Global's Influenza A (H1N1) Update - June 14, 2009

GMS INFLUENZA A (H1N1) Update as of June 14, 2009
(1100 HRS PST)

The next update will be on Monday, June 15, at 08:30 PST
The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths by Country (as of 9 AM PST, June 14th)

*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48. New case information can be found in both the local/national and international news sections.

Local/National News

• On June 12th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 10th has risen to 3513 from 2978. Ontario still has the most cases in Canada (1781), followed by Quebec (706), Saskatchewan (270), Alberta (240), British Columbia (167), Nunavut (145), Manitoba (119), Nova Scotia (79), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 182 required hospitalization and four deaths have occurred. PHAC

International News

• Following the pandemic declaration by the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC) urged businesses to review their pandemic plans to make sure they're flexible enough to respond to a moderate or severe pandemic. Lisa Koonin, MN, MPH, a senior adviser with the CDC's influenza coordination unit, said that because influenza viruses are so unpredictable and the pandemic may change or become more severe in the fall, now is the time for businesses to revise pandemic plans or begin developing one if they don't already have one. CIDRAP


• A private school in San Diego County says 36 of its students are being quarantined in China while being tested for the H1N1 flu virus. Eileen Mullady, head of Pacific Ridge School in Carlsbad, says the ninth graders were at the end of a 13-day educational tour of the country when a few students developed the sniffles. She said Chinese health officials decided on Thursday to place the students, along with seven chaperones, under quarantine in a hotel. Mercury News
  
  

Today’s Key Question

Does the World Health Organization (WHO) expect the severity of the Influenza A (H1N1) to change over time?

On June 11th 2009, the WHO announced that the world was officially in the midst of a pandemic. The WHO’s Director General, Margaret Chan, asserted in her statement to the world, that the WHO, thanks to close monitoring, careful investigation, and open reporting, has obtained somewhat of a picture of the virus’ spread and the range of illness it is capable of causing. Because of this, the WHO has reason to believe that this pandemic, at least at present, will be of moderate severity. However, Chan warned that the virus is that which “writes the rules,” and, like other influenza viruses, this virus may, without warning, change these rules.

With this in mind, Chan asked that counties prepare to see cases, or the further spread of cases, in the near future. She also warned those countries in which the virus has appeared to have peaked, to be prepared for a second wave of illness, while countries with only a few reported cases should remain vigilant. In summary, the WHO cannot presently predict whether or not the severity of H1N1 will worsen, however, they acknowledge this possibility and are advocating continued awareness, surveillance and monitoring. WHO

Global's Daily Influenza A (H1N1) Update - May 14, 2009

GMS INFLUENZA A (H1N1) Daily Update as of May 14, 2009(0830 HRS PST)

Current WHO Pandemic Alert remains at Phase 5

Influenza A (H1N1) Cases and Related Deaths by Country (as of 8 AM PST May 14th)

WHO Regions & Country	Lab Confirmed Cases		Lab Confirmed Deaths
	Cases Confirmed on May 13th	Total Cases	Deaths Confirmed on May 13th	Total Deaths
AMERICAS
Mexico	387	2446	4	60
US	343	3352	0	3
Canada	31	389	0	1
El Salvador	0	4	0	0
Costa Rica	0	8	0	1
Columbia	1	7	0	0
Guatemala	0	3	0	0
Brazil	0	8	0	0
Panama	0	29	0	0
Argentina	0	1	0	0
Cuba	0	1	0	0
EUROPE
UK	3	71	0	0
Spain	2	100	0	0
Germany	0	12	0	0
France	1	14	0	0
Austria	0	1	0	0
Netherlands	0	3	0	0
Switzerland	0	1	0	0
Denmark	0	1	0	0
Ireland	0	1	0	0
Italy	0	9	0	0
Portugal	0	1	0	0
Sweden	0	2	0	0
Poland	0	1	0	0
Norway	0	2	0	0
Finland	0	2	0	0
EASTERN MEDITERRANEAN
Israel	0	7	0	0
WESTERN PACIFIC
China (incl. Hong Kong)	1	4	0	0
New Zealand	0	7	0	0
Australia	0	1	0	0
Japan	0	4	0	0
SOUTH-EAST ASIA
Rep. of Korea	0	3	0	0
Thailand	0	2	0	0
TOTALS	769	6497	4	65

Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #28.

Local/National News

• On May 13th, the Public Health Agency of Canada announced that 31 additional cases of Influenza A (H1N1) had been confirmed. Ontario still has the most cases in Canada (119), followed by British Columbia (92), Nova Scotia (65), Alberta (61), Quebec (26), Saskatchewan (16), Manitoba (4), PEI (3), New Brunswick (2), and the Yukon (1). Canada’s total case count is now at 389. PHAC


• The British Columbia Centre for Disease Control (BCCDC) is now reporting the following confirmed cases across the province:




• 35 in Fraser Health


• 2 in Interior Health


• 19 in Northern Health


• 24 in Vancouver Coastal Health


• 12 on Vancouver Island




• Canadian officials are weighing an Alberta hog farmer's request to cull 2,200 pigs that were exposed to the novel H1N1 influenza virus. The farmer believes the swine flu stigma will bar him from selling the herd and he is requesting $500,000 in compensation. However, officials from Canada's food safety agency have said culling the entire herd may not be warranted and that they would meet with the farmer again to discuss a solution. CanWest News


• Japan’s women’s soccer team has cancelled three friendly matches in Canada and the United States owing to fears over swine flu, the American soccer federation revealed on Tuesday. “This is an unfortunate situation, but one that we had absolutely no control over,” said U.S. Soccer president, Sunil Gulati. National Post

International News

• Yesterday, Sylvie Briand, acting director of the World Health Organization’s (WHO) Global Influenza Programme, signaled that the agency is stepping back from plans to develop a way to grade pandemic severity. She noted that this was recommended by WHO experts because they believe severity will vary from place to place, making the development of an index difficult and its use impractical. She said severity is based on three components: the virulence and transmissibility of the virus, the vulnerability of the population, and the capacity of a country to fight the disease. All three components can vary across countries and pandemic waves, Briand said. "This is why it's hard to have an index." CIDRAP


• Many people who have novel H1N1 influenza don't experience fever, which could make the illness difficult to identify, according to infectious disease expert Richard P. Wenzel of Virginia Commonwealth University. During recent consultations at two Mexican hospitals, he found about a third of the patients screened had no fever, but nearly all had a cough and malaise. About 12% had diarrhea, and he said passage of the virus in stools would present infection control problems. New York Times


• Yesterday, Chinese authorities confirmed that the 2nd case in mainland China was from Canada. The Health Ministry said the man, identified only by his surname, Lu, tested positive for the Type A H1N1 virus and was being treated in isolation in the eastern city of Jinan. Mr. Lu arrived in Beijing aboard an Air Canada flight Friday and spent three days untracked in the capital before leaving Monday by train for Jinan, by which time he had a fever, sore throat, and headache. Globe and Mail


• Mexico says Peru has agreed to lift its ban on direct flights from Mexico, but three other Latin American nations — Cuba, Ecuador and Argentina — still have such measures in place. Associated Press

Vaccine News

• According to a poll by Zogby International and the University of Texas Health Science Center, less than a third of U.S. adults would get a vaccination especially made to protect against the new H1N1 virus. The poll also found that that 38 percent were not vaccinated for annual influenza, nor did they follow recommendations to wash or clean their hands frequently to prevent infection and restrict travel to Mexico. Reuters

Latest Guidance from the WHO, U.S. CDC, PHAC, and BCCDC

• The Public Health Agency of Canada (PHAC) released a formal update to the national pandemic plan’s annex on antiviral use. The Canadian Pandemic Influenza Plan for the Health Sector (CPIP), which has only received minor updates since 2006, now outlines the general parameters and assumptions behind Canada’s antiviral stockpile, its use (largely for treatment purposes), and the focus on next steps. However, some officials have already identified discrepancies between the new antiviral annex and the most recent PHAC guidance on the use of antivirals when dealing with H1N1 cases in Canada. PHAC


• Recently, the U.S. CDC published an H1N1 Flu PowerPoint Presentation. Businesses can freely use this PowerPoint presentation to provide general information about H1N1 flu to employees, constituents, and other partners.

Today’s Key Question

Have antivirals helped prevent the spread of the novel H1N1 strain?

It has been noted that the extent of emergence of the novel H1N1 virus has not been as widespread in Europe and Asia as it has been in North America. In a press conference today, the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) noted that this may be due to the fact that the disease had spread widely in North America before being detected, whereas Europe and Asia had some degree of warning, and were able to implement certain containment measures. These measures have included:

• The close monitoring of travelers returning from North America;


• Forced isolation of certain patients; and,


• The provision of antivirals to those infected as well as their close contacts.

Some believe it is this last measure, the extensive use of antivirals, which is making all of the difference. While European and Asian countries have been using antivirals aggressively, North American countries have been more discriminate and have generally reserved antiviral treatment for severe cases, and for those who are at greater risk from the virus due to underlying health problems. According to Dr. Nikki Shindo, head of the clinical team at the WHO Global Influenza Programme, there is no data that can prove that the antivirals have been able to lessen the virus’ severity and spread; however, studies have shown that the virus is currently not resistant to the drugs. Science Insider