14 - 300 - 2
14. Guyana 2 - 2
15. Honduras ... - 123 - 1
16. Jamaica ... - 33 - 1
17. Martinique ... - 3 - ...
18. Netherlands Antilles ... - 16 - ...
19. Nicaragua 14 - 335 - ...
20. Panama 40 - 457 - ...
21. Saint Lucia ... - 1 - ...
22. Suriname ... - 11 - ...
23. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2485 - 60
2. Bolivia 121 - 537 - ...
3. Brazil 72 - 977 - 1
4. Chile 641 - 9135 - 19
5. Colombia 20 - 138 - 4
6. Ecuador 41 - 204 - ...
7. Paraguay 8 - 114 - 3
8. Peru 1 - 1071 - 2
9. Uruguay 324 - 520 - 6
10. Venezuela 16 - 222 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan 14 - 14 - ...
2. Bangladesh ... - 19 - ...
3. China (mainland) 33 - 1151 - ...
4. Hong Kong SAR China 41 - 1055 - ...
5. India ... - 153 - ...
6. Japan 8 - 2026 - ...
7. Macao SAR China 6 - 68 - ...
8. Nepal ... - 6 - ...
9. South Korea ... - 286 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 174 - 1
2. Cambodia 1 - 8 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic ... - 5 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam ... - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 523 - 7290 - 18
2. Cook Islands ... - 1 - ...
3. Fiji 9 - 19 - ...
4. French New Caledonia ... - 12 - ...
5. French Polynesia ... - 4 - ...
6. New Zealand 159 - 1431 - 6
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 3 - ...

• TOTAL 3718 - 93,612 - 466

• 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.
• (*) Cases reported between 8 July 17:00 hours and 9 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

-
-----

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 10 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 10 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 2647 new confirmed cases reported from the EU and EFTA countries, including 2271 cases from the UK;
• The latest analysis of individual case reports in the EU/EEA countries is now available;
• 2199 new cases reported from non-EU and EFTA countries, reaching a total of 95,811;
• Two new non-EU/EFTA countries report their first cases: Tanzania and St Vincent;
• New Zealand reports on high influenza activity.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 10 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 13,667 confirmed cases, including 16 deaths.

In the past 24 hours, 2647 new cases were confirmed from the EU and EFTA countries, the majority of which come from the UK (Table1).

The analysis of influenza A(H1N1)v individual case reports in the EU and EEA countries has been updated as of 9 July. The results can be found at the end of this report, as well as on ECDC?s website: http://www.ecdc.europa.eu/en/files/...)_Analysis_of_individual_data_EU_EEA-EFTA.pdf.

The UK, now reporting on a weekly basis, confirmed a total of 9718 cases, including 14 deaths. The apparent large increase in the deaths reported is partly due to this weekly ?batch reporting?. The Health Protection Agency states that the majority of the pandemic influenza cases remain mild. The fatal cases all had underlying risk factors. The full update is available from: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1247125493338.

Spain reported a second fatal case, in a 41-year old man with underlying chronic illness: http://www.msc.es/gabinetePrensa/notaPrensa/desarrolloNotaPrensa.jsp?id=1575.

Outside of the EU and EFTA countries, a total of 2199 new cases have been reported within the last 24 hours, including 37 new fatal cases: Argentina (22), UK (11), Mexico (2), Spain (1) and Peru (1). The first cases of influenza A(H1N1)v were confirmed from Tanzania and St Vincent. A total of 95,811 cases are reported outside of the EU and EFTA countries, including 491 deaths (Table 2). The global number of confirmed cases is 109,478 and 507 deaths.

Several media reports discussed the latest surveillance report from the Institute of Environmental Science and Research of New Zealand highlighting the high consultation rates for influenza-like illness (ILI) from the national sentinel surveillance system. These continue to be much higher (184/100 000 population) than the previous two years and are still increasing. The predominant strain identified in samples from the sentinel population and from the laboratory surveillance is now influenza A(H1N1)v, despite the ongoing seasonal flu transmission.


European influenza surveillance network ? update week 27

The weekly bulletin of the European Influenza Surveillance Network (EISN) is published on the ECDC website: http://ecdc.europa.eu/en/Activities...sletter/SUN_EISN_INFL_Bulletin_2009week27.pdf

This week?s bulletin states that although a large number of influenza detections were reported, mainly due to A(H1N1)v virus, influenza activity remains at or below baseline levels in Europe. A(H1N1)v was the dominant type reported in Denmark, Ireland, and the UK (England).


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 10 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 19 - ...
2. Belgium 7 - 74 - ...
3. Bulgaria ... - 14 - ...
4. Cyprus 17 - 218 - ...
5. Czech Republic 3 - 20 - ...
6. Denmark 4 - 73 - ...
7. Estonia 1 - 15 - ...
8. Finland 9 - 88 - ...
9. France ... - 403 - ...
10. Germany 50 - 691 - ...
11. Greece 21 - 222 - ...
12. Hungary 2 - 26 - ...
13. Iceland ... - 4 - ...
14. Ireland 11 - 104 - ...
15. Italy ... - 180 - ...
16. Latvia 1 - 2 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg 6 - 13 - ...
19. Malta 18 - 66 - ...
20. Netherlands 9 - 152 - ...
21. Norway 7 - 60 - ...
22. Poland 3 - 31 - ...
23. Portugal 8 - 79 - ...
24. Romania 1 - 51 - ...
25. Slovakia 4 - 27 - ...
26. Slovenia 1 - 16 - ...
27. Spain 164 - 1034 - 2
28. Sweden 17 - 135 - ...
29. Switzerland 12 - 127 - ...
30. United Kingdom 2271 - 9718 - 14

• Total 2647 - 13,667 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Deaths are included in the cumulative number of confirmed cases

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 10 July 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*]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man ... - 2 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia ... - 34 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 19 - ...
3. Egypt ... - 79 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan ... - 25 - ...
8. Kuwait ... - 39 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman ... - 5 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia ... - 149 - ...
16. Syria ... - 1 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 21 - ...
5. Mauritius ... - 1 - ...
6. Seychelles ... - 1
7. South Africa 22 - 53 - ...
8. Tanzania 1 - 1 - ...
9. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 9429 - 37
2. Mexico 428 - 11699 - 121
3. **USA ... - 33902 - 170

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Aruba ... - 13 - ...
3. Bahamas ... - 10 - ...
4. Barbados ... - 17 - ...
5. Bermuda ... - 2 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands ... - 14 - ...
8. Costa Rica ... - 277 - 3
9. Cuba ... - 109 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 319 - 1
13. Guatemala ... - 300 - 2
14. Guyana ... - 2
15. Honduras ... - 123 - 1
16. Jamaica ... - 33 - 1
17. Martinique ... - 3 - ...
18. Netherlands Antilles ... - 16 - ...
19. Nicaragua ... - 335 - ...
20. Panama ... - 457 - ...
21. Saint Lucia ... - 1 - ...
22. Saint Vincent 1 - 1
23. Suriname ... - 11 - ...
24. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina 192 - 2677 - 82
2. Bolivia 10 - 547 - ...
3. Brazil ... - 977 - 1
4. Chile ... - 9135 - 19
5. Colombia 5 - 143 - 4
6. Ecuador ... - 204 - ...
7. Paraguay ... - 114 - 3
8. Peru 260 - 1331 - 3
9. Uruguay ... - 520 - 6
10. Venezuela ... - 222 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 14
2. Bangladesh ... - 19 - ...
3. China (mainland) 72 - 1223 - ...
4. Hong Kong SAR China 123 - 1178 - ...
5. India ... - 153 - ...
6. Japan 247 - 2273 - ...
7. Macao SAR China 5 - 73 - ...
8. Nepal ... - 6 - ...
9. South Korea ... - 286 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 65 - 239 - 1
2. Cambodia ... - 8 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic 1 - 6 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam ... - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 643 - 7933 - 18
2. Cook Islands ... - 1 - ...
3. Fiji ... - 19 - ...
4. French New Caledonia ... - 12 - ...
5. French Polynesia ... - 4 - ...
6. New Zealand 124 - 1555 - 6
7. Papua New Guinea ... - 1 - ...
8. Republic of Palau ... - 1 - ...
9. Samoa ... - 1 - ...
10. Vanuatu ... - 3 - ...

• TOTAL 2199 - 95,811 - 491

• 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. They also include confirmed cases from Puerto Rico

(...)
-
-----

 

[Giuseppe]

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

Analysis of influenza A(H1N1)v individual case reports in EU and EEA countries (ECDC, July 9, 2009, edited)

ECDC SURVEILLANCE REPORT

Analysis of influenza A(H1N1)v individual case reports in EU and EEA countries

[Original Full Document: LINK. EDITED.]


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


Latest developments

• Individual data were reported on 7706 confirmed cases of influenza A(H1N1)v infection by 28 EU/EEA countries until 6 June 2009 (78 % reported by the United Kingdom)
• Travel-related cases account for 19% of the reported cases. The main areas to which cases had travelled were the USA (61%), Mexico and South American countries (20%) and other EU/EEA countries.
• Seventy-seven percent of cases are reported in children and young adults under 30 years of age.
• Among 1695 reported cases of A(H1N1)v cases, 165 (9.7%) were reported with at least one underlying condition.

Number of cases, travel-association and hospital admission

As published in the ECDC situation report of 6 July, a total of 10,266 confirmed cases of influenza A(H1N1)v have been reported as aggregated case reports by 29 out of the 30 EU/ EEA countries (no case reported by Liechtenstein as of 6 July 2009).

Out of these, a total of 7,706 confirmed cases of influenza A(H1N1)v have been reported as individual case reports through the Early Warning and Response System by 28 of the 29 affected EU/EEA countries until 6 July 2009 10:00 CEST (Table 1). Country-specific publications and weekly bulletins on A(H1N1)v are available [1-6]. The UK accounts for 78% of the individual case reports.

The number of travel-related cases (having been outside the country of notification during the incubation period) is 1,480 (19%) among 7,644 A(H1N1)v cases with available information on travel. All other cases are considered as potential in-country transmission.

The majority of cases reported as travellers, were returning from North America (879 [61%] cases from the USA and 49 cases [3%] from Canada) and Mexico, plus South American countries (298, 20%). The proportion of cases who travelled to another EU/EEA country is 12% (180 cases), most of them having travelled to the United Kingdom (96 cases) and Spain (45 cases).

Fifty eight cases (4%) of A(H1N1)v reported in the EU/EEA countries travelled to other continents than Americas or Europe.

The information on hospital admission was available for 7,261 cases reported from 27 countries. Among these, 556 (7.3%) were reported having been admitted to hospital. It is important to note that in some countries hospitalisation was reported for isolation purposes (e.g. Austria, France), and that other countries have changed their strategy for hospital admission (e.g. UK is admitting patients now on clinical grounds). Therefore 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)v infection, travel association and hospital admission, 29 EU/EEA countries, as of 6 July 2009

[Country - Aggregated case reports: Cumulative number of confirmed cases / Individual case reports: Total cases(2) - Travel-related(2) - Hospitalised(2, 3) - Last reporting date]

1. Austria 19 / 18 - 15 - 16 - 5/7
2. Belgium 54 / 54 - 43 - 12 - 4/7
3. Bulgaria 13 / 8 - 4 - 8 - 29/6
4. Cyprus 117 / 82 - 10 - 20 - 3/7
5. Czech Republic 15 / 15 - 15 - 3 - 2/7
6. Denmark 66 / 65 - 37 - 6 - 5/7
7. Estonia 13 / 13 - 11 - 8 - 26/6
8. Finland 62 / 43 - 38 - 3 - 2/7
9. France 318 / 318 - 231 - 182 - 3/7
10. Germany 527 / 521 - 217 - 82 - 3/7
11. Greece 151 / ... - ... - ... - ...
12. Hungary 21 / 12 - 10 - 3 - 3/7
13. Iceland 4 / 4 - 3 - 0 - 22/6
14. Ireland 74 / 63 - 55 - 1 - 3/7
15. Italy 146 / 100 - 87 - 26 - 30/6
16. Lithuania 1 / 2 - 1 - 0 - 3/7
17. Luxembourg 3 / 6 - 4 - 1 - 30/6
18. Latvia 6 / 1 - 1 - 1 - 25/6
19. Malta 16 / 2 - 2 - 0 - 2/7
20. Netherlands 142 / 75 - 41 - 1 - 3/7
21. Norway 41 / 27 - 23 - 1 - 2/7
22. Poland 25 / 19 - 16 - 13 - 1/7
23. Portugal 45 / 18 - 18 - 15 - 2/7
24. Romania 44 / 44 - 27 - 44 - 6/7
25. Slovakia 19 / 18 - 17 - 15 - 6/7
26. Slovenia 14 / 7 - 7 - 0 - 3/7
27. Spain 776 / 113 - 74 - ... - 28/5
28. Sweden 87 / 84 - 59 - 5 - 3/7
29. United Kingdom 7447 / 5974 - 414 - 90 - 3/7

• Total 10,266 / 7706 - 1480 - 556

• (1) Reported daily through epidemic intelligence. (2) Reported as individual data. (3) Some hospitalisations were for isolation purposes.
• - no information available

Epidemic curves

Figure 1 compares the distribution of A(H1N1)v influenza cases by date of onset from the individual case reports (n=5,191) with the distribution of A(H1N1)v cases by reporting date from the aggregated case reports (n=10,328) from 11 April to 6 July 2009. The first peak appeared on 27 April in cases reported by date of onset (29 cases) and on 4 May in the aggregate case-reporting system (36 cases).

The reporting delay between date of onset and date of reporting is seven days for the first peak.

So far, the highest number of cases reported per date of onset (331) occurred on 22 June. As there is a reporting delay (between onset and reporting), we cannot yet say whether there is a decline or not for the epicurve by disease onset. The high number of cases reported on 30 June in aggregate reports (2645) is due to batch reporting from the United Kingdom.

Date of reporting (aggregate): 2645 cases reported on 30/06/2009 due to batch reporting from the UK

Information both on the date of onset and travel history was available for 5120 cases (3773 cases for domestic cases and 1349 cases for travel-related), which represents 66% of the total number of individual cases reported.
(...)

Figure 2 shows the distribution of domestic and travel-related cases of influenza A(H1N1)v infections by date of onset, as reported by 28 EU/EEA countries. Nine nine percent (296/329) of the case reported on 22 June were domestic.

Until mid-May, a large proportion of cases had travelled to Mexico. The proportion of cases that travelled to the USA increased after 13 May. In June, cases were returning from South America. Cases with travel history within the EU/EEA countries were reported from 30 May onwards. Cases with travel history outside Europe and Americas were reported from 8 June onwards.
(...)


Age and gender distribution

As shown in Table 2, information on age and gender of influenza A(H1N1)v infections is available for 6560 cases (85%). The male-to-female ratio is 1.1 (3417 males and 3143 females). Children and young adults under 20 years of age account for 54% of cases and 77% of cases are under 30 years of age (Figure 3).

Table 2 Distribution by age and gender of individual case reports of influenza A(H1N1)v infection, 28 EU/EEA countries, as of 6 July 2009 (n=6560)

[Age groups - Female - Male - Total - Percentage]

• Under 10: 688 - 770 - 1458 - 22%
• 10 to 19: 956 - 1167 - 2123 - 32%
• 20 to 29: 724 - 786 - 1510 - 23%
• 30 to 39: 316 - 289 - 605 - 9%
• 40 to 49: 236 - 234 - 470 - 7%
• 50 to 59: 157 - 107 - 264 - 4%
• ≥60: 66 - 64 - 130 - 2%
• Total: 3143 - 3417 - 6560

(...)

As shown in Table 3, information on age and travel history of influenza A(H1N1)v cases was available for 7681 cases (85%). The number of domestic cases is four times higher than the number of travel-related cases. This reflects the cases profiles mainly reported from the United Kingdom.

The proportion of travel-related cases aged 20 years or older (77%) was significantly higher when compared with domestic cases aged less than 20 (64%, X2=836p<0.001) The highest number of travel related cases was observed in the age group 20 to 29 years and the highest number of domestic cases was observed in the age group 10 to 19 years (Figure 4).


Table 3 Distribution by age and travel status of individual case reports of influenza A(H1N1)v infection, 28 EU/EEA countries, as of 6 July 2009 (n=7,681)

[Age groups - Domestic - Travel-related - Total]

• Under 10: 1681 - 123 - 1804
• 10?19: 2302 - 222 - 2524
• 20?29: 1089 - 541 - 1630
• 30?39: 418 - 256 - 674
• 40?49: 335 - 183 - 518
• 50?59: 181 - 98 - 279
• ≥60: 179 - 73 - 252
• Total: 6185 - 1496 - 7681

(...)


Clinical presentation

Symptoms were not reported by Belgium and Slovenia.

In the United Kingdom, information on symptoms was available for most of the symptoms in the first 301 reported cases. Therefore, frequencies of symptoms were calculated on data reported by 26 countries (not available in Belgium and Slovenia) with a denominator of 1972 cases (301 cases were included from the UK).

The frequencies of symptoms were:

• 81% for general symptoms (at least one case with fever, headache, muscle pain or join pain)
• 70% for respiratory symptoms (at least one case with dry/productive cough, sore throat, tunny nose, sneezing, shortness of breath)
• 14% for gastro-intestinal symptoms (at least one case with diarrhoea, vomiting, nausea)
• 37% in the category ?other? (at least one case with conjunctivitis, nose bleeding, altered consciousness, various other).

The most frequent symptoms reported in the category ?other? are : cough (187, 9%), fatigue (180, 9%).


Underlying conditions

The information on underlying conditions was available among 1695 cases (information not reported by Belgium, Slovenia, and Spain, information reported on the first 300 cases in the UK).

Among 1695 reported cases of A(H1N1)v cases, 165 (9.7%) were reported with at least one underlying condition.

Among 1695 cases, 22 (1.3%) were pregnant women.

Thirty two cases were reported with chronic lung diseases, 10 with chronic heart diseases and two with both lung and heart chronic diseases. Eleven cases had history of diabetes, and four of them also had heart and/or lung chronic conditions. The number of cases with history of cancer or HIV was five for each condition (Figure 3).

Among 1695 reported cases of A(H1N1)v cases, 76 (4.5%) persons were reported with an underlying condition in the category ?Other?. Among those, 13 had asthma(including 2 mild asthma), five had kidney and or liver related diseases. Other listed conditions/diseases are related to ear (4), allergy (3), gastro-enterology (3), neurological disorders (3), arthritis (2), hayfever (2), hypertention (2), urinary infection (2), Chron disease (1), congenital heart disorder (1), Eczema (1), Hashimotos disease (1), hepatitis B(1), myalgic encephalomyelitis (1), obesity and history of coronary artery (1), facial paralysie, laparotomie, seizure, septicaemia, spontaneous penumothorax.
(...)


Treatment and prophylaxis

Among 6856 cases with available information on antiviral treatment, 53% were reported having received antiviral treatment.

Among 827 cases with available information on prophylaxis, 6% were reported having received oseltamivir.

Among 6,719 cases (87% of all reported cases) with available information on previous seasonal influenza vaccination, only 1.4% were reported having received vaccination during the last season.


Conclusion

Results presented in this report provide descriptive analysis on A(H1N1)v cases reported in EU/EEA countries over a period of two months. As a large proportion of cases is reported by one country (the United Kingdom), specific analysis will be explored in order to look at trends in specific countries.

A particular focus was given on description of the diversity of symptoms among all cases and patients profiles for underlying conditions. Regarding symptoms, a large proportion was classified in the category ?other?. There is a need to agree on a common list of symptoms to be reported in a standard surveillance protocol at EU level in order to make this information comparable between countries. There still should be a way to capture un-expected symptoms reflecting a large severity range. It was possible to determine a proportion of patients with one or more underlying conditions (9.7%) among a group of 1695 reported cases.

Likewise the symptoms, the list of underlying conditions reported in the category ?other? was long.

Reporting information on individual A(H1N1)v cases is becoming challenging in some countries. In the meeting on Surveillance in a Pandemic 14 and 15 July in Stockholm options will be discussed how surveillance should be best done to provide the information necessary for public health action in a feasible way.


References

[1] Surveillance Group for New Influenza A(H1N1) Virus Investigation and Control in Spain. New influenza A(H1N1) virus infections in Spain, April-May 2009. Euro Surveill. 2009;14(19)ii=19209. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19209
[2] Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, HPA Northern Ireland Swine influenza investigation teams. Epidemiology of new influenza A (H1N1) virus infection, United Kingdom, April ? June 2009. Euro Surveill. 2009;14(22)ii=19232. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19232
[3] HPA Weekly National Influenza Report 24 June 2009 (Week 25). http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1246433639498
[4] New influenza A(H1N1) investigation teams. New influenza A(H1N1) virus infections in France, April ? May 2009. Euro Surveill. 2009;14(21)ii=19221. Available online:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19221
[5] Surveillance Group for New Influenza A(H1N1) Virus Investigation in Italy. Virological surveillance of human cases of influenza A(H1N1)v virus in Italy: preliminary results. Euro Surveill. 2009;14(24)ii=19247. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19247
[6] Neue Influenza A/H1N1 in Deutschland: Bewertung des bisherigen Geschehens.Vorabversion Epidemiologisches Bulletin Nr 25, Stand: 22.06.2009 http://www.rki.de/cln_153/nn_200120...Id=raw,property=publicationFile.pdf/25_09.pdf

Stockholm, June 2009

? European Centre for Disease Prevention and Control, 2009. Reproduction is authorised, provided the source is acknowledged.
-
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[Giuseppe]

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

Influenza A(H1N1)v infection - Update 11 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 11 July 2009, 17:00 hours CEST

[Original Full Text: LINK. EDITED.]


Main developments in past 24 hours

• 113 new cases confirmed reported from the EU and EFTA countries;
• 4388 new cases reported from non-EU and EFTA countries, reaching a total of 100199;
• Case reports for overseas territories of France and the Netherlands have been re-allocated in today?s report, therefore some discrepancies exist compared to July 10, 2009.
• Ecuador reported its first two fatal cases today
• The conclusions from the Pandemic 2009-2010 meetings organised by the Swedish EU

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 11 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 13,780 confirmed cases, including 16 deaths.

In the past 24 hours, 113 new cases were confirmed from the EU and EFTA countries.

Please note that Table 1 and Table 2 show some discrepancies compared to the situation report for July 10, 2009. This is because under the French confirmed cases we have now included France, Reunion-Mayotte, Antilles-Guyane, French Polynesia and French New Caledonia. For the Netherlands we have included all cases from the Netherlands, Aruba and Netherlands Antilles.


Reports from the UK - including a death in a previously health individual

Reports from the UK indicate that it is the most affected country in Europe to date and last week the authorities reported that they were moving to a strategy of Treatment rather than Containment which ECDC and WHO would call Mitigation. Details of that policy change are available from the UK Department of Health.

The Health Protection Agency is now giving weekly reports on the epidemiology in the UK. The most recent is from July 9th.

Media reported on a death in the UK from influenza A(H1N1)v which occurred in an otherwise healthy person with no risk factors for severe disease.

All other deaths in the UK from influenza A(H1N1)v were reported in persons from risk groups. It should be noted that such a few cases of severe disease and even death have been reported in healthy people in other countries during this pandemic as is also described for seasonal influenza. Even though such occurrences are rare, they are currently being investigated further. Further cases like this are to be occasionally expected in Europe.

Outside of the EU and EFTA countries, a total of 4388 new cases have been reported within the last 24 hours, including 53 new fatal cases: United States (41), Uruguay (3), Ecuador (2), El Salvador (2), Canada (2), Costa Rica (1), Brazil (1) and Peru (1). The global number of confirmed cases is 113,940 and 560 deaths.


Public Health developments

Conclusions from Pandemic 2009-2010 meetings organised by the Swedish EU Presidency - July 2-3rd and July 6-7th - Technical Workshop

There have been two important meetings organised by the Swedish Presidency in the past week concerning the 2009-2010 Pandemic of Influenza A(H1N1)v

The first was a technical workshop and was chaired by Dr Didier Houssin, the Chief Medical Officer for France.

This meeting focused on moving to mitigation and treatment, vaccines, public health measures and cross-sectoral work in EU countries.

The presentations from that workshop and the conclusions of the meeting are available on the Swedish Presidency Web-site.

They include a presentation of how influenza A(H1N1)v affected New York and the experiences learnt from there. In the summary report of the meeting, the main issues covered were: lessons learned so far, next steps, EU and International cooperation, vaccines and vaccination.


Among the ?Lessons Learned? the most important were:

• That trying to contain the virus in Europe with Containment Strategies was unsustainable. The UK presented why it has switched to a Treatment Approach. The meeting agreed that in view of cases reported, all countries would need to adopt mitigation strategies once they were affected.
• It is important to closely monitor the severity of the pandemic indicators such as mortality and intensive care use.
• There is also a need for countries to coordinate primary and secondary care to deal with the inevitable surge in people needing care as the pressure on emergency departments is expected to increase.
• Europe is diverse and the pandemic will not affect all countries at the same time. The actions taken will therefore differ in Member States. Equally countries will not take action all at the same time and a coordinated action is not necessarily a uniform action.
• Pandemic plans must be reviewed and adapted during the course of the outbreak.
• Schools will potentially close during the pandemic because of sickness in staff and pupils and all countries should prepare for this. Countries could use early (proactive) school closure as a possible preventive tool. However, it was recognised that this had only limited impact and experience shows that it has many demerits and could be undermined by children still meeting outside of schools. This measure should only be considered in the context of other measures and the negative impact it can have if attempted without adequate preparation
• Cross-sectoral EU coordination should be developed by Member States including what to do at borders and particularly to improve cooperation in sectors other than health.
• In addition it was agreed that:
  • Early experiences on antivirals and public health actions would be shared as would future experiences with pandemic vaccines.
  • Updates on when the vaccines are expected to be developed, produced and licensed should be made available on a regular basis.
  • Plans should be developed by Member States for the use of available vaccines for risk groups (those at higher risk of developing severe disease in a pandemic) and target groups (other groups to who vaccine will be offered). It was recognised that decisions on the latter may in particular vary from Member State to Member State.

Informal Health Council

Following the technical workshop the Health Ministers of the European Union Member States on Monday July 6th discussed their experience to date with the pandemic and future areas of cooperation to improve preparedness for the pandemic. The Ministers received presentations from ECDC, the European Medicines Agency (EMEA) and they were addressed by video-link by Dr Margaret Chan, Director General of WHO.

It was reported that work is ongoing on the development of a common strategy that can be decided on by the Health Ministers in the autumn. The Swedish Presidency announced that an extra formal EPSCO meeting would be planned for the beginning of October and that the continued work would be carried out in close cooperation with the WHO.

The Ministers discussed the importance of ensuring that all those living in the EU know how best to protect themselves and their family from influenza. It was emphasised that possible measures should be based on each Member State taking responsibility for planning and taking measures for its own population.

An important starting point is also the ambitions of each Member State to contribute to solidarity within the EU and globally. Influenza and its effects should quickly be integrated into all the EU?s policy areas so as to take charge of the multi-sectoral dimension.

The Member States will continue to look into ways in which the EU can support the international community in dealing with a pandemic. The Presidency noted that the cooperation will encompass different measures regarding vaccines, antiviral drugs and other public health measures.

In this context, it is important to develop strategies to protect people in different risk groups. The Member States also discussed the transition from attempting to delay or contain the pandemic to minimising the effects of the pandemic (mitigation). It was noted that such a transition must, however, occur at a point in time that is appropriate for the respective Member State. It was felt that at an EU level, it should be possible to reach agreement on how to communicate this in the best way to the Member States? citizens.


Guidance on Caring for Pregnant Women

The Public Health Agency of Canada (PHAC) issued on July 10, 2009 ?Interim Clinical Guidance for Pregnant and Breastfeeding Women with Influenza-Like Illness in the context of the Pandemic H1N1 2009 Virus?. As was reported in the ECDC Situation Report for July 10, 2009, ?pregnancy? was reported as the second most common underlying condition in confirmed cases in the EU.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 11 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria .... - 19 - ...
2. Belgium 13 - 87 - ...
3. Bulgaria ... - 14 - ...
4. Cyprus 32 - 250 - ...
5. Czech Republic ... - 20 - ...
6. Denmark ... - 73 - ...
7. Estonia ... - 15 - ...
8. Finland ... - 88 - ...
9. France*** 31 - 434 - ...
10. Germany ... - 691 - ...
11. Greece ... - 222 - ...
12. Hungary ... - 26 - ...
13. Iceland ... - 4 - ...
14. Ireland 12 - 116 - ...
15. Italy ... - 180 - ...
16. Latvia 2 - 4 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta 9 - 75 - ...
20. Netherlands**** ... - 152 - ...
21. Norway ... - 60 - ...
22. Poland ... - 31 - ...
23. Portugal 5 - 84 - ...
24. Romania 2 - 53 - ...
25. Slovakia ... - 27 - ...
26. Slovenia 1 - 17 - ...
27. Spain ... - 1034 - 2
28. Sweden ... - 135 - ...
29. Switzerland 6 - 133 - ...
30. United Kingdom ... - 9718 - 14

• Total 113 - 13780 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 8 July 17:00 hours and 9 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (****) Cases from the Netherlands include those reported from Aruba and the Netherlands Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 11 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man 1 - 3 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 3 - 37 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 19 - ...
3. Egypt ... - 79 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan ... - 25 - ...
8. Kuwait ... - 39 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman ... - 5 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia ... - 149 - ...
16. Syria ... - 1 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 21 - ...
5. Mauritius ... - 1 - ...
6. Seychelles ... - 1
7. South Africa ... - 53 - ...
8. Tanzania ... - 1 - ...
9. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada 288 - 9717 - 39
2. Mexico ... - 11699 - 121
3. ***USA 3344 - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Bahamas 7 - 17 - ...
3. Barbados 3 - 20 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 2 - ...
6. Cayman Islands ... - 14 - ...
7. Costa Rica 74 - 351 - 4
8. Cuba ... - 109 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador 46 - 365 - 3
12. Guatemala 39 - 339 - 2
13. Guyana ... - 2 - ...
14. Honduras ... - 123 - 1
15. Jamaica ... - 33 - 1
16. Nicaragua 22 - 357 - ...
17. Panama 23 - 480 - ...
18. Saint Lucia ... - 1 - ...
19. Saint Vincent ... - 1 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2677 - 82
2. Bolivia ... - 547
3. Brazil 50 - 1027 - 2
4. Chile ... - 9135 - 19
5. Colombia 9 - 152 - 4
6. Ecuador 35 - 239 - 2
7. Paraguay 4 - 118 - 3
8. Peru 249 - 1580 - 4
9. Uruguay 30 - 550 - 9
10. Venezuela ... - 222 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 14 - ...
2. Bangladesh ... - 19 - ...
3. China (mainland) ... - 1223 - ...
4. Hong Kong SAR China ... - 1178 - ...
5. India ... - 153 - ...
6. Japan ... - 2273 - ...
7. Macao SAR China ... - 73 - ...
8. Nepal ... - 6 - ...
9. South Korea 81 - 367 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 16 - 255 - 1
2. Cambodia ... - 8 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic ... - 6 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam ... - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 73 - 8006 - 18
2. Cook Islands ... - 1 - ...
3. Fiji ... - 19 - ...
4. New Zealand ... - 1555 - 6
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Vanuatu ... - 3 - ...

• TOTAL 4397 - 100160 - 544

• 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.
• (*) Cases reported between 6 July 17:00 hours and 7 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

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[AlaskaDenise]

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

It's good to read the following....

This meeting focused on moving to mitigation and treatment, vaccines, public health measures ....

In addition it was agreed that:
Early experiences on antivirals and public health actions would be shared...

The Ministers discussed the importance of ensuring that all those living in the EU know how best to protect themselves and their family from influenza...

.... it is important to develop strategies to protect people in different risk groups.

.

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 12 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 12 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 16 new cases confirmed reported from the EU and EFTA countries;
• 613 new cases reported from non-EU and EFTA countries, reaching a total of 100773;

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 12 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries are reporting a total of 13,796 confirmed cases, including 16 deaths. In the past 24 hours, 16 new cases were confirmed from the EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 613 new cases have been reported within the last 24 hours, including 12 new fatal cases reported from Argentina. The global number of confirmed cases is 114569 and 572 deaths.


Recent Publication

?Patients With Severe Novel Influenza A (H1N1) Virus Infections Referred to a Tertiary-Care Intensive Care Unit ? Michigan 2009.? MMWR 2009; July 10.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0710a1.htm

This report summarizes the clinical characteristics of ten patients who were critically ill with novel influenza A (H1N1) virus infection at a tertiary-care intensive care unit in Michigan.

All patients had respiratory failure and acute respiratory distress syndrome (ARDS), and required advanced mechanical ventilation. The described group of patients is notable for its predominance of men, high proportion (7/10) of extreme obesity (body mass index ≥ 40), multiple organ dysfunction syndrome (MODS) (9/10) and blockage of blood vessels in the lungs (5/10).

Whether or not extreme obesity is an independent risk factor for severe complications of novel influenza A (H1N1) virus infection cannot be concluded from this study.

It is recommended to administer antiviral treatment as soon as possible to hospitalized patients with suspected novel influenza A (H1N1) virus infection.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 12 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria .... - 19 - ...
2. Belgium ... - 87 - ...
3. Bulgaria ... - 14 - ...
4. Cyprus 8 - 258 - ...
5. Czech Republic ... - 20 - ...
6. Denmark ... - 73 - ...
7. Estonia ... - 15 - ...
8. Finland ... - 88 - ...
9. France*** ... - 434 - ...
10. Germany ... - 691 - ...
11. Greece ... - 222 - ...
12. Hungary ... - 26 - ...
13. Iceland ... - 4 - ...
14. Ireland 3 - 119 - ...
15. Italy ... - 180 - ...
16. Latvia ... - 4 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta ... - 75 - ...
20. Netherlands**** ... - 152 - ...
21. Norway ... - 60 - ...
22. Poland ... - 31 - ...
23. Portugal 2 - 86 - ...
24. Romania ... - 53 - ...
25. Slovakia ... - 27 - ...
26. Slovenia 3 - 20 - ...
27. Spain ... - 1034 - 2
28. Sweden ... - 135 - ...
29. Switzerland ... - 133 - ...
30. United Kingdom ... - 9718 - 14

• Total 16 - 13796 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (****) Cases from the Netherlands include those reported from Aruba and the Netherlands Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 12 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... -2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man ... - 3 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia ... - 37 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 19 - ...
3. Egypt 11 - 90 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan 7 - 32 - ...
8. Kuwait 3 - 42 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman ... - 5 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia ... - 149 - ...
16. Syria 1 - 2 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 21 - ...
5. Mauritius ... - 1 - ...
6. Seychelles ... - 1
7. South Africa ... - 53 - ...
8. Tanzania ... - 1 - ...
9. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 9717 - 39
2. Mexico ... - 11699 - 121
3. ***USA ... - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Bahamas ... - 17 - ...
3. Barbados ... - 20 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 2 - ...
6. Cayman Islands ... - 14 - ...
7. Costa Rica ... - 351 - 4
8. Cuba ... - 109 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 365 - 3
12. Guatemala ... - 339 - 2
13. Guyana ... - 2 - ...
14. Honduras ... - 123 - 1
15. Jamaica ... - 33 - 1
16. Nicaragua ... - 357 - ...
17. Panama ... - 480 - ...
18. Saint Lucia ... - 1 - ...
19. Saint Vincent ... - 1 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina 251 - 2928 - 94
2. Bolivia ... - 547 - ...
3. Brazil ... - 1027 - 2
4. Chile ... - 9135 - 19
5. Colombia ... - 152 - 4
6. Ecuador ... - 239 - 2
7. Paraguay ... - 118 - 3
8. Peru ... - 1580 - 4
9. Uruguay ... - 550 - 9
10. Venezuela 9 - 231 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 14 - ...
2. Bangladesh ... - 19 - ...
3. China (mainland) ... - 1223 - ...
4. Hong Kong SAR China ... - 1178 - ...
5. India ... - 153 - ...
6. Japan ... - 2273 - ...
7. Macao SAR China ... - 73 - ...
8. Nepal ... - 6 - ...
9. South Korea ... - 367 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 255 - 1
2. Cambodia ... - 8 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic ... - 6 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam ... - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 331 - 8337 - 18
2. Cook Islands ... - 1 - ...
3. Fiji ... - 19 - ...
4. New Zealand ... - 1555 - 6
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Vanuatu ... - 3 - ...

• TOTAL 613 - 100773 - 556

• 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.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)
-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 13 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 13 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 245 new cases confirmed reported from the EU and EFTA countries;
• 2,129 new cases reported from non-EU and EFTA countries, reaching a total of 102,902;

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 13 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries have reported a total of 14,041 confirmed cases, including 16 deaths. In the past 24 hours, 245 new cases were confirmed from the EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 2,129 new cases have been reported within the last 24 hours, including 6 new fatal cases reported from Chile, 1 from Peru and 1 from New Zealand.

The global number of confirmed cases is 116,943 and 580 deaths. 1


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 13 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 14 - 33 - ...
2. Belgium 22 - 109 - ...
3. Bulgaria 2 - 16 - ...
4. Cyprus ... - 258 - ...
5. Czech Republic ... - 20 - ...
6. Denmark ... - 73 - ...
7. Estonia ... - 15 - ...
8. Finland 15 - 103 - ...
9. France*** 30 - 464 - ...
10. Germany 46 - 737 - ...
11. Greece 68 - 290 - ...
12. Hungary ... - 26 - ...
13. Iceland ... - 4 - ...
14. Ireland ... - 119 - ...
15. Italy ... - 180 - ...
16. Latvia 2 - 6 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta ... - 75 - ...
20. Netherlands**** ... - 152 - ...
21. Norway 5 - 65 - ...
22. Poland 2 - 33 - ...
23. Portugal 8 - 94 - ...
24. Romania ... - 53 - ...
25. Slovakia 1 - 28 - ...
26. Slovenia 1 - 21 - ...
27. Spain ... - 1034 - 2
28. Sweden 29 - 164 - ...
29. Switzerland ... - 133 - ...
30. United Kingdom ... - 9718 - 14

• Total 245 - 14041 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (****) Cases from the Netherlands include those reported from Aruba and the Netherlands Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 13 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 1 - ...
5. Island of Man ... - 3 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia ... - 37 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain 10 - 29 - ...
3. Egypt ... - 90 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 16 - ...
6. Israel ... - 727 - ...
7. Jordan ... - 32 - ...
8. Kuwait ... - 42 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman 1 - 6 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia ... - 149 - ...
16. Syria 1 - 3 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Cape Verde ... - 3 - ...
2. Ethiopia ... - 3 - ...
3. Ivory Coast ... - 2 - ...
4. Kenya ... - 21 - ...
5. Mauritius ... - 1 - ...
6. Seychelles ... - 1
7. South Africa 9 - 62 - ...
8. Tanzania ... - 1 - ...
9. Uganda ... - 1 - ...

• NORTH AMERICA

1. Canada ... - 9717 - 39
2. Mexico ... - 11699 - 121
3. ***USA ... - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 2 - ...
2. Bahamas ... - 17 - ...
3. Barbados ... - 20 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 2 - ...
6. Cayman Islands ... - 14 - ...
7. Costa Rica ... - 351 - 4
8. Cuba 35 - 144 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador ... - 365 - 3
12. Guatemala ... - 339 - 2
13. Guyana ... - 2 - ...
14. Honduras ... - 123 - 1
15. Jamaica ... - 33 - 1
16. Nicaragua ... - 357 - ...
17. Panama ... - 480 - ...
18. Saint Lucia ... - 1 - ...
19. Saint Vincent ... - 1 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2928 - 94
2. Bolivia ... - 547 - ...
3. Brazil ... - 1027 - 2
4. Chile 414 - 9549 - 25
5. Colombia ... - 152 - 4
6. Ecuador ... - 239 - 2
7. Paraguay ... - 118 - 3
8. Peru 173 - 1753 - 5
9. Uruguay ... - 550 - 9
10. Venezuela ... - 231 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 14 - ...
2. Bangladesh ... - 19 - ...
3. China (mainland) 79 - 1302 - ...
4. Hong Kong SAR China 87 - 1265 - ...
5. India ... - 153 - ...
6. Japan 383 - 2656 - ...
7. Macao SAR China ... - 73 - ...
8. Nepal ... - 6 - ...
9. South Korea ... - 367 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 255 - 1
2. Cambodia ... - 8 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic ... - 6 - ...
5. Malaysia ... - 468 - ...
6. Myanmar ... - 1 - ...
7. Philippines ... - 1709 - 1
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam ... - 248 - ...

• AUSTRALIA AND PACIFIC

1. Australia 713 - 9050 - 18
2. Cook Islands ... - 1 - ...
3. Fiji ... - 19 - ...
4. New Zealand 224 - 1779 - 7
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Vanuatu ... - 3 - ...

• TOTAL 2129 - 102902 - 564

• 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.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

-
------

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 14 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 14 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 253 new cases confirmed reported from the EU and EFTA countries;
• 2,148 new cases reported from non-EU and EFTA countries, reaching a total of 105,050;
• Media discussing three UK deaths with no underlying conditions, including a GP;
• Belgium announces a mitigation strategy and Finland stops contact tracing travellers;
• Nature online published a letter on in vivo and in vitro studies on the influenza A(H1n1)v strain;
• WHO immunization recommendations by SAGE were published.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 14 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries have reported a total of 14,294 confirmed cases, including 16 deaths. In the past 24 hours, 253 new cases were confirmed from the EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 2,148 new cases have been reported within the last 24 hours, including 9 deaths; 1 new fatal case reported from Australia, Jamaica, 2 from Bolivia, Philippines and 3 from Colombia. The global number of confirmed cases is 119,344 and 591 deaths.

Several UK and international media sources are discussing recent three deaths among people with no underlying conditions; a 30-year old man from Essex, a 6-year old girl from London and a 64?year old male general practitioner from Bedfordshire. The causes of death for the two latter are yet to be officially reported.

Cases of severe illness and death among previously healthy people are not unexpected during influenza pandemics or seasonal influenza epidemics. Health care workers will continue to be at risk of infection as the pandemic proceeds and appropriate infection control measures should be vigorously applied during contacts with potentially infectious patients.

Belgium officially announced yesterday a move towards mitigation as the national control strategy. This implies discontinuing contact tracing procedures and changing from laboratory based surveillance to surveillance via a sentinel network.

Finland announced discontinuing contact tracing for cases related to air and ground transport.

A letter published by the journal Nature is being discussed in the media today. The main results of the study suggest that sera from people born before 1920 have neutralizing antibody activity against the pandemic H1N1 strain. In addition, replication of the influenza A(H1n1)v virus in mice, ferrets and non-human primates is more efficient than with the seasonal H1N1 and causes more severe lung lesions in these species.


WHO recommendations on pandemic (H1N1) 2009 vaccines

The Strategy Advisory Group of Experts (SAGE) is the highest level of advisory bodies in WHO on immunization matters. SAGE met last week on 7 July to be updated about the epidemiological status and the clinical status of H1N1 as well as being provided with an update on expected vaccine availability. They also reviewed the status of production of the current seasonal epidemic vaccine.

At the end of the meeting SAGE delivered recommendations that have been adopted by the WHO Director-General last Friday on potential options for vaccine use.

First of all, SAGE does not consider that there is a need to recommend a "switch" from seasonal to pandemic vaccine production, as most of the production of the seasonal vaccine for the 2009-2010 influenza season in the northern hemisphere is almost complete and is therefore unlikely to affect production of pandemic vaccine.

Regarding pandemic (H1N1)v vaccines, any decision ? to be taken at country level according to the local epidemiological situation and vaccine availability ? should derive from which objective every single country might set among a) reduce transmission of the pandemic virus; b) protect the integrity of essential services; c) reduce morbidity and mortality.

In view of these three objectives countries might have, and depending on their own decision, they may consider immunization of different groups:

• all countries should immunize their health-care workers as a first priority to protect the essential health infrastructure;
• then, a step-wise approach to vaccinate particular groups may be considered as vaccines available initially will not be sufficient. SAGE suggests the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions:
  • pregnant women;
  • those aged above 6 months with one of several chronic medical conditions;
  • healthy young adults of 15 to 49 years of age;
  • healthy children;
  • healthy adults of 50 to 64 years of age;
  • and healthy adults of 65 years of age and above.

SAGE recommended to promote production and use of adjuvanted vaccines and live attenuated influenza vaccines, in view of the anticipated limited vaccine availability at global level. Under this perspective, it is very important to implement post-marketing surveillance of the highest possible quality, as some new technologies involved in the production of some pandemic vaccines, have not yet been extensively evaluated for their safety in certain population groups.

In the same way, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the international community will be essential for allowing countries to make necessary adjustments to their vaccination policies.

The briefing note on the WHO recommendations on pandemic (H1N1) vaccines is available at the link: http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090713/en/index.html

The audio file and the transcript of the press briefing is available at the link: http://www.who.int/mediacentre/multimedia/swineflupressbriefings/en/index.html

All background documents of the 7th July 2009 SAGE meeting are available at the link: http://www.who.int/immunization/sage/previous_july2009/en/index.html


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 14 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 2 - 35 - ...
2. Belgium 15 - 124 - ...
3. Bulgaria 1 - 17 - ...
4. Cyprus 39 - 297 - ...
5. Czech Republic ... - 20 - ...
6. Denmark 4 - 77 - ...
7. Estonia ... - 15 - ...
8. Finland 6 - 109 - ...
9. France*** ... - 464 - ...
10. Germany 26 - 763 - ...
11. Greece 33 - 323 - ...
12. Hungary ... - 26 - ...
13. Iceland ... - 4 - ...
14. Ireland 25 - 144 - ...
15. Italy 44 - 224 - ...
16. Latvia ... - 6 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta 7 - 82 - ...
20. Netherlands**** ... - 152 - ...
21. Norway ... - 65 - ...
22. Poland ... - 33 - ...
23. Portugal 5 - 99 - ...
24. Romania 2 - 55 - ...
25. Slovakia 2 - 30 - ...
26. Slovenia 4 - 25 - ...
27. Spain ... - 1034 - 2
28. Sweden 23 - 187 - ...
29. Switzerland 15 - 148 - ...
30. United Kingdom ... - 9718 - 14

• Total 253 - 14294 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (****) Cases from the Netherlands include those reported from Aruba and the Netherlands Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 14 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia 2 - 5 - ...
5. Island of Man 6 - 7 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 13 - 50 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 7 - ...
2. Bahrain ... - 29 - ...
3. Egypt 12 - 102 - ...
4. Iran ... - 1 - ...
5. Iraq 4 - 20 - ...
6. Israel ... - 727 - ...
7. Jordan ... - 32 - ...
8. Kuwait 2 - 44 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman 2 - 8 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia ... - 149 - ...
16. Syria ... - 3 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Botswana 1 - 1 - ...
2. Cape Verde ... - 3 - ...
3. Ethiopia ... - 3 - ...
4. Ivory Coast ... - 2 - ...
5. Kenya 1 - 22 - ...
6. Mauritius ... - 1 - ...
7. Seychelles ... - 1 - ...
8. South Africa 8 - 70 - ...
9. Tanzania ... - 1 - ...
10. Uganda 4 - 5 - ...

• NORTH AMERICA

1. Canada ... - 9717 - 39
2. Mexico ... - 11699 - 121
3. ***USA ... - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda 1 - 3 - ...
2. Bahamas 4 - 21 - ...
3. Barbados ... - 20 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 2 - ...
6. Cayman Islands ... - 14 - ...
7. Costa Rica ... - 351 - 4
8. Cuba ... - 144 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador 14 - 379 - 3
12. Guatemala ... - 339 - 2
13. Guyana ... - 2 - ...
14. Honduras ... - 123 - 1
15. Jamaica 6 - 39 - 2
16. Nicaragua ... - 357 - ...
17. Panama ... - 480 - ...
18. Saint Lucia ... - 1 - ...
19. Saint Vincent ... - 1 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 2928 - 94
2. Bolivia ... - 547 - 2
3. Brazil ... - 1027 - 2
4. Chile ... - 9549 - 25
5. Colombia 14 - 166 - 7
6. Ecuador 17 - 256 - 2
7. Paraguay 7 - 125 - 3
8. Peru 159 - 1912 - 5
9. Uruguay ... - 550 - 9
10. Venezuela 3 - 234 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 14 - ...
2. Bangladesh ... - 19 - ...
3. China (mainland) 60 - 1362 - ...
4. Hong Kong SAR China 62 - 1327 - ...
5. India ... - 153 - ...
6. Japan 263 - 2919 - ...
7. Macao SAR China 8 - 81 - ...
8. Nepal ... - 6 - ...
9. South Korea 79 - 446 - ...
10. Sri Lanka ... - 22 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 45 - 300 - 1
2. Cambodia 1 - 9 - ...
3. Indonesia ... - 28 - ...
4. Laos Peoples Democratic Republic 1 - 7 - ...
5. Malaysia 304 - 772 - ...
6. Myanmar ... - 1 - ...
7. Philippines 959 - 2668 - 3
8. Singapore ... - 1217 - ...
9. Thailand ... - 2428 - 9
10. Vietnam 61 - 309 - ...

• AUSTRALIA AND PACIFIC

1. Australia ... - 9050 - 19
2. Cook Islands ... - 1 - ...
3. Fiji 25 - 44 - ...
4. New Zealand ... - 1779 - 7
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Vanuatu ... - 3 - ...

• TOTAL 2148 - 105050 - 573

• 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.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also include confirmed cases from Puerto Rico

(...)

-
-----

 

[Giuseppe]

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

Influenza A(H1N1)v infection - Update 15 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 15 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 157 new cases confirmed reported from the EU and EFTA countries;
• 6,492 new cases reported from non-EU and EFTA countries, reaching a total of 111,542;

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 15 July 2009, 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

Out of the 31 EU and EFTA countries, 30 countries have reported a total of 14,451 confirmed cases, including 16 deaths. In the past 24 hours, 157 new cases and no fatal cases were confirmed from the EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 6,492 new cases have been reported within the last 24 hours, including 78 deaths; 43 from Argentina, 15 from Thailand, 8 from Chile, 3 from Mexico and Costa Rica, 2 from Australia and New Zealand and 1 from Brazil and Ecuador.

Globally, the total number of confirmed and reported influenza A(H1n1)v cases to date is 125,993 and 667 deaths.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 15 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 35 - ...
2. Belgium ... - 124 - ...
3. Bulgaria ... - 17 - ...
4. Cyprus ... - 297 - ...
5. Czech Republic 1 - 21 - ...
6. Denmark ... - 77 - ...
7. Estonia 2 - 17 - ...
8. Finland 2 - 111 - ...
9. France*** ... - 464 - ...
10. Germany ... - 763 - ...
11. Greece ... - 323 - ...
12. Hungary ... - 26 - ...
13. Iceland 3 - 7 - ...
14. Ireland ... - 144 - ...
15. Italy ... - 224 - ...
16. Latvia ... - 6 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta 2 - 84 - ...
20. Netherlands**** 12 - 164 - ...
21. Norway 18 - 83 - ...
22. Poland 2 - 35 - ...
23. Portugal 3 - 102 - ...
24. Romania 1 - 56 - ...
25. Slovakia ... - 30 - ...
26. Slovenia 3 - 28 - ...
27. Spain 65 - 1099 - 2
28. Sweden 13 - 200 - ...
29. Switzerland 30 - 178 - ...
30. United Kingdom ... - 9718 - 14

• Total 157 - 14451 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (****) Cases from the Netherlands include those reported from Aruba and the Dutch Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 15 July 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**]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia ... - 7 - ...
5. Island of Man ... - 5 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation ... - 3 - ...
9. Serbia 4 - 54 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria 1 - 8 - ...
2. Bahrain ... - 29 - ...
3. Egypt ... - 102 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 20 - ...
6. Israel 163 - 890 - ...
7. Jordan ... - 32 - ...
8. Kuwait ... - 44 - ...
9. Lebanon ... - 53 - ...
10. Libya ... - 1 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman 2 - 10 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia 67 - 216 - ...
16. Syria ... - 3 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Botswana 1 - 2 - ...
2. Cape Verde ... - 3 - ...
3. Ethiopia ... - 3 - ...
4. Ivory Coast ... - 2 - ...
5. Kenya ... - 22 - ...
6. Mauritius ... - 1 - ...
7. Seychelles ... - 1 - ...
8. South Africa 23 - 93 - ...
9. Tanzania ... - 1 - ...
10. Uganda ... - 5 - ...

• NORTH AMERICA

1. Canada 138 - 9855 - 39
2. Mexico 946 - 12645 - 124
3. ***USA ... - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 3 - ...
2. Bahamas ... - 21 - ...
3. Barbados ... - 20 - ...
4. Bermuda ... - 2 - ...
5. British Virgin Islands ... - 2 - ...
6. Cayman Islands ... - 14 - ...
7. Costa Rica 77 - 428 - 7
8. Cuba ... - 144 - ...
9. Dominica ... - 1 - ...
10. Dominican Republic ... - 108 - 2
11. El Salvador 25 - 404 - 3
12. Guatemala ... - 339 - 2
13. Guyana ... - 2 - ...
14. Honduras ... - 123 - 1
15. Jamaica ... - 39 - 2
16. Nicaragua 11 - 368 - ...
17. Panama 27 - 507 - ...
18. Saint Lucia ... - 1 - ...
19. Saint Vincent ... - 1 - ...
20. Suriname ... - 11 - ...
21. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina 128 - 3056 - 137
2. Bolivia 38 - 585 - 2
3. Brazil ... - 1027 - 3
4. Chile 942 - 10491 - 33
5. Colombia 9 - 175 - 7
6. Ecuador 21 - 277 - 3
7. Paraguay ... - 125 - 3
8. Peru 170 - 2082 - 5
9. Uruguay ... - 550 - 9
10. Venezuela ... - 234 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan 1 - 15 - ...
2. Bangladesh 3 - 22 - ...
3. China (mainland) ... - 1362 - ...
4. Hong Kong SAR China 62 - 1389 - ...
5. India 76 - 229 - ...
6. Japan 205 - 3124 - ...
7. Macao SAR China 6 - 87 - ...
8. Nepal 8 - 14 - ...
9. South Korea ... - 446 - ...
10. Sri Lanka 15 - 37 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam 34 - 334 - 1
2. Cambodia ... - 9 - ...
3. Indonesia 84 - 112 - ...
4. Laos Peoples Democratic Republic ... - 7 - ...
5. Malaysia ... - 772 - ...
6. Myanmar 1 - 2 - ...
7. Philippines ... - 2668 - 3
8. Singapore ... - 1217 - ...
9. Thailand 1629 - 4057 - 24
10. Vietnam ... - 309 - ...

• AUSTRALIA AND PACIFIC

1. Australia 1339 - 10389 - 21
2. Cook Islands ... - 1 - ...
3. Fiji 29 - 73 - ...
4. New Zealand 205 - 1984 - 9
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Tonga 2 - 2 - ...
9. Vanuatu ... - 3 - ...

• TOTAL 6492 - 111542 - 651

• 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.
• (*) Cases reported between 11 July 17:00 hours and 12 July 17:00 hours
• (**) Deaths are included in the cumulative number of confirmed cases
• (***) Cases in the US include both probable and confirmed cases. They also 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)v infection - Update 16 July 2009, 17:00 hours CEST (ECDC, edited)

ECDC SITUATION REPORT

Influenza A(H1N1)v infection - Update 16 July 2009, 17:00 hours CEST

[Original Full Document: LINK. EDITED.]


Main developments in past 24 hours

• 208 new cases and no new deaths confirmed and reported from the EU and EFTA countries;
• 2,072 new cases reported from non-EU and EFTA countries, reaching a total of 113,614;
• Ireland and Greece announced moving towards mitigation as a control strategy.

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 16 July 2009, 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. Several countries have now announced concentrating on mitigation measures and this usually implies focused laboratory testing. For these countries, the reported numbers of cases presented in this report will severely underestimate the true incidence in the country and will not be comparable to countries still recommending laboratory tests of all suspected influenza cases.


Epidemiologic update

Out of the 31 EU and EFTA countries, 30 countries have reported a total of 14,659 confirmed cases, including 16 deaths. In the past 24 hours, 208 new cases and no fatal cases were confirmed from the EU and EFTA countries.

Outside of the EU and EFTA countries, a total of 2,072 new cases have been reported within the last 24 hours, including 12 deaths; the first fatal case from Hong Kong, six cases from Canada, three from Australia, and one from New Zealand and Brazil.

Globally, the total number of confirmed and reported influenza A(H1N1)v cases to date is 128,273 and 679 deaths.


Other developments
Ireland and Greece announced a move towards mitigation as a control strategy.


Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 16 July 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria 13 - 48 - ...
2. Belgium ... - 124 - ...
3. Bulgaria ... - 17 - ...
4. Cyprus ... - 297 - ...
5. Czech Republic ... - 21 - ...
6. Denmark 9 - 86 - ...
7. Estonia 2 - 19 - ...
8. Finland 14 - 125 - ...
9. France** 17 - 481 - ...
10. Germany 71 - 834 - ...
11. Greece ... - 323 - ...
12. Hungary ... - 26 - ...
13. Iceland ... - 7 - ...
14. Ireland 2 - 146 - ...
15. Italy ... - 224 - ...
16. Latvia ... - 6 - ...
17. Lithuania ... - 5 - ...
18. Luxemburg ... - 13 - ...
19. Malta ... - 84 - ...
20. Netherlands*** ... - 164 - ...
21. Norway 22 - 105 - ...
22. Poland ... - 35 - ...
23. Portugal 9 - 111 - ...
24. Romania ... - 56 - ...
25. Slovakia 1 - 31 - ...
26. Slovenia 4 - 32 - ...
27. Spain ... - 1099 - 2
28. Sweden 38 - 238 - ...
29. Switzerland 6 - 184 - ...
30. United Kingdom ... - 9718 - 14

• Total 208 - 14659 - 16

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Deaths are included in the cumulative number of confirmed cases
• (**) Cases reported from France include those reported from Reunion-Mayotte (5), Antilles-Guyane (8), French Polynesia (5) and French New Caledonia (34).
• (***) Cases from the Netherlands include those reported from Aruba and the Dutch Antilles

Table 2: Reported cumulative number of confirmed cases and deaths of influenza A(H1N1)v as of 16 July 2009, 16:00 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*]

• OTHER EUROPEAN COUNTRIES and CENTRAL ASIA

1. Bosnia and Herzegovina ... - 2 - ...
2. Channel Islands ... - 16 - ...
3. Croatia ... - 3 - ...
4. Former Yugoslav Republic of Macedonia 4 - 9 - ...
5. Island of Man ... - 7 - ...
6. Monaco ... - 1 - ...
7. Montenegro ... - 10 - ...
8. Russian Federation 1 - 4 - ...
9. Serbia ... - 54 - ...
10. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria ... - 8 - ...
2. Bahrain ... - 29 - ...
3. Egypt 6 - 108 - ...
4. Iran ... - 1 - ...
5. Iraq ... - 20 - ...
6. Israel ... - 890 - ...
7. Jordan 2 - 34 - ...
8. Kuwait ... - 44 - ...
9. Lebanon 19 - 72 - ...
10. Libya 3 - 4 - ...
11. Morocco ... - 20 - ...
12. Occupied Palestinian Territory ... - 104 - ...
13. Oman ... - 10 - ...
14. Qatar ... - 23 - ...
15. Saudi Arabia 16 - 232 - ...
16. Syria ... - 3 - ...
17. Tunisia ... - 5 - ...
18. Turkey ... - 40 - ...
19. United Arab Emirates ... - 8 - ...
20. Yemen ... - 8 - ...

• AFRICA

1. Botswana ... - 2 - ...
2. Cape Verde ... - 3 - ...
3. Ethiopia ... - 3 - ...
4. Ivory Coast ... - 2 - ...
5. Kenya ... - 22 - ...
6. Mauritius ... - 1 - ...
7. Seychelles ... - 1 - ...
8. South Africa 10 - 103 - ...
9. Tanzania ... - 1 - ...
10. Uganda 1 - 6 - ...

• NORTH AMERICA

1. Canada 301 - 10156 - 45
2. Mexico ... - 12645 - 124
3. **USA ... - 37246 - 211

• CENTRAL AMERICA AND CARIBBEAN

1. Antigua and Barbuda ... - 3 - ...
2. Bahamas ... - 21 - ...
3. Barbados 2 - 22 - ...
4. Belize 15 - 15 - ...
5. Bermuda 2 - 4 - ...
6. British Virgin Islands ... - 2 - ...
7. Cayman Islands 8 - 22 - ...
8. Costa Rica ... - 428 - 7
9. Cuba ... - 144 - ...
10. Dominica ... - 1 - ...
11. Dominican Republic ... - 108 - 2
12. El Salvador ... - 404 - 3
13. Guatemala ... - 339 - 2
14. Guyana ... - 2 - ...
15. Haiti 3 - 3 - ...
16. Honduras ... - 123 - 1
17. Jamaica ... - 39 - 2
18. Nicaragua 16 - 384 - ...
19. Panama ... - 507 - ...
20. Saint Kitts and Nevis 1 - 1 - ...
21. Saint Lucia ... - 1 - ...
22. Saint Vincent ... - 1 - ...
23. Suriname ... - 11 - ...
24. Trinidad-Tobago ... - 65 - ...

• SOUTH AMERICA

1. Argentina ... - 3056 - 137
2. Bolivia ... - 585 - 2
3. Brazil 148 - 1175 - 4
4. Chile ... - 10491 - 33
5. Colombia 10 - 185 - 7
6. Ecuador ... - 277 - 3
7. Paraguay ... - 125 - 3
8. Peru ... - 2082 - 5
9. Uruguay ... - 550 - 9
10. Venezuela ... - 234 - ...

• NORTH-EAST AND SOUTH ASIA

1. Afghanistan ... - 15 - ...
2. Bangladesh ... - 22 - ...
3. China (mainland) 82 - 1444 - ...
4. Hong Kong SAR China 163 - 1552 - 1
5. India ... - 229 - ...
6. Japan 317 - 3441 - ...
7. Macao SAR China 3 - 90 - ...
8. Nepal ... - 14 - ...
9. South Korea ... - 446 - ...
10. Sri Lanka ... - 37 - ...
11. Taiwan ... - 72 - ...

• SOUTH-EAST ASIA

1. Brunei Darussalam ... - 334 - 1
2. Cambodia ... - 9 - ...
3. Indonesia ... - 112 - ...
4. Laos Peoples Democratic Republic ... - 7 - ...
5. Malaysia ... - 772 - ...
6. Myanmar ... - 2 - ...
7. Philippines ... - 2668 - 3
8. Singapore ... - 1217 - ...
9. Thailand ... - 4057 - 24
10. Vietnam 11 - 320 - ...

• AUSTRALIA AND PACIFIC

1. Australia 805 - 11194 - 24
2. Cook Islands ... - 1 - ...
3. Fiji ... - 73 - ...
4. New Zealand 123 - 2107 - 10
5. Papua New Guinea ... - 1 - ...
6. Republic of Palau ... - 1 - ...
7. Samoa ... - 1 - ...
8. Tonga ... - 2 - ...
9. Vanuatu ... - 3 - ...

• TOTAL 2072 - 113614 - 663

• 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. They also include confirmed cases from Puerto Rico

(...)

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