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 - June 13, 2009

GMS INFLUENZA A (H1N1) Update as of June 12, 2009

(0830 HRS PST)

The next update will be on Sunday, June 14, at 11:00 PST

The WHO Pandemic Alert level remains at Phase 6

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th, 2009)

*This case map has been provided by the WHO’s latest 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 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC



• The rising case totals in first nation communities in Northern Manitoba have led First Nations leaders to heavily criticize federal planning. According to Chief David Harper, “We are in a war with no artillery” and “The federal government says it has a plan in place, but that plan doesn't appear to include this part of the country.” The federal government did release guidelines for first nations pandemic planning two years ago, but there was no money attached according to Kim Barker, public health physician with the Assembly of First Nations. Globe and Mail
  

International News

• Friday, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO



• The US Centers for Disease Control and Prevention (CDC) reported yesterday that the nation's count of novel flu cases has grown to 17,855, an increase of 4,638 from its last report on Jun 5. Deaths reported to the CDC over the past week rose by 18 to reach 45. Wisconsin, Texas, and Illinois have the most cases, while New York has reported the most fatalities (13). Current CDC numbers



• On Thursday, Hong Kong authorities ordered all primary schools in the city to be closed for two weeks after 12 students at a city secondary school were found to have contracted the H1N1 virus. AFP
  

Vaccine News

• On Friday, Baxter International Inc said that it is in full-scale production of an A/H1N1 flu pandemic vaccine that could be ready for commercial use next month. A number of national public health authorities have agreements with Baxter that allow them to place orders for a vaccine now that a pandemic has been declared by WHO, Baxter said. Baxter said it would also work with WHO to allocate a portion of the company's commercial vaccine production to address global public health issues deemed most urgent. Reuters
  

Today’s Key Question

How have national agencies responded to the phase 6 announcement?

In light of the recent World Health Organization (WHO) decision to raise the level of influenza pandemic alert from phase 5 to phase 6, the Government of Canada, in conjunction with the Public Health Agency of Canada (PHAC), has responded with reassurances to Canadians that it will continue to implement the Canadian Pandemic Influenza Plan in close coordination with domestic and international partners in order to address the H1N1 flu virus.

“Since the beginning, Canada has taken decisive action to address the H1N1 flu virus and protect Canadians,” said Minister of Health, Leona Aglukkaq. “The decision by the WHO does not change our approach. Entering phase 6 means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan.”

PHAC and other federal officials have also said they will continue to advance the following activities as a result of the WHO’s phase 6 pandemic alert level:

• Ensuring that the National Antiviral Stockpile can be mobilized quickly so Canadians can receive the treatment they need



• Working with vaccine manufacturer GlaxoSmithKline to advance the process of developing and testing a vaccine in accordance with a pre-established standing contract



• Managing the National Emergency Stockpile System (NESS) which contains hospital supplies, equipment and other pharmaceuticals (including a stockpile of anti-viral medication)



• Assessing implementation of community-based strategies aimed at mitigating potential impact on the healthcare system and society as whole



• Working with national professional organizations and non-government organizations to optimize and monitor essential health-related resources such as: medical supplies, antivirals, vaccines, sanitizers and antibiotics, health care worker availability, hospital occupancy/availability, and use of alternative health facilities

In addition, the Government of Canada has stated that since a proactive approach in addressing the virus has already been taken, the declaration of phase 6 will result in the continuation of several ongoing efforts, including:

• Monitoring the progress of the H1N1 flu virus and assessing incoming information to inform future actions



• Continuing to communicate widely with Canadians and ensuring information is easily accessible



• Providing health care professionals with updated guidelines and advice based on what is known about the disease



• Utilizing the National Microbiology Laboratory (NML) in Winnipeg to provide laboratory testing to the provinces and territories



• Sharing information with Canadians via the government website, http://www.fightflu.ca/, the media, and a 1-800 number (1-800-454-8302)
  

Global's Daily Influenza A (H1N1) Update - June 12, 2009

GMS INFLUENZA A (H1N1) Update as of June 12, 2009

(0830 HRS PST)

The next update will be on Saturday, June 13, at 11:00 PST

The WHO Pandemic Alert level remains at Phase 6

Yesterday, the World Health Organization (WHO) raised its pandemic alert level from Phase 5 to Phase 6 as a result of the ongoing spread of the novel influenza A (H1N1) virus. Phase 6 is the official WHO declaration that a pandemic is underway. It is characterized by human-to-human spread of the virus in at least two countries in one WHO region, as well as community-level outbreaks in at least one other country in a different WHO region. Human-to-human spread of the virus in Mexico, Canada, and the United States, as well as community-level outbreaks in Australia, has led to this declaration.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 12th)

*This case map has been provided by the WHO’s Influenza A (H1N1) – Update #48.

Local/National News

• On June 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) since June 8th has risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases thus far, 138 required hospitalization and four deaths have occurred. PHAC


• Following the phase 6 announcement, the Government of Canada issued a statement to reassure Canadians. According to Minister of Health, Leona Aglukkaq, “Today’s decision by the WHO does not change our approach. Entering phase 6 means we will build on the surveillance and management measures that are already in place under the Canadian Pandemic Influenza Plan.” PHAC


• Amid rising novel flu cases and hospitalizations, Manitoba's regional health authority warned residents to limit hospital visits and asked people with flu-like symptoms to stay away. Two more people were placed on ventilators yesterday, bringing the total to 27. Many are from the province's First Nations communities. The chief of one group said authorities are sanitizing public places and that crowded housing is contributing to the spread of the flu. Globe and Mail

International News

• Today, the WHO released its latest case count for novel H1N1 influenza worldwide: 29,669 cases and 145 deaths in 74 countries, up 1,932 cases and 4 deaths from Wednesday's numbers. Countries reporting the greatest increase in laboratory-confirmed cases since yesterday were Canada (532), Mexico (524), Britain (156), Spain (131), Argentina (87), Australia (83), Japan (33), and China (32). WHO


• By the end of trading yesterday, manufacturers of vaccines and antivirals had seen a sizable increase in their respective share prices. Vaccine makers, GlaxoSmithKline and Sanofi Aventis saw their stocks rise 4.07% and 1.28% on the day. Roche the maker of Tamiflu saw a 3.47% increase.

Vaccine News

• The US CDC recently posted interim guidance on use of the 23-valent pneumococcal vaccine during the novel flu outbreak. The vaccine is still recommended for those aged 65 or older and patients aged 2 to 64 who have certain high-risk conditions. The CDC urges that those younger than 65 who have underlying health conditions receive the vaccine, because vaccination rates are low and rates of severe novel H1N1 infections are high. CDC


• Novartis AG expects a vaccine for the H1N1 virus to be available by the autumn after it produced the first batch for testing ahead of schedule. The vaccine will enter clinical trials next month. Reuters

Antiviral News

• Supplies of oseltamivir (Tamiflu) are scarce at some Australian pharmacies, prompting health minister Nicola Roxon to state that many patients with mild illnesses don't need the drug and that government stockpiles are reserved for those at highest risk, such as those with underlying medical conditions. The country's case count has risen to 1,275, with several hospitalizations, including four with reportedly no risk factors in intensive care units. Herald Sun

Today’s Key Question

What were some of the highlights from the World Health Organization’s (WHO) announcement to move to a pandemic alert level of Phase 6?

On June 11th, 2009, the WHO raised the level of pandemic alert to phase 6, the highest level on the six-point scale, indicating that a pandemic is currently underway. Margaret Chan, the Director-General of the WHO, made the official announcement. Important highlights and quotes from this announcement are outlined below:

• “Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”

Although a pandemic has been officially declared, this does not mean that there is any indication that the severity of the virus has intensified. In fact, the WHO’s alert scale, thus far, does not take a virus’ severity into account, only the degree of geographical spread.

• “We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years. Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years. This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.”

From the data presently available, it would appear that, as is the case with previous pandemics, H1N1 affects an inordinately large proportion of younger individuals.

• “Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.”

The 1918 Spanish Flu, the most severe pandemic of the 20th century, also saw pregnant women at increased risk of complications.

• “We do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.”

It is important to note that although the pandemic currently appears to be only moderately severe, the virus may have increased negative impacts as it spreads to countries with inadequate resources, deficient health care systems, and populations with a higher incidence of underlying medical issues. Chan urged countries to be prepared to see more cases, and focus on the appropriate management of patients and concluded by saying, “We are all in this together, and we will all get through this, together.”

Global's Influenza A (H1N1) Update - June 11, 2009

GMS INFLUENZA A (H1N1) Update as of June 11, 2009

(0830 HRS PST)

The next update will be on Friday, June 12, at 08:30 PST

The WHO Pandemic Alert level has been raised to Phase 6.

Today, the World Health Organization (WHO) raised its pandemic alert level from Phase 5 to Phase 6 as a result of the ongoing spread of the novel influenza A (H1N1) virus. Phase 6 is the official WHO declaration that a pandemic is underway. It is characterized by human-to-human spread of the virus in at least two countries in one WHO region, as well as community-level outbreaks in at least one other country in a different WHO region. Human-to-human spread of the virus in Mexico, Canada and the United States, as well as community-level outbreaks in Australia and other Asia-Pacific countries have led to this declaration.

What does this mean?

Raising the WHO pandemic alert level to Phase 6 does not mean that the H1N1 virus has become more deadly. In fact, current reports of death and illness, when compared with previous pandemics, indicate that we are experiencing a pandemic of lesser severity. What this does mean is that the virus has been officially recognised as widespread around the world and will most likely continue to spread globally over several more weeks. That said, the H1N1 virus is unpredictable and we can anticipate that as we get closer to our own annual flu season, we will be hearing from authorities to begin increasing our vigilance in North America in response to the possibility that the virus mutates and becomes more severe in a second wave (late 2009, early 2010).

In addition, it is unlikely that the WHO will recommend member states activate strict containment measures, such as border closures or quarantine efforts. Instead, focus ought to be on treatment (e.g., efficient and focused use of antiviral stores), with some community-level mitigation strategies in place for those countries only now seeing a surge in cases.

What should Canadian and American organizations be doing?

As was the case when the WHO raised its pandemic alert level to 4, and then 5, it is expected that media and public interest in this latest development will be substantial. Anxiety and concern may increase as a result of misinformation or poor communication. For your organization, clear and concise communication with employees and stakeholders should be a priority. Beyond communication, organizations may require the activation of their pandemic response measures should the pandemic become more severe in North America.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 11th)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #46 and PHAC.



Local/National News

• Health Minister Leona Aglukkaq announced recently that Canadian health officials have created a network of 80 scientists from 30 research and public health institutions to speed up influenza research, and test new vaccines against the H1N1 flu. The network, led by Dr. Scott Halperin, director of the Canadian Center for Vaccinology in Halifax, has received C$10.8 million in funding, and links the Canadian Institutes of Health Research and the Public Health Agency of Canada. Reuters


• Political tensions are flaring over pandemic flu planning for Canada’s First Nations, as a remote Manitoba reserve struggles to deal with a possible outbreak of the H1N1 virus. St. Theresa Point First Nation has confirmed three cases of H1N1and more than 20 residents of the community have been flown to Winnipeg Hospital suffering from flu-like symptoms. Manitoba Health Minister Theresa Oswald is claiming that the Manitoba government has offered Ottawa help with First Nations pandemic planning, but was repeatedly turned down. Federal Health Minister Leona Aglukkaq is denying the claim, stating that she has daily conversations about the H1N1 virus with health ministers across the country, but that Manitoba Health Minister Theresa Oswald never brought up the matter. The Vancouver Sun


• Dr. Isaac Sobol, Nunavut’s Chief Medical Health Officer, is disputing remarks made recently by Dr. Keiji Fukuda of the World Health Organization (WHO), citing a disproportionate number of serious cases occurring in Inuit communities in Canada. The WHO’s concerns came after Nunavut confirmed 28 new cases of H1N1 influenza Tuesday, more than doubling the total in the territory from 25 to 53. Sobol maintained that the severity of illness in Canada's North is the same as that found in other jurisdictions across Canada. CBC


• Nova Scotia Health Officials have recently confirmed the province’s first hospitalized case of H1N1. The province's total number of documented cases of the H1N1 influenza A virus is 77. In its statement, the Health Promotion and Protection Department said other cases are mild, and those affected are recovered or recovering. CBC


• On June 10th, the Public Health Agency of Canada (PHAC) announced that the number of confirmed cases of influenza A (H1N1) which had been confirmed in the country since June 8th was had risen to 2978 from 2446. Ontario still has the most cases in Canada (1562), followed by Quebec (611), Saskatchewan (221), Alberta (195), British Columbia (151), Nunavut (96), Nova Scotia (78), Manitoba (56), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Of the Canadian cases, 121 required hospitalization and four deaths occurred. PHAC


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




• 58 in Fraser Health


• 5 in Interior Health


• 28 in Northern Health


• 42 in Vancouver Coastal Health


• 18 in Vancouver Island Health

International News

• The recent surge in Influenza A (H1N1) cases in Australia has pushed the World Health Organization (WHO) to declare the first influenza pandemic since 1968. WHO influenza chief Keiji Fukuda said the agency was concerned about the potential harmful effects of moving the alert from its current status of phase 5 to the highest level, phase 6, indicating a full pandemic. Fukuda cited concerns over possible panic among the public or inappropriate steps taken by governments. Dr. Margaret Chan, the WHO’s director general has stated that, in her opinion, the world is in a pandemic. However, she believed it was crucial to verify that H1N1 had become established beyond North America before a pandemic was officially declared. ABC News


• The number of confirmed H1N1 cases in Australia has reached 1,211, the highest number outside of the Americas. The southeastern state of Victoria continues to be the worst-hit region in Australia with 1,011 confirmed cases. Australia has canceled its Grand Prix, scheduled for later this month in the Victorian capital, Melbourne, due to the risk of H1N1 flu and quarantine procedures. Additionally, several professional rugby league players may have to miss matches this weekend over fears they have contracted the virus. Bloomberg


• According to his office, Ray Nagin, the mayor of New Orleans, has been released from quarantine in Shanghai following an H1N1 scare. Nagin was detained after a fellow passenger on his flight fell ill with a suspected case of the virus. AFP


• As of June 10th, 74 countries have officially reported 27,737 cases of influenza A/H1N1 infection, including 141 deaths. WHO

Vaccine News

• On Tuesday, Hong Kong's government endorsed a plan to immunize 2.5 million people with a novel flu vaccine that it expects to be available no earlier than October. According to the plan, four groups will receive free vaccination: healthcare workers, children between 6 months and 6 years old, those older than age 65, and people who have chronic medical conditions. The government will stockpile enough doses for an additional 500,000 people. Hong Kong Standard

Latest Guidance from the WHO, the US CDC, PHAC, and the BCCDC

The World Health Organization (WHO) has recently released the following guidance documents:

• Influenza A(H1N1) patient care checklist


• Gene sequences of the reassortant candidate vaccine viruses for the novel influenza A (H1N1)

The U.S. CDC has recently released the following materials:

• Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak


• Audio Public Service Announcements, regarding:




• Leaving your home or hotel room if you’re sick with flu-like symptoms


• Changing your travel plans if you’re sick with flu-like symptoms

Today’s Key Question

How can Global Consulting help?

Global Consulting will continue to provide analysis regarding the pandemic through our regularly updated blog and free planning resources on our website, as we have been since the onset of the novel H1N1 virus. Additionally, Global has developed a Pandemic Advisory Service to provide timely and effective guidance to help organizations maintain and enhance operations during this global public health emergency.

Our team can also address your needs by:

• Providing concise updates on the status of the Influenza A (H1N1) virus as it relates to the number of cases, incubation periods, infectivity, and anticipated actions.


• Presenting a medical and pandemic planning context that can assist in the immediate development of pandemic policies and procedures.


• Helping you implement comprehensive infection control policies at your workplace.


• Offering clarification and guidance on the numbers and types of items to be included in personal protective equipment (PPE) stockpiles.


• Ensuring that your efforts are grounded in pandemic preparedness best practices.
  

Global's Influenza A (H1N1) Update - June 9, 2009

GMS INFLUENZA A (H1N1) Update as of June 9, 2009(830 HRS PST)

The next update will be on Thursday, June 11, at 8:30 PST

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 9th)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #45 and PHAC.

Local/National News

• An elderly woman from Quebec City has become the fourth Canadian to die of the novel H1N1 virus, health officials said Monday. AFP


• On Friday, the Government of Canada announced $10.8 million to fund a new influenza network to better connect researchers with public health officials. Led by Dr. Scott Halpern of Dalhousie University in Halifax, the network will involve 80 scientists at 30 research institutions across Canada. CBC


• The Alberta farmer whose pigs apparently contracted the novel H1N1 virus from an infected worker recently culled the rest of his herd. He had originally culled 500 of his pigs. He said he had the remaining 3,000 animals destroyed because they were under quarantine and he was unable to market them. The farmer is expected to seek government assistance with replacing his herd. CP


• On June 3rd, the Public Health Agency of Canada (PHAC) announced that 331 new cases of influenza A (H1N1) had been confirmed in the country since June 5th. Ontario still has the most cases in Canada (1223), followed by Quebec (547), Saskatchewan (210), Alberta (172), British Columbia (145), Nova Scotia (76), Manitoba (40), Nunavut (25), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Canada’s total case count is now at 2,446 with 121 hospitalizations and four deaths.


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




• 56 in Fraser Health


• 4 in Interior Health


• 27 in Northern Health


• 41 in Vancouver Coastal Health


• 17 in Vancouver Island Health

International News

• Trust for America’s Health, a non-profit organization based in Washington, D.C., has issued a detailed critique, called “Pandemic Flu Preparedness: Lessons from the Frontlines”, examining early lessons learned from the response and ongoing concerns about overall U.S. preparedness for potential pandemic flu outbreak. The report praises federal, state, and local governments for having invested in pandemic planning, including the stockpiling of drugs and training public health officials to respond appropriately. It specifically commends U.S. President Barack Obama and the health officials who work under him for “providing clear, straightforward information to the public,” which the report says has both allayed fears and built trust.
  

• Chinese authorities have quarantined New Orleans Mayor Ray Nagin, his wife, and a security guard in Shanghai after another traveler on their flight from New Jersey exhibited suspected H1N1 flu symptoms. Nagin's office said the three were quarantined in a hotel Sunday as a precaution and were exhibiting no flu symptoms. AP


• Forty-three more cases of H1N1 human influenza have been confirmed today in the biggest daily increase so far in Scotland. It brings the total number of confirmed cases in Scotland to 232. The figures were disclosed by Health Secretary Nicola Sturgeon, who said the rise was in line with predictions and could increase further. Daily Record


• The Australian state, Victoria, is the epicenter of the H1N1 flu outbreak in Australia. So far the state has had over 1,000 cases and many other out-of-state cases have stemmed from contacts in Victoria’s city of Melbourne. Victoria's high infection rate has prompted Singapore to place a travel warning on the state and some Australian states have ordered children to be quarantined for a week when they travel home from Melbourne. In addition, an Australian health expert today warned that the county's indigenous populations may be at greater risk for infections because of greater levels of chronic diseases. The Age & ABC News

Will the World Health Organization (WHO) raise its Pandemic Alert Level?

Since the WHO level of pandemic alert was raised to phase 5, experts have been speculating as to if and when the alert level would move to phase 6. This speculation was further fueled when cases of Influenza A (H1N1) appeared in Europe (notably Spain and the UK). However, despite some indicative comments from WHO officials, the alert level was not raised.

Following the large jump in Japanese cases of Influenza A (H1N1), which occurred approximately two weeks ago, speculation surrounding a possible move to Phase VI was renewed. During this time, the WHO also discussed whether or not the alert level phases needed to encompass a severity index, as many officials worried that a move to phase 6 would foster undue panic.

Last week, Dr. Keiji Fukuda, the WHO assistant director-general for health security and the environment, stated, "Globally, we believe we're in phase 5 but are getting closer to phase 6." Fukuda also suggested that the WHO would discern an appropriate manner by which to describe the severity of the epidemic. There has been a large increase in cases of the virus in Australia, which have been determined to be community level spread. This definitively meets the WHO phase 6 definition (community level spread in countries in two world regions).

Finally, on Friday, the WHO consulted its emergency committee of flu experts on the severity of the swine flu virus and possible travel recommendations. This group is the same committee that recommended the Phase Alert level be raised from 3 to 4 and then from 4 to 5. However, this time the group simply gave advice regarding a number of parameters that can provide information for the assessment of the severity of the epidemic.

Global's Influenza A (H1N1) Update - June 4, 2009

GMS INFLUENZA A (H1N1) Update as of June 4, 2009(830 HRS PST)

The next update will be on Tuesday, June 9, at 8:30 PST

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 4th)

*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #43, the CDC, and PHAC.


Local/National News

• On June 3rd, the Public Health Agency of Canada (PHAC) announced that 265 new cases of influenza A (H1N1) had been confirmed in the country since June 1st. Ontario still has the most cases in Canada (894), followed by Quebec (346), Saskatchewan (153), British Columbia (136), Alberta (141), Nova Scotia (74), Manitoba (38), Nunavut (5), PEI (3), New Brunswick (2), Northwest Territories (2), and the Yukon (1). Canada’s total case count is now at 1,795 with 98 hospitalizations and three deaths.


• Toronto Public Health has decided to cease updates to parents when other students in their children’s school contract the novel H1N1 flu virus. This move was prompted by observations of greater and more efficient spread of H1N1 outside of school settings. According to spokesman Susan Sperling, "We felt parents were getting a false sense of security. Just because someone else in their child's school hadn't been diagnosed with H1N1 didn't mean there were no concerns. In fact, we are finding the virus is more commonly spread in contact within the home." Toronto Sun


• A spokesman for Ontario's health minister has confirmed that a person who had been hospitalized with swine flu infection died Sunday afternoon. The unidentified person had a number of medical conditions and it is not clear how the infection with the novel H1N1 flu virus contributed to the death. This is Canada’s 3rd H1N1 related death. Canadian Press


• The H1N1 influenza virus is responsible for at least two cases of severe illness at St. Theresa Point, a first nations reserve in a remote part of Winnipeg. St. Theresa Point Chief David McDougall said there’s a total of 20 residents from the community in a Winnipeg hospital suffering from flu-like symptoms. Additionally, two Winnipeg paramedics who transported the patients from the reserve might have contracted the virus themselves. The Manitoba Government Employees Union (MGEU) said the two paramedics who picked up the patients at the airport in Winnipeg weren't given any advance warning about the possibly infectious disease and, consequently, weren't wearing the necessary protective gear. Winnipeg Free Press


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

• 50 in Fraser Health


• 4 in Interior Health


• 26 in Northern Health


• 39 in Vancouver Coastal Health


• 17 in Vancouver Island Health

International News

• On June 2nd, The World Bank approved a $500 million program to offer developing and middle-income countries speedy access to funds to prevent and control novel H1N1 virus outbreaks. The amount will be added to an existing $500 million credit line established in January 2006 to help countries battle H5N1 avian influenza. The program helps governments buy items such as drugs and medical equipment and finance measures such as surveillance upgrades and communication campaigns. World Bank press release


• Chile's health ministry yesterday reported that a 37-year-old man who worked as a plumber has died of novel H1N1 influenza, the first death from the disease in South America. The report said he died of "massive respiratory failure" but did not mention if he had an underlying medical condition. Chile has the most cases in South America with 313, according to the WHO's latest count. AP story


• The White House is asking lawmakers to sign off on an additional $2 billion to respond to the H1N1 flu outbreak, with the bulk of that money going to boost vaccine stockpiles and expand federal detection efforts. In a letter to House Speaker Nancy Pelosi, President Barack Obama said, "These funds should be provided with maximum flexibility to allow us to address this emerging situation." Wall Street Journal

Why is it difficult to grade pandemics on severity?

The World Health Organization (WHO) announced Tuesday that they are close to moving the level of pandemic alert from Phase V to Phase VI, despite the relative mildness of Influenza A (H1N1). Due to the potential panic such an action might induce, many national governments have requested that the WHO transition to an alert level scale which takes the virus’ severity into account. However, severity is difficult to measure because what is meant by ‘mild’ and ‘severe’ is not a simple scale. Some of the factors which could be used to assess the severity of a pandemic are as follows:

• The Case Fatality Ratio: The likelihood that an infected person will die from their illness.


• Varying Rates of Illness in Certain Subsets of the Population: Historically, pandemics have lead to higher rates of infection in certain groups such as children, pregnant women, and young healthy adults.


• National Abilities: Severity often varies from country to country. In poorer nations with fewer doctors and deficient access to healthcare, the effects of a given virus may be more severe than in a richer country with more resources.


• Overall Case Load: The number of people falling ill with respiratory illnesses at one time and the associated pressure on the health services’ ability to deal with the increased load. This is expected to increase in the winter.


• Critical Service Impact: The peak percentage of people absent from work due to illness or because they are caring for others.


• Public and Media Perception: A certain virus may be perceived as severe by the public because it is receiving so much media attention, when in fact it is mild. On the other hand, the public may be too lax with regard to a more severe virus if it is not currently in the media spotlight.

In addition, severity may vary over time. Certain past pandemics, including the 1918 Spanish Flu, started off as mild and became more severe as time went on. European Centre for Disease Prevention and Control

Global's Influenza A (H1N1) Update - June 2, 2009

GMS INFLUENZA A (H1N1) Update as of June 2, 2009(830 HRS PST)

The next update will be on Thursday, June 4, at 8:30 PST

The WHO Pandemic Alert level remains at Phase 5.

Influenza A (H1N1) Cases and Deaths by Country (as of 8 AM PST, June 2nd)*Lab confirmed cases and deaths have been provided by the WHO’s Influenza A (H1N1) – Update #42.


Local/National News

• On June 1st, the Public Health Agency of Canada (PHAC) announced that 194 new cases of influenza A (H1N1) had been confirmed in the country since May 29th. Ontario still has the most cases in Canada (715), followed by Quebec (309), British Columbia (132), Alberta (126), Saskatchewan (153), Nova Scotia (73), Manitoba (11), Nunavut (4), PEI (3), New Brunswick (2), Yukon (1), and the Northwest Territories (1). Canada’s total case count is now at 1,530 with 57 hospitalizations and two deaths.


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




• 47 in Fraser Health


• 4 in Interior Health


• 25 in Northern Health


• 39 in Vancouver Coastal Health


• 17 in Vancouver Island Health

International News

• Recently, the US Centers for Disease Control and Prevention (CDC) reported that:


• 77% of US influenza virus isolates tested during the week of May 17th to 23rd were the novel H1N1 type,


• Four states reported widespread activity: Arizona, California, New Jersey, and Virginia,


• None of the novel H1N1 isolates tested showed resistance to neuraminidase inhibitors,


• The proportion of deaths from pneumonia and flu was below the epidemic threshold, and


• Outpatient visits for flu-like symptoms were below the national baseline.


• The source of exposure is unknown in about 45% of US H1N1 flu cases so far, according to findings presented yesterday by Michael W. Shaw, PhD, of the CDC's Influenza Division. Speaking at a webinar, Shaw said that 25% of patients contracted the virus from a family member, 12% had traveled to Mexico, 12% had contact with a known or suspected case, and 5% were health care workers who were exposed on the job. NYAS H1N1 webinar information


• Australian authorities will let 2,000 passengers and crew on Carnival’s Pacific Dawn cruise ship disembark in Sydney after they were cleared of the disease (after two voyages on the vessel, 53 people had tested positive for the H1N1 virus). Twenty-five health officials who boarded the ship at the weekend cleared the occupants after swab testing. Carnival has reimbursed the passengers. Bloomberg


• Australia's health department has confirmed 401 novel flu cases, including 306 in the southwestern state of Victoria. The number is doubling every 2 days, with evidence of community spread that might prompt the World Health Organization (WHO) to raise the pandemic alert level to 6. Bloomberg


• Chile's health ministry said on Sunday that it had confirmed 276 novel H1N1 flu cases, the most in South America. Officials said most of the illnesses have been mild, though three patients have been hospitalized. Meanwhile, Argentina reported 115 cases, the second-highest in South America. Influenza experts are closely watching developments in the southern hemisphere, which is just starting its annual flu season. AFP story

Vaccine News

• MedImmune, Inc., based in Gaithersburg, Md., said Monday that US officials have awarded the company an initial $90 million contract to produce a live attenuated nasal-spray vaccine to protect priority groups identified in the nation's pandemic flu plan against the novel H1N1 virus. The US is the only country that has licensed MedImmune's intranasal vaccine technology, though the company said it would make vaccine for countries that offer regulatory approval if it has enough production capacity. MedImmune press release

Latest Guidance from the US CDC, WHO, PHAC and BCCDC

• Recently, the US Center for Disease Control and Prevention released General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers. This guidance is to help employers with employees in OSHA's Lower Risk (Caution) assessment tool: employees who have minimal occupational contact with the general public and other coworkers (for example, office employees).

What are some of the steps employers can take to protect employees from the novel H1N1 virus?

This exert from the recently released General Business and Workplace Guidance from the US CDC, provides an excellent overview of some of the steps companies can take to protect their employees from both the novel H1N1 virus and the seasonal flu.

• Encourage sick workers to stay home and away from the workplace, and provide flexible leave policies.


• Encourage infection control practices in the workplace by displaying posters that address and remind workers about proper hand washing, respiratory hygiene, and cough etiquette. These posters can be found on the Germ Stopper: Posters and Other Materials page.


• Provide written guidance (such as email, memos, etc.) on novel influenza A (H1N1) flu appropriate for the language and literacy levels of everyone in the workplace. Employers should work closely with local and state public health officials to ensure they are providing the most appropriate and up-to-date information (e.g., the CDC H1N1 Flu website, the GMS update).


• Provide sufficient facilities for hand washing and alcohol-based (at least 60%) hand sanitizers (or wipes) in common workplace areas such as lobbies, corridors, and restrooms.


• Provide tissues, disinfectants, and disposable towels for employees to clean their work surfaces, as well as appropriate disposal receptacles for use by employees.


• To reduce the chance of spread of the novel influenza A (H1N1) virus, disinfect commonly touched hard surfaces in the workplace, such as work stations, counter tops, door knobs, and bathroom surfaces by wiping them down with a household disinfectant according to directions on the product label. One study has shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.