Announcement

**Giuseppe** · May 15, 2009, 03:35 AM

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

NEW H1N1 INFLUENZA: ECDC SITUATION REPORT - Main developments in past 24 hours (May 15, 2009, 08:00 CEST, Edited)

ECDC SITUATION REPORT

Main developments in past 24 hours

[Original Document: LINK. EDITED.]

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of probable and confirmed cases as of 15 May, 08:00 hours CEST, is presented in Table 1 and Table 2.

Epidemiological update

Within the last 24 hours, 12 new confirmed cases were reported in the EU and EFTA countries, reaching a total of 234 confirmed cases reported from 16 countries (Table 1). Three new cases were confirmed from the Netherlands, one from Poland and one from Belgium; all have a history of travel to Mexico or the United States. Out of the seven new confirmed cases reported from the United Kingdom, four are linked to previous confirmed cases; the three remaining persons have a history of travel. There is now a total of 66 reported in-country transmissions in the EU and EFTA countries.

Outside the EU and EFTA countries, the number of confirmed cases increased to 7509 new influenza A(H1N1) virus infections, reported from 18 countries (Table 2). Three additional deaths were reported from Mexico, bringing the total to 64 deaths among the 2656 confirmed cases. As of 14 May, the US reports the cumulative number of both probable and confirmed cases together, reaching a total of 4298 cases, including three deaths.

Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries has not changed: no sustained community transmission is currently reported and the priority for Europe remains the containment of the clustered in-country transmissions, in an attempt to avoid wider spread of the new influenza A(H1N1) infection on the continent. ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.

New influenza A(H1N1) infection - Update 15 May 2009, 08:00 hours CEST

12 new confirmed cases reported from EU and EFTA countries;
Eurosurveillance issue with descriptive epidemiology from the cases in Spain and the United Kingdom, and a paper estimating the reproduction ratio in Mexico.

From the literature

This week?s Eurosurveillance issue focuses on the new influenza A(H1N1) infections in Spain and the United Kingdom. In addition, a paper estimating the reproduction ratio, which measures the average number of secondary cases per primary case, is published.

Spain, the first country in Europe to report new influenza A(H1N1) infections, reports on 98 confirmed cases, 76 (78%) of whom had a history of travel, all to Mexico. A total of 21 cases were due to secondary, and one to tertiary transmission within the country. The autonomous communities reporting the highest number of cases include Andaluc?a (29), Valencia (28) and Catalu?a (26). All reported cases had a mild clinical presentation. The most affected age group in the cases reported from Spain corresponds to the earlier reports from Mexico and the US; the age of the confirmed cases ranges from 14 to 55 years old, with a median of 22 years. Analysis from the Spanish cases indicates an incubation period from one to seven days, with a median of three days. The article is
available from the following link: http://www.eurosurveillance.org/View...rticleId=19209.

The paper by health authorities of the United Kingdom reports that 56% of all confirmed cases (n = 65) acquired infection through secondary transmission within the country, mainly through household or close contacts. In addition, transmission occurred in school settings as well. Out of the 29 cases with a history of travel, 24 (83%) had travelled to Mexico and five to the US before becoming ill. As in Spain, all of the cases reported from the United Kingdom had a mild clinical presentation, similar to seasonal influenza.
The article is available from the following link: http://www.eurosurveillance.org/View...rticleId=19213.

Researchers from France estimated the reproductive ratio for the outbreak in Mexico, using two different methods. Depending on the underlying assumptions, the results suggest a maximum reproductive ratio between 2.2 and 3.1, which falls in the same range as previous influenza pandemics. The article is available using the following link: http://www.eurosurveillance.org/View...rticleId=19205

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 15 May 2009, 08:00 hours (CEST) in EU and EFTA countries

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

Austria ... - 1 - ...
Belgium 1 - 2 - ...
Denmark ... - 1 - ...
Finland ... - 2 - ...
France ... - 14 - ...
Germany ... - 12 - 2
Ireland ... - 1 - ...
Italy ... - 9 - 1
Netherlands 3 - 6 - ...
Norway ... - 2 - ...
Poland 1 - 2 - ...
Portugal ... - 1 - ...
Spain ... - 100 - 22
Sweden ... - 2 - ...
Switzerland ... - 1 - ...
United Kingdom 7 - 78 - 41
Total 12 - 234 - 66

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

Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 15 May 2009, 08:00 hours (CEST) outside of the EU and EFTA area

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

WHO EURO REGION

Israel ... - 7 - 0

WHO PAHO REGION

Argentina ... - 1 - 0
Brazil ... - 8 - 0
Canada 60 - 449 - 1
Colombia 4 - 10 - 0
Costa Rica ... - 8 - 1
Cuba 2 - 3 - 0
El Salvador ... - 4 - 0
Guatemala ... - 3 - 0
Mexico 210 - 2656 - 64
Panama 10 - 39 - 0
USA 946** - 4298** - 3

WHO SEARO REGION

Thailand ... - 2 - 0

WHO WPRO REGION

Australia ... - 1 - 0
China ... - 4 - 0
Japan ... - 4 - 0
New Zealand 2 - 9 - 0
Republic of Korea ... - 3 - 0

Total 1234 / 7509 / 69

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

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

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**Giuseppe** · May 15, 2009, 12:34 PM

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

ECDC. Outbreak of influenza A/H1N1 virus - Case Count (May 15, 2009, 17:00 CEST, Edited)

Outbreak of influenza A(H1N1) virus

"ECDC is closely following the development of the present epidemic of influenza A(H1N1). Via our Emergency Operation Centre, ECDC experts and scientists are working closely with the European Commission, WHO and health authorities and agencies inside and outside Europe to assess the risk presented by this new virus and to identify means to counteract its effects. As each day passes, we learn more about the disease and what we should do to prevent it from spreading. At this stage, we do not yet know exactly how the situation will evolve. However, in the event of a global epidemic, Europe today stands better prepared than ever before. ECDC will continue to monitor the situation and communicate with the European community, providing advice and educational information about influenza A(H1N1) based on the latest scientific data available to our experts". Zsuzsanna Jakab, Director ECDC

Personal Protective measures

With increasing numbers of confirmed cases being reported by European countries, ECDC has been working with the European Commission and its partners in the Member States to prepare some simple advice for EU citizens on how they can help to protect themselves and others from becoming infected with the influenza virus A(H1N1).

Current Pandemic Situation Reports

== Human cases of influenza A(H1N1) in the EU and EFTA countries - Last update: 15 May, 17:00 CEST ==

[Country / Current number of probable cases / Cumulative number of confirmed cases / Cumulative number of in-country transmission]

Austria 0 - 1 - 0
Belgium 0 - 2 - 0
Denmark 0 - 1 - 0
Finland 0 - 2 - 0
France 1 - 14 - 0
Germany 0 - 12 - 2
Ireland 0 - 1 - 0
Italy 0 - 9 - 1
Netherlands 0 - 3 - 0
Norway 0 - 2 - 0
Poland 0 - 2 - 0
Portugal 0 - 1 - 0
Spain 0 - 100 - 22
Sweden 0 - 2 - 0
Switzerland 0 - 1 - 0
UK 8 - 82 - 41

TOTAL 9 / 235 / 66

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<cite cite="http://www.ecdc.europa.eu/en/Health%5Ftopics/novel%5Finfluenza%5Fvirus/2009%5FOutbreak/">Outbreak of influenza A/H1N1 virus</cite>

**Giuseppe** · May 16, 2009, 02:20 AM

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

NEW INFLUENZA H1N1: ECDC SITUATION REPORT - Main developments in past 24 hours (5/16/09, Edited)

ECDC SITUATION REPORT

Main developments in past 24 hours

[Original Document: LINK. EDITED.]

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 16 May, 08:00 hours CEST, is presented in Table 1 and Table 2.

Epidemiological update

Within the last 24 hours, 11 new confirmed cases were reported in the EU and EFTA countries, reaching a total of 242 confirmed cases reported from 16 countries (Table 1). Two additional cases were reported from Belgium and four from the United Kingdom, all close contacts from previously confirmed cases. In addition, two more cases were reported from Germany, both were asymptomatic and found through contact tracing of a previously confirmed case. Both of them had received antiviral post exposure prophylaxis. Three new cases were also confirmed in Spain. In total 82 cases were confirmed with in country transmission.

Outside the EU and EFTA countries, the number of confirmed cases increased to 8216 new influenza A(H1N1) virus infections, reported from 21 countries (Table 2). Ecuador, Peru and Malaysia confirmed their first case each. One additional death is reported from the US, a woman in her forties with underlying illness. Two more deaths were reported from Mexico, the last one deceased on 10 May. This brings the total number of deaths to 72. A probable case currently under investigation is a crew member of a cruise ship with a route covering Mexico, US and Canada on the Western North American coast.

Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries has not changed: no sustained community transmission is currently reported and the priority for Europe remains the containment of the clustered in-country transmissions, in an attempt to avoid wider spread of the new influenza A(H1N1) infection on the continent.

New influenza A(H1N1) infection - Update 16 May 2009, 08:00 hours CEST

Eleven new confirmed cases reported from EU and EFTA countries;
First cases reported from Peru (1), Ecuador (1) and Malaysia (1), respectively;
Two asymptomatic cases confirmed in Germany in contacts having received post-exposure prophylaxis
One new fatal case from the US;
Two more deaths confirmed in Mexico;

ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website From the literature This week?s Weekly Epidemiological Record (WER) published by the World Health Organization (WHO) provides a global surveillance summary of new influenza A(H1N1) infections. Confirmed cases are currently reported from three WHO areas, with the great majority of cases occurring in the Americas. The first case confirmed in Mexico dates from 10 March 2009. Of the total number of confirmed cases in the country, 72% is younger than 30 years of age. A similar age pattern of confirmed cases is observed in the US as well. While most cases present mild clinical illness with influenza-like symptoms including fever, cough or runny nose, some of the laboratory confirmed cases did not present fever. Severe clinical illness and deaths have been reported, but not always related to underlying illness. Out of the confirmed deaths in Mexico, 71% was below 45 years old. The implication of the younger age groups in severe disease and deaths is different than from what is observed during seasonal influenza outbreaks. Community transmission is currently widespread in Mexico and the US, with a secondary attack rate estimated to be 22%, even though this was higher in closed settings like in schools.

The full article is available from the following link: http://www.who.int/wer/2009/wer8420/en/index.html

Recent data from EU influenza surveillance system shows that from calendar week 18 to 19 in 2009, the number of virological specimens submitted under the sentinel system decreased from 289 to 224. The proportion of specimens that were found positive for influenza virus remained stable at around 6%. During this week 19, 11 samples of new influenza A (H1N1) were identified through this surveillance system. By genetic analysis, the new A(H1N1) viruses have been assessed as being sensitive to oseltamivir and zanamivir. http://www.eiss.org/cgi-files/bulletin_v2.cgi

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 16 May 2009, 08:00 hours (CEST) in EU and EFTA countries

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

Austria 0 - 1 - ...
Belgium 2 - 4 - 2
Denmark 0 - 1 - ...
Finland 0 - 2 - ...
France 0 - 14 - ...
Germany 2 - 14 - 4
Ireland 0 - 1 - ...
Italy 0 - 9 - 1
Netherlands 0 - 3 - ...
Norway 0 - 2 - ...
Poland 0 - 2 - ...
Portugal 0 - 1 - ...
Spain 3 - 103 - 30
Sweden 0 - 2 - ...
Switzerland 0 - 1 - ...
United Kingdom 4 - 82 - 45

Total 11 - 242 -82

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

Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 16 May 2009, 08:00 hours (CEST) outside of the EU and EFTA area

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

WHO EURO REGION

Israel 0 - 7 -0

WHO PAHO REGION

Argentina 0 - 1 - 0
Brazil 0 - 8 - 0
Canada 47 - 496 - 1
Colombia 0 - 10 - 0
Costa Rica 1 - 9 - 1
Cuba 0 - 3 - 0
El Salvador 0 - 4 - 0
Equador 1 - 1
Guatemala 0 - 3 - 0
Mexico 237 - 2895 - 66
Panama 1 - 40 - 0
Peru 1 - 1 - 0
USA 416** - 4714** - 4

WHO SEARO REGION

Thailand 0 - 2 - 0

WHO WPRO REGION

Australia 0 - 1 - 0
China 0 - 4 - 0
Japan 0 - 4 - 0
Malaysia 1 - 1 - 0
New Zealand 0 - 9 - 0
Republic of Korea 0 - 3 - 0

Total 705 - 8216 - 72

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

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

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**Giuseppe** · May 16, 2009, 11:46 AM

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

ECDC. Outbreak of influenza A/H1N1 virus - Case Count (May 16, 2009, 17:00 CEST, Edited)

Outbreak of influenza A(H1N1) virus

"ECDC is closely following the development of the present epidemic of influenza A(H1N1). Via our Emergency Operation Centre, ECDC experts and scientists are working closely with the European Commission, WHO and health authorities and agencies inside and outside Europe to assess the risk presented by this new virus and to identify means to counteract its effects. As each day passes, we learn more about the disease and what we should do to prevent it from spreading. At this stage, we do not yet know exactly how the situation will evolve. However, in the event of a global epidemic, Europe today stands better prepared than ever before. ECDC will continue to monitor the situation and communicate with the European community, providing advice and educational information about influenza A(H1N1) based on the latest scientific data available to our experts". Zsuzsanna Jakab, Director ECDC

Personal Protective measures

With increasing numbers of confirmed cases being reported by European countries, ECDC has been working with the European Commission and its partners in the Member States to prepare some simple advice for EU citizens on how they can help to protect themselves and others from becoming infected with the influenza virus A(H1N1).

Current Pandemic Situation Reports

== Human cases of influenza A(H1N1) in the EU and EFTA countries - Last update: 16 May, 17:00 CEST ==

[Country / Cumulative number of confirmed cases / Cumulative number of in-country transmission]

Austria 1 - ...
Belgium 4 - 2
Denmark 1 - ...
Finland 2 - ...
France 14 - ...
Germany 14 - 4
Ireland 1 - ...
Italy 9 - 1
Netherlands 3 - ...
Norway 2 - ...
Poland 2 - ...
Portugal 1 - ...
Spain 103 -30
Sweden 3 - ...
Switzerland 1 - ...
UK 82 - 45

TOTAL 243 - 82

(...)
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<cite cite="http://www.ecdc.europa.eu/en/Health%5Ftopics/novel%5Finfluenza%5Fvirus/2009%5FOutbreak/">Outbreak of influenza A/H1N1 virus</cite>

**Giuseppe** · May 18, 2009, 03:14 AM

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

NEW INFLUENZA H1N1. ECDC SITUATION REPORT - Main developments in past 24 hours (May 18, 2009, Edited)

ECDC SITUATION REPORT

Main developments in past 24 hours

[Original Document: LINK. EDITED.]

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 18 May, 08:00 hours CEST, is presented in Table 1 and Table 2.

Epidemiological update

Within the last 24 hours, 14 new confirmed cases were reported in the EU and EFTA countries, reaching a total of 263 confirmed cases reported from 16 countries (Table 1). All of the new confirmed cases were reported from the UK, 11 of them were contacts of previously confirmed cases. This brings the total of confirmed cases in the UK to 101, 56 of them (55%) were due to in-country transmission.

In EU and EFTA countries, a total of 94 cases (36%) were confirmed with in country transmission among 263 confirmed cases.

During the weekend, a total of 21 new confirmed cases were reported from Japan. None of them had contact with the previously 4 reported confirmed cases from Japan, or a recent travel history. All confirmed cases are high school students (12 from Kobe and 9 from Osaka). The WHO Regional Office for the Western Pacific reported that there are still no clear signs of the virus transmitting into local communities.

Panama reported 12 more confirmed cases resulting in a total of 55 confirmed cases. The first 2 cases were confirmed from Chile in returning travellers from Panama. One more confirmed case was reported from Malaysia (1 new, 2 total) and one from Hong Kong (China: 1 new, 6 total).

In Mexico, 2 more deaths were reported resulting in 68 deaths in Mexico and 74 globally.

Outside the EU and EFTA countries, the number of confirmed cases increased to 8469 new influenza A(H1N1) virus infections, reported from 24 countries (Table 2).

New influenza A(H1N1) infection - Update 18 May 2009, 08:00 hours CEST

21 new confirmed cases from Japan, not travel related and without link to previously confirmed cases;
14 new confirmed cases reported from the UK, 11 with in-country transmission;
Chile confirmed its first 2 cases;
Two more deaths reported from Mexico;
Total of 94 confirmed cases of in-country transmission in EU and EFTA countries;
No updates during the weekend available from Canada and the US;

Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries has not changed: no sustained community transmission is currently reported and the priority for Europe remains the containment of the clustered in-country transmissions, in an attempt to avoid wider spread of the new influenza A(H1N1) infection on the continent. ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website The 62nd session of the World Health Assembly is scheduled to take place in Geneva during 18-22 May 2009. At this session, the Health Assembly will discuss a number of public health issues, including the pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits. (http://www.who.int/mediacentre/event.../en/index.html)

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 18 May 2009, 08:00 hours (CEST) in EU and EFTA countries

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

Austria 0 - 1 - ...
Belgium 0 - 5 - 3
Denmark 0 - 1 - ...
Finland 0 - 2 - ...
France 0 - 14 - ...
Germany 0 - 14 - 4
Ireland 0 - 1 - ...
Italy 0 - 9 - 1
Netherlands 0 - 3 - ...
Norway 0 - 2 - ...
Poland 0 - 2 - ...
Portugal 0 - 1 - ...
Spain 0 - 103 - 30
Sweden 0 - 3 - ...
Switzerland 0 - 1 - ...
United Kingdom 14 - 101 - 56

Total 14 - 263 - 94

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

Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 18 May 2009, 08:00 hours (CEST) outside of the EU and EFTA area

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

WHO EURO REGION

Israel 0 - 7 - 0
Turkey 0 - 2 - 0

WHO PAHO REGION

Argentina 0 - 1 - 0
Brazil 0 - 8 - 0
Canada*** 0 - 496 - 1
Chile 2 - 2 - 0
Colombia 0 - 11 - 0
Costa Rica 0 - 9 - 1
Cuba 0 - 3 - 0
El Salvador 0 - 4 - 0
Ecuador 0 - 1
Guatemala 0 - 3 - 0
Mexico 208 - 3103 - 68
Panama 12 - 55 - 0
Peru 0 - 1 - 0
USA*** 0 - 4714** - 4

WHO SEARO REGION

India 0 - 1 - 0
Thailand 2 - 0

WHO WPRO REGION

Australia 0 - 1 - 0
China 1 - 6 - 0
Japan 21 - 25 - 0
Malaysia 1 - 2 - 0
New Zealand 0 - 9 - 0
Republic of Korea 0 - 3 - 0

Total 245 - 8469 - 74

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

*Deaths are included in the cumulative number of confirmed cases
** Cases in the US include both probable and confirmed cases.
*** no updates available

(...)

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**Giuseppe** · May 18, 2009, 02:58 PM

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

ECDC. Outbreak of influenza A/H1N1 virus (May 18, 2009, 17.00 CEST, Edited)

Human cases of influenza A(H1N1) in the EU and EFTA countries

Last update: 18 May, 17:00 CEST

[Country - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

Austria 1 - ...
Belgium 5 - 3
Denmark 1 - ...
Finland 2 - ...
France 14 - ...
Germany 14 - 4
Ireland 1 - ...
Italy 9 - 1
Netherlands 3 - ...
Norway 2 - ...
Poland 2 - ...
Portugal 1 - ...
Spain 103 - 30
Sweden 3 - ...
Switzerland 1 - ...
UK 102 - 56

TOTAL 264 - 94

(...)
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<cite cite="http://www.ecdc.europa.eu/en/Health%5Ftopics/novel%5Finfluenza%5Fvirus/2009%5FOutbreak/">Outbreak of influenza A/H1N1 virus</cite>

**Giuseppe** · May 19, 2009, 02:56 AM

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

NEW INFLUENZA H1N1. ECDC SITUATION REPORT - Main developments in past 24 hours (May 19, 2009, Edited)

ECDC SITUATION REPORT

Main developments in past 24 hours

[Original Document: LINK. EDITED.]

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 18 May, 08:00 hours CEST, is presented in Table 1 and Table 2.

Epidemiological update

Within the last 24 hours, 2 new confirmed cases were reported in the EU and EFTA countries, reaching a total of 265 confirmed cases reported from 17 countries (Table 1). Greece reported its first case in a returning traveller from New York (US) and the UK reported one more case. In EU and EFTA countries, the total number of cases is now at 265.

Japan reported 104 new laboratory confirmed cases of influenza A(H1N1) on 18 May, taking its total number of confirmed cases to 129 from 25 reported in yesterday?s Situation Report. The confirmed case count in Hyogo Prefecture, which includes Kobe City, rose to 78 after new cases were found at 10 schools throughout the prefecture. The case count at Osaka City rose to 47 on 18 May, from nine reported the previous day.

Four more deaths were reported from Mexico resulting in a total of 72 deaths. One more death was reported from the US in a person with underlying disease. This brings the total number of deaths to 79 globally.

Due to a national public holiday no updates are available from Canada.

Outside the EU and EFTA countries, the number of confirmed cases increased to 9533 new influenza A(H1N1) virus infections, reported from 24 countries (Table 2).

New influenza A(H1N1) infection Update 19 May 2009, 08:00 hours CEST

104 new confirmed cases from Japan (total 129);
Greece confirmed its first case;
Four more deaths reported from Mexico;
One more death reported from the US;
No updates available from Canada;

Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries has not changed: no sustained community transmission is currently reported and the priority for Europe remains the containment of the clustered in-country transmissions, in an attempt to avoid wider spread of the new influenza A(H1N1) infection on the continent. ECDC, in collaboration with the Member States, the European Commission and the World Health Organisation, continues to closely monitor this rapidly evolving situation, and provide daily updates on its website.

Assessment outside the EU

With regards to the Japanese situation, all new Japanese cases appear to have acquired the virus independently of the country's previous four cases, which had histories of overseas travel. At the moment, the cases seem to be mainly associated with schools. While at this stage WHO Regional Office for the Western Pacific, states that there is no clear sign of the virus transmitting widely into local communities, efforts are now being made to carefully assess this possibility.

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 19 May 2009, 08:00 hours (CEST) in EU and EFTA countries

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

Austria 0 - 1 - ...
Belgium 0 - 5 - 3
Denmark 0 - 1 - ...
Finland 0 - 2 - ...
France 0 - 14 - ...
Germany 0 - 14 - 4
Greece 1 - 1 - ...
Ireland 0 - 1 - ...
Italy 0 - 9 - 1
Netherlands 0 - 3 - ...
Norway 0 - 2 - ...
Poland 0 - 2 - ...
Portugal 0 - 1 - ...
Spain 0 - 103 - 30
Sweden 0 - 3 - ...
Switzerland 0 - 1 - ...
United Kingdom 1 - 102 - 56

Total 2 - 265 - 94

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

Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 19 May 2009, 08:00 hours (CEST) outside of the EU and EFTA area

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

WHO EURO REGION

Israel 0 - 7 - ...
Turkey 0 - 2 - ...

WHO AMRO REGION

Argentina 0 - 1 - ...
Brazil 0 - 8 - ...
Canada*** 0 - 496 - 1
Chile 2 - 4 - ...
Colombia 0 - 11 - ...
Costa Rica 0 - 9 - 1
Cuba 0 - 3 - ...
El Salvador 0 - 4 - ...
Ecuador 0 - 1 - ...
Guatemala 0 - 3 - ...
Mexico 545 - 3648 - 72
Panama 4 - 59 - ...
Peru 0 - 1 - 0
USA 409 - 5123** - 5

WHO SEARO REGION

India 0 - 1 - ...
Thailand 0 - 2 - ...

WHO WPRO REGION

Australia 0 - 1 - ...
China 0 - 6 - ...
Japan 104 - 129 - ...
Malaysia 0 - 2 - ...
New Zealand 0 - 9 - ...
Republic of Korea 0 - 3 - ...

Total 1064 - 9533 - 79

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

*Deaths are included in the cumulative number of confirmed cases
** Cases in the US include both probable and confirmed cases.
*** no updates available

(...)
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**Giuseppe** · May 19, 2009, 11:56 AM

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

ECDC. Outbreak of influenza A/H1N1 virus - Case Count (May 19, 2009, 17:00 CEST, Edited)

Human cases of influenza A(H1N1) in the EU and EFTA countries

Last update: 19 May, 17:00 CEST

[Country - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

Austria 1 - ...
Belgium 5 - 3
Denmark 1 - ...
Finland 2 - ...
France 16 - ...
Germany 14 - 4
Greece 1 - ...
Ireland 1 - ...
Italy 9 - 1
Netherlands 3 - ...
Norway 2 - ...
Poland 2 - ...
Portugal 1 - ...
Spain 107 - 30
Sweden 3 - ...
Switzerland 1 - ...
UK 107 - 56

TOTAL 276 - 94

(...)
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<cite cite="http://www.ecdc.europa.eu/en/Health%5Ftopics/novel%5Finfluenza%5Fvirus/2009%5FOutbreak/">Outbreak of influenza A/H1N1 virus</cite>

**Giuseppe** · May 20, 2009, 03:32 AM

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

NEW INFLUENZA H1N1. ECDC SITUATION REPORT - Main developments in past 24 hours (May 20, 2009, Edited)

ECDC SITUATION REPORT

Main developments in past 24 hours

[Original Document: LINK. EDITED.]

This report is based on official information provided by the national public health websites, or through other official communication channels. In addition, outside of the EU and EFTA countries, media reports from credible sources are included when quoting national authorities. An update on the number of confirmed cases as of 20 May, 08:00 hours CEST, is presented in Table 1 and Table 2.

New influenza A(H1N1) infection - Update 20 May 2009, 08:00 hours CEST

11 more cases reported from EU and EFTA countries;
One more death reported from the US;
Rapid increase of cases reported from Japan, mainly linked to school outbreaks.

Epidemiological update

Within the last 24 hours, 11 new confirmed cases were reported in the EU and EFTA countries, reaching a total of 276 confirmed cases reported from 17 countries (Table 1). Five more cases were reported from the United Kingdom, including one additional case from Scotland. Spain reported four additional cases, and France two.

Outside of the EU and EFTA countries, a total of 9939 cases are currently reported, including 80 deaths (Table 2).

In the past 24 hours, the US reported an additional 346 cases and one death, while Japan reported 47 new confirmed cases. A total of eight cases have now been confirmed from China.

Assessment and response in the EU and EFTA countries

The assessment for the EU and EFTA countries does not change: no sustained community transmission is currently reported and the priority for Europe remains the containment of the clustered in-country transmissions, in an attempt to avoid wider spread of the new influenza A(H1N1) infection on the continent.

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

Assessment outside the EU

As indicated in the previous update, the cases in Japan are mainly linked to school outbreaks, and there is no indication that the virus has spread in the community. However, investigations are ongoing to investigate the possibility of community transmission.

The World Health Organisation stated that the pandemic alert level remains in phase 5, while reflections are ongoing on the current criteria needed for moving to phase 6, which do not include any indication for severity of infection. However, these criteria were established based on the H5N1 avian influenza infection which has a mortality of 50%-60%, much higher than the generally mild clinical illness caused by the new influenza A(H1N1).

On 19 May, the heads of the World Health Organisation and the United Nations met with more than 30 vaccine manufacturers to make sure vaccines for the new influenza A(H1N1) virus will be made available in a spirit of equity and fairness also in the developing countries.

More information is available from the WHO website: http://www.who.int/mediacentre/news/.../en/index.html

From the literature

The US CDC?s Morbidity and Mortality Weekly Report (MMWR) of 18 May reports on the 30 hospitalised cases of new influenza A(H1N1) infection, out of the total of 553 cases reported in the state of California, US, including 333 confirmed and 220 probable. Of these 30 hospitalised cases, 26 were confirmed and 4 were considered probable pending the test results.

The median age of the hospitalised cases was 27.5 years, ranging from 27 days and 89 years of age, and underlying conditions were present for 19 patients (64%). Radiological findings of 15 out of the 25 patients for which a chest radiograph was taken, suggested the presence of pneumonia. Five (17%) of the 30 hospitalised patients were pregnant, two of whom developed serious complications; however, to which extent these complications were related to the new influenza A(H1N1) infection, remains unclear.

Half of the hospitalised patients received oseltamivir as treatment, and six out of the 22 patients for whom the information is available, had received seasonal influenza vaccination.

The full article is available from the following link: http://www.cdc.gov/mmwr/preview/mmwr...m58e0518a1.htm

Table 1: Reported cumulative number of confirmed cases and of in-country transmission of new influenza A(H1N1) as of 20 May 2009, 08:00 hours (CEST) in EU and EFTA countries

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

Austria ... - 1 - ...
Belgium ... - 5 - 3
Denmark ... - 1 - ...
Finland ... - 2 - ...
France 2 - 16 - ...
Germany ... - 14 - 4
Greece ... - 1 - ...
Ireland ... - 1 - ...
Italy ... - 9 - 1
Netherlands ... - 3 - ...
Norway ... - 2 - ...
Poland ... - 2 - ...
Portugal ... - 1 - ...
Spain 4 - 107 - 30
Sweden ... - 3 - ...
Switzerland ... - 1 - ...
United Kingdom 5 - 107 - 60

Total 11 - 276 - 98

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

Table 2: Reported cumulative number of confirmed cases and deaths of new influenza A(H1N1) as of 20 May 2009, 08:00 hours (CEST) outside of the EU and EFTA area

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

WHO EURO REGION

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

WHO AMRO REGION

Argentina ... - 1 - ...
Brazil ... - 8 - ...
Canada ... - 496 - 1
Chile 6 - 10 - ...
Colombia ... - 11 - ...
Costa Rica ... - 9 - 1
Cuba ... - 3 - ...
El Salvador 2 - 6 - ...
Ecuador ... - 1 - ...
Guatemala ... - 3 - ...
Mexico ... - 3648 - 72
Panama ... - 59 - ...
Peru 2 - 3 - 0
USA 346 - 5469** - 6

WHO SEARO REGION

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

WHO WPRO REGION

Australia ... - 1 - ...
China 2 - 8 - ...
Japan 47 - 176 - ...
Malaysia ... - 2 - ...
New Zealand ... - 9 - ...
Republic of Korea ... - 3 - ...
Taiwan 1 - 1 - ...

Total 406 - 9939 - 80

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

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

(...)

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**Giuseppe** · May 20, 2009, 11:31 AM

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

ECDC. Outbreak of influenza A/H1N1 virus (May 20, 2009, 17:00 CEST, Edited)

Human cases of influenza A(H1N1) in the EU and EFTA countries

Last update: 20 May, 17:00 CEST

[Country - Cumulative number of confirmed cases - Cumulative number of in-country transmission]

Austria 1 - ...
Belgium 5 - 3
Denmark 1 - ...
Finland 2 - ...
France 16 - ...
Germany 14 - 4
Greece 1 - ...
Ireland 1 - ...
Italy 10 - 1
Netherlands 3 - ...
Norway 3 - ...
Poland 2 - ...
Portugal 1 - ...
Spain 107 - 30
Sweden 3 - ...
Switzerland 1 - ...
UK 109 - 62

TOTAL 280 - 100

(...)
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<cite cite="http://www.ecdc.europa.eu/en/Health%5Ftopics/novel%5Finfluenza%5Fvirus/2009%5FOutbreak/Outbreak_new_table.aspx">Outbreak of influenza A/H1N1 virus</cite>

**Giuseppe** · May 22, 2009, 02:22 AM

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]

Main developments since previous update

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

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

Epidemiological update

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

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

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

Assessment and response in the EU and EFTA countries

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

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

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

Assessment outside the EU

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

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

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

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

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

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

Total 10 - 290 - 111

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

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

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

WHO EURO REGION

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

WHO AMRO REGION

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

WHO SEARO REGION

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

WHO WPRO REGION

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

Total 717 - 10789 - 85

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

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

(...)

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**Giuseppe** · May 22, 2009, 03:20 PM

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

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

ECDC SITUATION REPORT

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

Main developments since previous update

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

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

Epidemiological update

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

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

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

Assessment and response in the EU and EFTA countries

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

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

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

Assessment outside the EU

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

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

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

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

Total 26 - 316 - 111

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

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

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

WHO EURO REGION

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

WHO AMRO REGION

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

WHO SEARO REGION

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

WHO WPRO REGION

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

Total 992 - 11783 - 85

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

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

(...)

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**Giuseppe** · May 23, 2009, 04:26 PM

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]

Main developments since previous update

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

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

Epidemiological update

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

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

Assessment and response in the EU and EFTA countries

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

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

Mortality in Mexico

The ministry of health in Mexico provided additional data on the reported influenza A(H1N1) deaths, representing 2% of the total number of cases and more than half of whom were women (56%). Up to 90% of the deaths occurred in persons having an onset of their symptoms before 23 April, and the majority (77%) occurred in persons between 20 to 54 years of age. Almost a third (29%) of the persons who died had an underlying metabolic disease and 15% had cardio-vascular antecedents. Cough, fever and dyspnoea were the most common symptoms reported. The full report is available from: http://portal.salud.gob.mx/descargas...mia_220509.pdf

From the literature

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

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

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

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

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

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

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

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

WHO EURO REGION

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

WHO AMRO REGION

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

WHO SEARO REGION

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

WHO WPRO REGION

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

Total 327 - 12110 -91

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

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

(...)

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**Giuseppe** · May 24, 2009, 11:32 AM

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]

Main developments in past 24 hours

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

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

Epidemiological update

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

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

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

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

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

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

Assessment and response in the EU and EFTA countries

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

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

From the literature

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

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

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

The WHO guidance document on the clinical management of cases is available from the following link: http://www.who.int/csr/resources/pub...1_May_2009.pdf.

In addition, the WHO report of a high level consultation, describing key uncertainties, lessons learnt and challenges of the current outbreak of influenza A(H1N1) was published: http://www.who.int/csr/resources/pub...8_May_2009.pdf.

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

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

Austria ... - 1 - ...
Belgium ... - 7 - 3
Denmark ... - 1 - ...
Finland ... - 2 - ...
France ... - 16 - ...
Germany ... - 17 - 4
Greece ... - 1 - ...
Iceland ... - 1 - ...
Ireland ... - 1 - ...
Italy 5 - 19 - 2
Netherlands ... - 3 - ...
Norway 1 - 4 - ...
Poland 1 - 3 - ...
Portugal ... - 1 - ...
Spain 7 - 133 - 31
Sweden ... - 3 - ...
Switzerland 1 - 3 - ...
United Kingdom 11 - 133 - 80

Total 26 - 349 - 120

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

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

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

WHO EURO REGION

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

WHO AMRO REGION

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

WHO SEARO REGION

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

WHO WPRO REGION

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

Total 42 - 12,152 - 91

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

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

(...)

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**Giuseppe** · May 25, 2009, 12:04 PM

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

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

ECDC SITUATION REPORT

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

[Original Document: LINK. EDITED.]

Main developments in past 24 hours

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

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

Epidemiological update

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

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

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

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

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

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

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

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

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

Assessment and response in the EU and EFTA countries

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

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

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

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

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

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

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

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

WHO EURO REGION

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

WHO AMRO REGION

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

WHO EMRO REGION

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

WHO SEARO REGION

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

WHO WPRO REGION

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

Total 305 - 12,457 - 92

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

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

(...)

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