WHO - Swine Influenza - Statements and statistics

[Gert van der Hoek]

Influenza-Like Illness in the United States and Mexico



24 April 2009 -- The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.

The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital.

Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.

Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.

The World Health Organization has been in constant contact with the health authorities in the United States, Mexico and Canada in order to better understand the risk which these ILI events pose. WHO (and PAHO) is sending missions of experts to Mexico to work with health authorities there.

It is helping its Member States to increase field epidemiology activities, laboratory diagnosis and clinical management. Moreover, WHO's partners in the Global Alert and Response Network have been alerted and are ready to assist as requested by the Member States.

WHO acknowledges the United States and Mexico for their proactive reporting and their collaboration with WHO and will continue to work with Member States to further characterize the outbreak.

http://www.who.int/csr/don/2009_04_24/en/index.html

[Gert van der Hoek]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

Statement by WHO Director-General, Dr Margaret Chan

25 April 2009


Current WHO phase of pandemic alert

International Health Regulations (IHR)



In response to cases of swine influenza A(H1N1), reported in Mexico and the United States of America, the Director-General convened a meeting of the Emergency Committee to assess the situation and advise her on appropriate responses.

The establishment of the Committee, which is composed of international experts in a variety of disciplines, is in compliance with the International Health Regulations (2005).

The first meeting of the Emergency Committee was held on Saturday 25 April 2009.

After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.

The Committee advised that answers to several specific questions were needed to facilitate its work.

The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.

Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.

Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.

The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.

http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/index.html

[FrenchieGirl]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

http://www.who.int/csr/disease/swine...s_20090425.pdf

Viral gene sequences to assist update diagnostics for swine influenza A(H1N1)

25 April 2009

WHO published a Guidance to influenza laboratories on response to swine influenza A(H1N1) infections1. Due to the fact that it is a new reassortant virus, diagnostics has to be updated accordingly.

The full genome sequence of the newly identified swine influenza virus
A/California/04/2009 A(H1N1) has been made available by the WHO Collaborating Center in CDC, Atlanta, USA on the GISAID sequence database2 and has the following accession numbers.

Further update on availability on other public sequence databases will be provided when available.

? HA:
SequenceID: EPI176470
SequenceName: 2009712049_seg4
Length: 1701
Isolate: A/California/04/2009
? NA:
SequenceID: EPI176472
SequenceName: 2009712049_seg6
Length: 1410
Isolate: A/California/04/2009
? M:
SequenceID: EPI176471
SequenceName: 2009712049_seg7
Length: 972
Isolate: A/California/04/2009
? PB2:
SequenceID: EPI176486
SequenceName: 2009712049_1
Length: 2280
Segment: PB2
1 http:// ?. Link to the first document on web please
2 http://www.gisaid.org
Proteins: N/A
Isolate: A/California/04/2009
? PB1:
SequenceID: EPI176485
SequenceID: 2009712049_2
Length: 2274
Segment: PB1
Proteins: N/A
Isolate: A/California/04/2009
? PA:
SequenceID: EPI176484
SequenceName: 2009712049_3
Length: 2151
Segment: PA
Proteins: PA (716aa)
Isolate: A/California/04/2009
? NP:
SequenceID: EPI176482
SequenceName: 2009712049_5
Length: 1497
Segment: NP
Proteins: N/A
Isolate: A/California/04/2009
? NS:
SequenceID: EPI176483
SequenceName: 2009712049_8
Length: 838
Segment: NS
Proteins: N/A
Isolate: A/California/04/2009

[flutrackers@cool.fr.nf]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

Thank you FrenchieGirl!

[FrenchieGirl]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

http://www.who.int/csr/disease/swine...s_20090425.pdf


Guidance to Influenza Laboratories

Diagnosing Swine Influenza A/H1N1 Infections of current concern


25 April 2009

All un-subtypable influenza A specimens are strongly recommended to be sent immediately to one of the five WHO Collaborating Centres for influenza for diagnosis and further characterization.

Sample collection and handling

? The current influenza specimen collection protocol should be followed.1

? Standard influenza specimen storage, packaging and shipping practice and relevant IATA regulations should be followed.2

Available laboratory tests

? Rapid antigen tests designed to detect influenza A viruses should be able to detect this swine virus but due to the low sensitivity, compared to other lab diagnostic methods, may give false negative results.

? It is possible that the antibodies used in immunofluorescence and other immunoassays may not bind to targets on the virus and could result in false negative results.

? While primers used in PCR assays to detect highly conserved parts of the influenza genome and confirm the presence of influenza A will probably work; primers currently used in PCR diagnostics for subtyping influenza A virus may not detect non-human viruses. Information on specific assays will be available in the near future.

? The only reliable means of confirming swine influenza A/H1N1 would require virus isolation (virus isolation should be done in a BSL-3 facility) and at least partial sequencing of the genome.

? Partial or complete virus genome sequencing from clinical samples, if possible, will provide definitive identification of the new strain.

? Laboratory biosafety measures for handling possible pandemic strains should follow the published guidelines on handling influenza viruses. 3

Updating laboratory tests

The WHO Collaborating Centre in CDC Atlanta is currently updating PCR protocols for detection of the swine A(H1N1) reassortant viruses:

1 http://www.who.int/csr/disease/avian.../en/index.html
2 http://www.who.int/csr/disease/avian.../en/index.html
3 http://www.who.int/csr/disease/avian.../en/index.html
2

? The current CDC influenza subtyping PCR assay kit cannot detect the new reassortant swine A(H1N1) virus.

? A modification to include testing procedures for recent swine viruses is being prepared by CDC.

? The gene targets of the PCR will be influenza A, universal swine NP and swine H1 HA.

? CDC is preparing a "Swine Influenza PCR Testing Kit? which will include the primers and probes as well as positive control samples. The kits will be available to National Influenza Centres under defined process.

Contact information of the five WHO Collaborating Centres: 4

Professor A. Kelso
WHO Collaborating Centre for Reference and Research on Influenza
45 Poplar Road, Parkville, Victoria 3052, Australia
Fax: +61 3 9389 1881
Email: Ian.Barr@influenzacentre.org

http://www.influenzacentre.org/

Dr M. Tashiro
WHO Collaborating Centre for Reference and Research on Influenza
National Institute of Infectious Diseases, Department of Virology III
4-7-1 Gakuen, Musashi-Murayama-shi, Tokyo 208-0011, Japan
Fax: +81 42 561 0812
Email: todagiri@nih.go.jp

http://idsc.nih.go.jp/index.html

Dr A. Hay
WHO Collaborating Centre for Reference and Research on Influenza
National Institute for Medical Research
Mill Hill, London NW7 1AA, United Kingdom
Fax: +44 208 906 44 77
Email: whocc@nimr.mrc.ac.uk

http://www.nimr.mrc.ac.uk/wic/

Dr N. Cox
WHO Collaborating Centre for the Surveillance, Epidemiology and Control of Influenza
Centers for Disease Control and Prevention, Influenza Branch
1600 Clifton Road, G16, Atlanta, Georgia 30333, United States of America
Fax: +1 404 639 0080
Email: axk0@cdc.gov

http://www.cdc.gov/flu/

Dr R. Webby
WHO Collaborating Center for Studies on the Ecology of Influenza in Animals
Virology Division, Department of Infectious Disease
St. Jude Children's Research Hospital
332 North Lauderdale Street, Memphis TN 38105-2794, United States of America
Fax: +1 901 523 2622
Email: richard.webby@stjude.org

http://www.stjude.org

4 http://www.who.int/csr/disease/influ.../en/index.html

[sharon sanders]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

Thank you FrenchieGirl!

Yes. Thank you.

[FrenchieGirl]

Re: WHO Press Releases - Influenza-Like Illness in the United States and Mexico

Oh, my pleasure I've mixed up my posts a bit. This is the next instalment. It essentially repeats what Dutchy posted yesterday.

Statement by WHO Director-General, Dr Margaret Chan
25 April 2009

Swine influenza

In response to cases of swine influenza A(H1N1), reported in Mexico and the United States of America, the Director-General convened a meeting of the Emergency Committee to assess the situation and advise her on appropriate responses.

The establishment of the Committee, which is composed of international experts in a variety of disciplines, is in compliance with the International Health Regulations (2005).

The first meeting of the Emergency Committee was held on Saturday 25 April 2009.

After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.

The Committee advised that answers to several specific questions were needed to facilitate its work.

The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.

Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.

Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.

The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.

[Niko]

WHO - Swine Influenza - Statements and statistics

<hr style="border: 1px none ; height: 1px; background-color: rgb(0, 0, 0); width: 100%;" align="left">
Influenza-like illness in the United States and Mexico


24 April 2009 --

The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.

The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.

Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.

The World Health Organization has been in constant contact with the health authorities in the United States, Mexico and Canada in order to better understand the risk which these ILI events pose. WHO (and PAHO) is sending missions of experts to Mexico to work with health authorities there. It is helping its Member States to increase field epidemiology activities, laboratory diagnosis and clinical management. Moreover, WHO's partners in the Global Alert and Response Network have been alerted and are ready to assist as requested by the Member States.

WHO acknowledges the United States and Mexico for their proactive reporting and their collaboration with WHO and will continue to work with Member States to further characterize the outbreak.

For more information, please contact:

Thomas Abraham
Communications in English
Mobile: +41 79 516 3136
E-mail: abrahamt@who.int
Fadela Chaib
Communications in English and French
Mobile: +41 79 475 5556
E-mail: chaibf@who.int
Sari Setiogi
Communications in English and Bahasa
Mobile: +41 79 701 9467
E-mail: setiogis@who.int
Gregory Hartl
Communications in English, French, German and Spanish
Mobile: +41 79 203 6715
E-mail: hartlg@who.int
Aphaluck Bhatiasevi
Communications in English, Thai and Hindi
Mobile: +41 79 484 2979
E-mail: bhatiaseviap@who.int
<!-- include footer--><!-- include ftr-->

http://www.who.int/csr/don/2009_04_24/en/index.html

<!-- end ftr--><!-- end footer-->

[Niko]

Re: WHO - Swine Influenza - Statements and statistics

Swine influenza

<table class="bgbx"><tbody><tr><td class="bx7">
<table align="right" border="0" cellpadding="0" cellspacing="0" width="118"> <tbody><tr> <td class="iright"> </td> </tr> </tbody></table> WHO is coordinating the global response to human cases of swine influenza A (H1N1) and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public.

Latest information
24 April 2009
Influenza-like illness in the United States and Mexico

</td> </tr></tbody></table> Background information

- Swine influenza questions and answers [pdf 79kb] Media centre

WHO statement on swine influenza, Dr Margaret Chan, WHO Director-General
25 April 2009
Virtual press briefing - swine influenza (25 April 2009) [mp3 15 Mb]
Listen to the audio file from the briefing Guidance

Viral gene sequences to assist update diagnostics for swine influenza A(H1N1) [pdf 172kb]
25 April 2009
Guidance to Influenza Laboratories. Diagnosing Swine Influenza A/H1N1 Infections of current concern [pdf 115kb]
25 April 2009 Related links

Ministry of Health of Mexico
Pan American Health Organization (PAHO)
US Centers for Disease Control and Prevention

[Niko]

Re: WHO - Swine Influenza - Statements and statistics

<hr style="border: 1px none ; height: 1px; background-color: rgb(0, 0, 0); width: 100&#37;;" align="left"> Statement by WHO Director-General, Dr Margaret Chan
25 April 2009

Swine influenza


In response to cases of swine influenza A(H1N1), reported in Mexico and the United States of America, the Director-General convened a meeting of the Emergency Committee to assess the situation and advise her on appropriate responses.

The establishment of the Committee, which is composed of international experts in a variety of disciplines, is in compliance with the International Health Regulations (2005).

The first meeting of the Emergency Committee was held on Saturday 25 April 2009.

After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.

The Committee advised that answers to several specific questions were needed to facilitate its work.

The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.

Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.

Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.

The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.

http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/index.html

[Giuseppe]

Re: WHO - Swine Influenza - Statements and statistics

WHO | Swine flu illness in the United States and Mexico - update 2

Swine flu illness in the United States and Mexico - update 2

26 April 2009 --

As of 26 April 2009, the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas and 1 in Ohio).


All 20 cases have had mild Influenza-Like Illness with only one requiring brief hospitalization.

No deaths have been reported.

All 20 viruses have the same genetic pattern based on preliminary testing.

The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1.


Investigation is continuing to clarify the spread and severity of the disease in Mexico.

Suspect clinical cases have been reported in 19 of the country's 32 states.


WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities.

WHO and its partners are actively investigating reports of suspect cases in other Member States as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management.

On Saturday, 24 April, upon the advice of the Emergency Committee called under the rules of the International Health Regulations, the Director-General declared this event a Public Health Emergency of International Concern.

WHO is not recommending any travel or trade restrictions.
-

<cite cite="http://www.who.int/csr/don/2009_04_26/en/index.html">WHO | Swine flu illness in the United States and Mexico - update 2</cite>

[Giuseppe]

Re: WHO - Swine Influenza - Statements and statistics

WHO. INFLUENZA- LIKE ILLNESS OUTBREAK IN THE US AND MEXICO (Transcript Press Conference, April 25, 2009)

INFLUENZA- LIKE ILLNESS OUTBREAK IN THE US AND MEXICO

[Full PDF document available at LINK. EDITED.]

Transcript of GLOBAL TELEPHONE NEWS CONFERENCE wi t h Dr Ma r g a r e t Ch a n , Di r e c t o r -Ge n e r a l , Wo r l d He a l t h Or g a n i z a t i o n - 2 5 Ap r i l 2 0 0 9


O p e n i n g S t a t e m e n t b y Dr Ma r g a r e t Ch a n

Good afternoon, thank you for coming. WHO is concerned about cases of swine 'flu currently being reported in some areas of Mexico and in the United States. A new virus is responsible for cases in both countries. The situation is evolving quickly. A new disease is, by definition, poorly understood. We do not yet have a complete picture of the epidemiology or the risks, including possible spread beyond the currently affected areas. Nonetheless, in the assessment of WHO, this is a serious situation which must be watched very closely. Yesterday, while in the United States, I was able to speak directly with health officials in the US and in Mexico. Both countries have expressed their concern and I know they are taking the situation very seriously. I thank them for their openness, transparency, and willingness to work with WHO to address this newly emerging infection.

Yesterday, I cancelled all planned meetings on other matters and cut short my trip to get back to Geneva. Today, I spoke with WHO epidemiologists and infectious disease specialists in the
different geographical offices of WHO. We do not, at present, have indications of similar outbreaks in other parts of the world. Our vigilance will remain high. It would be prudent for health officials within countries to be alert to outbreaks of influenza-like illness, or pneumonia especially if these occur in months outside the usual peak influenza season.

Another important signal is excess cases of severe or fatal flu-like illness in groups other than young children and the elderly, who are usually at highest risk during normal seasonal flu. We are today convening a meeting of an Emergency Committee to evaluate the evidence and advise me on an appropriate course of action. The Committee will also advise me on whether WHO needs to introduce any temporary measures in the interest of protecting international health.

Influenza viruses are notoriously unpredictable and full of surprises, as we are seeing right now. The viruses causing cases in some parts Mexico and the US are genetically the same. This is an animal strain of the H1N1 virus, and it has pandemic potential because it is infecting people.

However, we cannot say, on the basis of currently available laboratory, epidemiological, and clinical evidence, whether or not it will indeed cause a pandemic. As a precautionary measure, I have instructed all regional offices in WHO to work closely with their countries to assess if indeed similar outbreaks or unusual patterns of 'flu like illness and pneumonia have been observed. And we have also sent experts to Mexico at the request of the Government, to work with them to further analyse all the data and information, to answer some of the critical questions.

For example, how many of the 800 plus cases of severe pneumonia requiring hospitalization are indeed caused by this new virus, or other causes. And in addition, we will work with US scientists and scientists from other countries to help us to assess other important dimensions. For example, we need to know how the virus is spread, and what is the transmission pattern, and whether or not it is going to cause severe disease and what in age group. Clearly, in the days and weeks ahead, we need to work very closely with the US authorities as well as with the Mexican authorities, bringing together the world's experts to bear on this very important issue. Above all, it is important that we will keep you, the public and keep our countries, our Member States and our ministers of health informed as we move forward on these and other issues. All these issues are receiving my highest personal attention. I will stop here and will be happy to answer any questions that colleagues from the media community may have.

Journalist Associated Press.
I wondered if you could talk first of all about what some of the other countries are doing, if other Member States are taking measures and also go through some of things WHO might consider, like about travel recommendations, or border closures, what are the things being considered? Are there recommendations for public health interventions, like stopping mass gatherings?

Dr Chan:
thank you for that question. At this stage the most important recommendation coming from WHO to other countries is to increase and enhance their surveillance. As I said, for unusual pattern of disease, whether or not there is an increase in pneumonia cases, whether or not there are outbreaks of 'flu-like illness outside of their seasonal 'flu peak season. So those are the most important. Without that kind of information, it is very difficult to realize - to know whether or not the situation is indeed confined to US and Mexico as we're seeing now. Now as to your question about other border closures and travel advisories, I think it think it is too premature at this stage to make those announcements without, first and foremost having a better analysis, trying to understand the data that are coming from the Mexican authorities and help us to further understand exactly what is happening there. So for now, we will not issue those recommendations, but of course, of course, these will be questions to be addressed by the Emergency Committee that will be convened later today.

Journalist Canadian Press:
Thanks very much for taking my question, Dr Chan. I was wondering if you could tell us if you have any indication from the Mexican authorities about potential mild illness. We've been hearing about a death, and a death suspected to be associated with this virus, and lots of hospitalized cases. Given the pattern of infections in the United States, and given infectious diseases in general, you would expect, or at least hope, that there would be lots of mild cases, or that's what we are seeing is the tip of the iceberg, do you have any evidence for that?

Dr Chan:
Thank you for that question. clearly this is an important question. Based on the limited number of cases in the US, so far reported 8 cases, all of them have recovered, and they are mild in terms of the severity of the disease. In Mexico, the picture, because of the size of the number of cases, we are seeing a range of severity, from mild to severe and to some deaths. So that is exactly what I was referring to in my earlier answer to Maria's question. We need to really comb through those data and get the granularities and understand exactly who is suffering and in which group the diseases are more severe than others and these are the work that the experts that we dispatch to the ground, they are already on the ground, working with the Mexican authorities, and hopefully, this will give us more information in the days ahead.

HB:
Could I ask a follow-up question?

Dr Chan:
Yes, go ahead.

Journalist:
If I hear you correctly, would you say that it would be premature to try to assess what the case fatality of the virus is and I'd also like to ask if WHO is thinking about asking vaccine manufacturers to potentially switch to production of swine 'flu vaccine?

Dr Chan:
Yes indeed. At this point in time it is too premature to calculate the case fatality rate. Hopefully, you know, more evidence will emerge to give us a better sense. And your second question is again we will definitely discuss this with the emergency committee, but on the basis of information available now, I'm sure, you know, the experts will agree we need to wait for a few more days and perhaps, based on the final analysis we can have a better handle on which way to go, vis a vis, vaccine production.

Journalist at National Public Radio in the US.
My first question is what, precisely is the Emergency Committee going to consider today? There's been a bit of confusion whether you're considering whether to raise the alert level or whether you're meeting to decide to declare a public health emergency of international concern. And then I have a follow-up.

Dr Chan:
Well, thank you for your question. I would expect the members of the Emergency Committee, having heard the reports and representations by the 2 governments, namely the US and Mexico, and also the overall assessment by WHO, they may need to address those questions, indeed.

Journalist:
So, the question of pandemic alert is on the table?

Dr Chan:
Yes, indeed.

Journalist:
My follow-up is from my colleague Richard Knox. We've had a lot of trouble dialing into the conference today, here from the US. He wonders about the capacity of Mexico, especially Mexico City, to do the kind of 'flu virus typing that's needed in the kind of speed with which you need to come to decisions. Do they have the capacity there or will WHO somehow be helping them out with additional laboratory equipment or what?

Dr Chan:
Thank you for that question. I think that this is a very important question. Our experience is that with any new and emerging infection no matter how good your existing laboratory capacity is, there would be requirement for additional research capacity in terms of having the right kind of methodology and the kind of skills to do those tests. But I have to say the Mexican government has been very open, transparent, and they have shared virus samples with Health Canada and as well as with US Center for Disease Control (CDC). Scientists from these two countries are working with them to do exactly the kind of work that you are talking about. And in fact, I actually met the US authorities and I talked to the Minister of Health in Mexico. We also talked about providing WHO additiional expert support in laboratory science to the Mexican authority. So I just want to say, yes, we are gearing up on our side and so is the Mexican authority and I would like to thank the international community who come to assist in this assessment. It is important that we get to the bottom of the matter as soon as possible. Speed is important. Capacity is important, and we are addressing both.

Journalist from Reuters in Geneva:
Are you satisfied with the Mexican authorities have enough anti virals to address this outbreak and whether you fell that Tamiflu is going to be the answer to this and whether you have any indication that there is resistance to it among any population or any certain groups affected.

Dr Chan:
At this point time the resistance test that has been done by scientist demonstrated that this new virus is sensitive to also Tamiflu. I also had a discussion with the Minister of Health on the issue of medicine. They do have a sizeable supply themselves but of course depending on how the outbreak evolves, WHO stands ready along with international partners to support the government if it is required to acquire additional supply.

Journalist from NHK, Japan -
Want to confirm with Dr Chan, can we regard this virus as a pandemic potential virus and what kind of decisions do you think you can make in this Emergency Committee?

Dr Chan:
As I mentioned in my statement earlier, this is clearly an animal strain of the H1N1 virus and it has pandemic potential because it is infecting people. The emergency committee that is convened under the authority of the International Health Regulation 2005 will examine a range of questions including whether or not based on the information available so far, what kind of recommendations they make. But perhaps, let me take this opportunity to qualify. As I said, there are a lot of information gaps still because of the size of the outbreak, we need to really work in
the days and weeks ahead with the Mexican authorities to find answers to some of the critical questions. Depending on how strong is the strength of evidence available today, we may have some answers to the kind of recommendations or questions you have raised and we may need perhaps a few more days to get further evidence to answer other questions. So in a nut shell, the experts would be examining a range of issues and we will do our best working with the two governments to present the available evidence, and based on those evidence, we will make appropriate temporary measures.

Washington Post:
Timing of the meeting today and if you will be making a decision today and if so, what time and if you could explain, if you do raise the pandemic alert as a result of this meeting, what will be the impact of that.

Dr Chan:
The Expert Committee will be convened today at about 16.00hrs Geneva time. Based on the whether the information as I said, whether we are going to announce this, confirm this, this is going to be a public health emergency of international concern - it has a set of implications and experts will need to look at what kind of temporary recommendations they can make. Some examples have been given - in the International Health Regulations 2005, article 18, some suggestions have been given for the consideration of the Emergency Committee.

Bloomberg News in Paris:
What explanation do you have for the epidemiology in Mexico indicating disproportionate numbers of otherwise healthy young people coming to the illness and what parallels if any can we draw between this and the 1918 Spanish 'flu?

Dr Chan:
Can we draw any parallel to the 1918 Spanish 'flu - it is too premature to say. Having said that, I suspect the reason you raise this question is because reports say a rather high proportion of young adults suffer from severe disease. This is one feature we were observing in the 1918 outbreak. Now, to answer your question whether or not we are indeed seeing that picture, that is one question we would like to have an answer and we need to look at whether or not the big number of cases reported are genuinely infections due to this new H1N1 or it is due to other viruses or
other causes of pneumonia, so don't have those data now and we will be happy to provide those date as and when they are available.

Journalist from Japanese Newspaper -
Reported that many patients in Mexico are workers at hospitals and I would like to know why so many people in the medical field are infected by the virus?

Dr Chan:
I would like to put on the record - it is not correct to say that there are "many" health care workers affected or infected, it is true that we have information that two health care workers were affected so we need to understand - that's the epidemiology and the history we need together, under what circumstances are the possible reasons for those infections to occur. It would be premature to jump to conclusions because they are health care workers that automatically the infection is from the health care setting - it could be or it could be due to other reasons. Those are
exactly the kind of work, the kind of analysis WHO experts are working with Mexican authorities to find out and report back to all my Member States and of course to the media and through the media to the general public.
*******

[Giuseppe]

Re: WHO - Swine Influenza - Statements and statistics

WHO. Transcript of the Press Conference undertaken with Dr Keiji Fukuda, Assistant Director-General ad. Interim for Health Security and Environment World Health Organization.

Transcript of the Press Conference undertaken with Dr Keiji Fukuda, Assistant Director-General ad. Interim for Health Security and Environment World Health Organization

[Original PDF Document available at this LINK. EDITED.]

26 April 2009


The first thing is that we will be giving regular meeting with the press on a daily basis and this is the first of those meetings. We know that the need for information is very great and we hope to help fill that gap by meeting with you every day. First I shall start by setting the context of what we are thinking about and what we are facing and then I will go into some of the specifics of what we know right now, and then we shall also provide some information about some of the actions which are being taken and then we shall take questions.

Many of you know that the world has been talking about and preparing for pandemic influenza for at least the past five years and there are a number of reasons for this. We know that influenza pandemics have occurred at least a couple of times each century and in the past five years we have been working very hard with our colleagues in many different countries because of a specific pandemic threat known as avian influenza or H5N1 and because of that many countries have been very focused on strengthening their defences for such a situation.

In the past several days, we have now heard about cases of infection in people caused by a different influenza know as the swine H1N1 influenza virus. Influenza viruses have been know infect pigs for quite a long time and we know that every once in a while such viruses have caused infections in people, but right now in the current situation we appear to be in a situation where one of the swine viruses appears to be affecting significant number of people in at least a couple of different countries in different locations. This situation has raised questions about whether we are entering into a pandemic period.

Before we go further to what we know about this specific situation, let me just quickly review what we mean by a pandemic. A pandemic of influenza means that we have a new influenza virus to which most people in the world either have little immunity or no immunity and so this is different than our situation with regular influenza viruses. When we see such a new virus, if it has the ability to infect people and if it especially has the ability to move from person to person in a way that it is able to cause community outbreaks, large outbreaks of infection, then we certainly have the potential for the virus to spread from one country or one location to another.

Again, we have seen such occurrences a couple of times each century and so the question right now is whether we are in such a situation right now. Let us review the specifics: One of the first things I want to caution everybody about is that we are in an evolving situation so we cannot be too focussed on numbers. These numbers can change quite rapidly as we know from any outbreak situation. So we have confirmed virus infections in the United States and in Mexico. Let me take the situations. In the United States as of the 25 April, yesterday, there were 11 laboratory-confirmed human cases of this swine influenza H1N1 virus. Seven of these infections in people occurred in California, two in Texas, two in Kansas. So we have 11 infections in total and I want to point out that all of these infections have been relatively mild, one of them did lead to a hospitalization for a brief period of time, but in general the infections have been mild.

Traditionally, as I mentioned as I mentioned these viruses have circulated in pigs but so far we evidence which suggests that these people were exposed to any sick pigs so we don't have any direct connect to swine right now. In addition preliminary virologic analysis of these viruses all show that they are basically the same virus when the genetic analyses are done. Other analyses continue right now, but basically we think the viruses have been seen in California, and in Kansas and in Texas are the same virus.

We also know that in the United States, there have been other reports of illness, so these are being investigated. For example, we know that in New York City, there have been cases of influenza, eight cases of influenza that have occurred in students, and that specimens have been sent to the US Centers for Disease Control for confirmatory testing. In addition, we know that at 100 students have been reported to have influenza like illness.

So far, among these students, as far as we understand, the disease has been mild. Right now we await further confirmation from New York.

In Mexico, we know that there have been cases of respiratory disease and cases of pneumonia and amongst these people some specimens have been sent out for testing, confirmatory testing. For example, 51 specimens from 51 people were sent to the public health laboratory in Winnipeg, Canada, and we know that 16 of these samples have been positive for this swine H1N1 influenza virus. Furthermore, we know that based on the work done in Canada and in the United States, that the viruses being seen in Mexico are essentially the same as the viruses that are being seen in the United States.

Testing is on-going and as this testing goes on we will have a better handle on all of the properties of these viruses.

Moreover we know that in Mexico there have been at least 1,000 cases of respiratory illness that were reported when the authorities have been studying this situation in April and among these cases there have been about 71 deaths. But I want to point out, these are cases of respiratory illness and we don't really know whether these cases represent a lot of swine 'flu infections or very few swine 'flu infections and so as investigations continue, we hope to have a better picture on this information.

One of the issues that all of this raises is what is the overall take on this situation and where are we. I think if look at the epidemiologic situation we have new influenza viruses that are being detected in a couple of different locations and we know that these are the same viruses and so there are a number of questions we have about the extent of spread of the viruses that is how far are, and to what extent they might be seen in the countries where they are being reported from now and whether they are being found in any other locations. There is a great deal of work being done by authorities in many different countries.

In terms of the virology of these viruses, or again what is known about the viruses themselves, they are swine influenza viruses, that is they are an animal influenza virus, however, they are different from other swine influenza viruses that have been described in the US and in Mexico. To that extent they do represent a new kind of swine influenza infection. So at this time it is fair to characterize our assessment of the situation as serious and WHO and the countries which are being affected by this, and certainly all countries are looking at this situation very seriously, but it is also clear that we are in a period in which the picture is evolving, it is also clear that we are in a period in which we have to be very careful to collect the best possible information.

We really need to understand a bit more about the epidemiology, we want to understand a bit more about the behaviour of these viruses and we want to understand to the extent that these viruses cause mild infections, and the extent to which these viruses can cause serious infections.

So in response to this situation, WHO has initiated several different actions. Let me go over some of them to give you an idea of the range of the activities underway. On Friday (24 April) WHO activated its emergency response room, what we call the SHOC Room (Strategic Health Operations Centre) and what this allows us to do is be in contact simultaneously with countries, institutions, different authorities around the world, with the media, different partners and this allows us to bring together a lot of different functions which can handle in an emergency situation. We have been in very close contact with many different governments as well as many other partners. For example we have been in contact with the UN, with non-governmental agencies, with industry, and we shall continue to work with all these partners so that everyone is as informed as possible and so that we can coordinate any necessary actions as well as possible.

Another action that was undertaken, is that after discussion with authorities in Mexico, the Mexican authorities did request that some assistance be provided and so WHO working with the governments in Canada, in the United States and in Mexico have helped to put together a number of people to go in to provide assistance to help clarify the epidemiologic situation as well as possible.

Another action undertaken by WHO was to convene the Emergency Committee of the International Health Regulations (IHR). This occurred yesterday (Saturday 25 April). The International Health Regulations are basically the overall public health architecture for how we deal with these large public health events or potential large public health events and basically it gives a way for all of the countries and authorities in the world to interact together, to coordinate their actions and to deal with health threats and this is one of the major improvements in modern day public health.

The role of the Emergency Committee is to provide advice and guidance to the Director- General of the World Health Organization. One of the issues that was discussed with the Emergency Committee in which they provided advice, was whether we are in what is called a Public Health Emergency of International Concern. Basically are we facing a situation which appears quite serious. I think that the Committee unanimously agreed that we are in such a situation and that it really warrants the utmost attention. So on the basis of that and the basis of the work and assessment being done by WHO and other colleagues, we have requested countries to help clarify this situation and to provide as much information as possible. So for example, we have asked all countries to increase their surveillance and watchfulness so that we can detect as quickly as possible how this virus may or may not be spreading.

One of the issues which was raised to the Committee, was whether we are in a situation where WHO should increase its pandemic phase, we are currently in Phase 3 and whether we should move it up to Phase 4. The Emergency Committee deliberated on this, and what they said is that we would like a little bit more information and a little bit more time to consider this. This is underway and more information is being collected and the Committee will be reconvened on Tuesday (29 April) unless there is additional information which indicates that we should meet earlier and right now the information does change on a fairly frequent basis. We will be mindful of that.

In addition, WHO is also undertaking a number of other actions. For example, we know that if this situation evolves, one of the questions that will come up very soon, is what is the availability of vaccines. We are already working with our collaborating centres, we have begun the preliminary work need to prepare influenza viruses for potential swine vaccine if we need it.

In addition, there has been a lot of work going on to make sure that we reduce the confusion as much as possible. For example, to produce a standard case definition which will be helpful both to the authorities looking for potential swine influenza cases as well as for the rest of us when we talk about what the situation is, so that we don't get disease mixed up with laboratory-confirmed cases and so on. In addition, the collaborating centres have been working very hard to produce the kinds of tests and reagents needed by other laboratories around the world so detect these infections. So there is a great deal of work going on that we can as quickly detect and monitor the situation and do this as well as is possible.

That provides a broad overview of why we take the situation seriously, what the specific situation is based on the information we have at this time and some of the actions which have been initiated at this time. As you know from experience that the situations evolve and we will continue to meet with you on a regular basis and provide the information as it becomes available to us. Let me stop there and we will take any questions.

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[Niko]

Re: WHO - Swine Influenza - Statements and statistics

This is posted elsewhere at FT, but thought a refresher may be in order.

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

Current WHO phase of pandemic alert

Current phase of alert in the WHO global influenza preparedness plan

Pandemic preparedness In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1?3 correlate with preparedness, including capacity development and response planning activities, while Phases 4?6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.
The current WHO phase of pandemic alert is 3.

<table border="0" cellpadding="1" cellspacing="0" width="750"> <tbody><tr> <td> </td> </tr> </tbody></table>
In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ?community-level outbreaks.? The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region (Figure 4). While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.
Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate ?at-ease? signal may be premature.
In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

[Niko]

Re: WHO - Swine Influenza - Statements and statistics

WHO press briefings found here: Swine influenza virtual press briefings

Future briefings will be posted in this thread.