Archive. ECDC: Pandemic Influenza H1N1 2009, Situation Updates (August 4 - December 31, 2009)

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 10 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 10 November 2009, 09:00 hours CEST

Main developments in past 24 hours

• Updates from U.S.A. and Canada included;
• Updates from EpiWatch included;
• Total of 414 fatal cases in Europe and EFTA countries and 6 094 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 09 November 2009 -16:00 hours CEST, for the world, and 10 November 2009 - 09:00 hours CEST, for Europe.

Updates from U.S.A. and Canada
United States
Update Data as of 06 November 2009 17:00 CEST, for week ending 31 October, 2009 (Week 43)

• Virology:
  
  • >99% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses.
  • 99.7% of all specimens were type A. Two A(H3), 1 A(H1), and 14 type B were reported. One seasonal influenza A (H1N1) virus was tested and is related to the influenza A (H1N1) component of the 2009-10 Northern Hemisphere influenza vaccine (A/Brisbane/59/2007).
  • Both influenza A (H3N2) viruses tested showed reduced titers with antisera produced against A/Brisbane/10/2007, the 2009-2010 Northern Hemisphere influenza A (H3N2) vaccine component, and were antigenically related to A/Perth/16/2009, the WHO recommended influenza A (H3N2) component of the 2010 Southern Hemisphere vaccine formulation.
  • Since September 1, 2009, four infections with Oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States (N.B. A previously reported case has been reclassified as susceptible).
• Mortality Surveillance:
  
  • Pneumonia and Influenza Hospitalization and Deaths:
    
    • From August 30 ? October 24, 2009, 17,838 laboratory-confirmed influenza associated hospitalizations, 672 laboratory-confirmed influenza associated deaths were reported to CDC.
  • Pneumonia and Influenza (P&I) Mortality Surveillance:
    
    • During week 43, 7.4% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.7% for week 43 and the percentage has been above the threshold for 5 weeks.
  • Influenza-associated Pediatric Mortality:
    
    • Eighteen influenza-associated pediatric deaths were reported to CDC during week 43. Fifteen of these deaths were associated with 2009 influenza A (H1N1) virus infection and three were associated with an influenza A virus for which the subtype is undetermined. These deaths occurred between 12 July and 31 October 2009.
    • Since 30 August 2009, CDC has received 85 reports of influenza-associated pediatric deaths that occurred during the current influenza season (73 due to 2009 influenza A(H1N1) and 12 due to undetermined subtype influenza A).
    • Among the 85 deaths in children, 53 children had specimens collected for bacterial culture from normally sterile sites and 17 (32.1%) of the 53 were positive; Staphylococcus aureus was identified in 8 (47.1%) of the 17 children.
    • A total of 129 deaths in children associated with 2009 H1N1 virus have been reported to CDC.
• Influenza-associated hospitalizations:
  
  • Laboratory-confirmed influenza-associated hospitalizations are monitored in the U.S. using a population-based surveillance network comprising 10 Emerging Infections Program sites and 6 new sites.
  • Laboratory-confirmed influenza-associated hospitalization rates were reported during 01 September ? 31 October 2009 (rates include influenza A, influenza B, and 2009 influenza A (H1N1)).
    
    • Rates [EIP (new sites)] for children aged 0-4 years and 5-17 years were 3.1 (7.3) and 1.5 (2.9)per 10,000, respectively.
    • Rates [EIP (new sites)] for adults aged 18-49 years, 50-64 years, and ≥ 65 years were 1.2 (1.2), 1.3 (1.2) and 1.0 (1.1)per 10,000, respectively.
• Influenza-like Illness (ILI):
  
  • Nationwide during week 43, 7.7% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.3%. On a regional level, the percentage of outpatient visits for ILI ranged from 5.0% to 10.7% during week 43.
• Geographic spread:
  
  • Widespread influenza activity was reported by 48 states. Regional influenza activity was reported by 2 states. Local influenza activity was reported by the District of Columbia. Sporadic influenza activity was reported by Puerto Rico and Guam. The U.S. Virgin Islands did not report.
• Other information: The 2009-2010 U.S. Influenza Season (for purposes of surveillance and reporting) began 4 October 2009.
  
  • For more information: U.S. Centers for Disease Control and Prevention ?What's New on the H1N1 Flu Site? LINK
  • U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report LINK
  • Overview of Influenza Surveillance in the United States LINK

Canada Update
Data as of November 2009 19:00 CEST, for week ending 31 October, 2009 (Week 43)
There was an increase in the influenza activity level reported this week with the proportion of positive influenza tests of more than 35%, the national ILI consultation rate higher than 100 per 1,000 visits and over 700 influenza outbreaks reported.
This increased activity occurred in almost all provinces and territories.

• Virology:
  
  • 99.7% of all subtyped influenza A viruses being reported to Public Health Agency of Canada (PHAC) were 2009 influenza A (H1N1) viruses; the remainder were A(H1), A(H3) and B.
  • The proportion of tests that were positive for influenza was 36.3% which was a significant increase to the previous weeks.
  • 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine.
  • No viruses resistant to Oseltamivir were detected in week 43.
• Hospitalizations and Deaths:
  
  • 661 hospitalizations (a large increase over the previous week) and 8 deaths were reported for week 43.
  • Pediatric Influenza Hospitalizations and Deaths:
    
    • In week 43, 120 laboratory-confirmed influenza-associated pediatric hospitalizations were reported through the Immunization Monitoring Program Active (IMPACT) network.
    • Since the beginning of the pandemic, four deaths due to Pandemic (H1N1) 2009 had been reported through the IMPACT network among children under 16 years of age.
• Influenza-like Illness (ILI):
  
  • The national ILI consultation rate increased to 111consultations per 1,000 patient visits this week which was a large increase over the previous week and an increase for a seventh consecutive week and was above the expected range for this time of the year.
• Geographic spread:
  
  • Nineteen regions reported widespread activity and 16 regions reported localized activity, while 18 regions reported sporadic activity and 7 regions reported no activity.
  • 737 influenza outbreaks were reported; all were in schools except for 11 in hospitals, 9 in an unspecified location and 7 in long-term care facilities.
• Other information:
  
  • All the provinces and territories have started their vaccination campaigns.
  • For more information:
    
    • Public Health Agency of Canada: LINK
    • Public Health Agency of Canada FluWatch LINK

Updates from EpiNorth
Update on situation in Moldova
As of November 9 at 7:30 am, 615 suspected cases of A(H1N1) were reported in the Republic of Moldova, according to the National Scientific-Practical Centre for Preventive Medicine of the Republic of Moldova. Among them 316 cases of influenza A(H1N1) were laboratory confirmed. Also, there were reported 3 deaths caused by influenza A(H1N1) in the Republic of Moldova.
Read more from EpiWatch.

Update on epidemics in Ukraine
As of November 8, a total of 969, 247 cases of SARI/ILI were reported by the Ministry of Health of Ukraine on its website. The worst situation is reported from Lviv Oblast ? 155,895 cases, Ivano-Frankivsk Oblast ? 88,703 cases, Kiev-city ? 60,366 cases, Chernivtsi Oblast ? 47,167 cases, Donetsk Oblast ? 48,263, and Ternopil Oblast ? 30,510 cases. Furthermore, a total of 48,972 persons were hospitalised in the whole country, of them 155 people died as of 8 November 2009.
Read more from EpiWatch.

Outbreak of influenza A(H1N1) at the chess tournament in Vologda oblast, Russia
As of 9 November, 75 cases of influenza A(H1N1), among them 59 children, were reported at the Northwestern Russia chess tournament held in Vologda oblast, according to the Directorate of Rospotrebnadzor in Vologda oblast. Read more from EpiWatch.

Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 414 deaths have been reported; the information is available in Table 2. The latest available updates as of November 09, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 10 November 2009, 09:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (02.11.) ? ? ? ? ? ? ? ?
2. Belgium (05.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (04.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (05.11.) ? ? ? ? ? ? ? ?
6. Denmark (04.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (04.11.) ? ? ? ? ? ? ? ?
9. France (04.11.) ? 203 ? 625 ? 36 ? 131
10. Germany (05.11.) ? ? ? ? ? ? ? ?
11. Greece (04.11.) ? ? ? ? ? ? ? ?
12. Hungary (01.11.) ? ? - 68 ? ? ? ?
13. Iceland (30.10.) - 43 ? ? - 11 ? ?
14. Ireland (05.11.) ? 165 ? 665 ? 19 ? 54
15. Italy (09.11) ? ? - 184 ? ? ? 82
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (05.11.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (21.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (06.11.) ? 273 ? 611 ? 28 ? 69
22. Norway (04.11.) ? 69 ? 497 ? 4 ? 69
23. Poland (09.11.) ? ? ? ? ? ? ? ?
24. Portugal (04.11.) - 63 ? ? - 9 ? ?
25. Romania (08.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (05.11.) ? ? ? ? ? ? ? ?
29. Sweden (01.11.) ? 51 - 241 ? ? ? ?
30. Switzerland (01.11.) ? 6 - 33 ? ? ? ?
31. United Kingdom (a) (05.11.) - 848 ? ? - 172 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (691 cumulative hospitalisations), Wales (251) and Northern Ireland (495).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 10 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 09 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 8
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland ? ? 2
  • France 8 ? 57 (a)
  • Germany ? ? 9
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 14
  • Italy 2 ? 31
  • Latvia 1 ? 1
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 17
  • Norway 1 ? 16
  • Portugal ? ? 5
  • Slovakia 1 ? 1
  • Spain ? ? 73
  • Sweden ? ? 3
  • United Kingdom ? ? 155
    
    • Total 13 ? 414
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Belarus ? ? 7
  • Croatia ? ? 1
  • Moldova ? ? 3
  • Russia ? ? 15
  • Serbia 3 ? 7
  • Ukraine ? ? 1
    
    • Total 3 ? 34
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? - 6
  • Egypt ? ? 6
  • Iran ? ? 33
  • Iraq ? ? 7
  • Israel ? ? 39
  • Jordan ? ? 7
  • Kuwait ? ? 22
  • Lebanon ? ? 3
  • Occupied Palestinian Territory ? ? 2
  • Oman ? ? 25
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 7
  • Turkey 4 ? 27
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 4 ? 278
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 115
  • Mexico ? ? 398
  • USA ? ? 1004
    
    • Total ? ? 1517
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? - 23
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia 1 ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total 1 ? 168
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 56
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 136
  • Ecuador ? ? 80
  • Paraguay ? ? 52
  • Peru ? ? 180
  • Uruguay ? ? 33
  • Venezuela ? ? 97
    
    • Total ? ? 2742
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan 2 ? 11
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 16
  • Hong Kong SAR China ? ? 39
  • India 1 ? 485
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 8
  • South Korea ? ? 48
  • Sri Lanka 1 ? 1
  • Taiwan ? ? 27
    
    • Total 4 ? 671
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? - 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 39
    
    • Total ? ? 364
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 187
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 212
• TOTAL 25 ? 6508

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 30 in mainland France.
(?)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 11 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 11 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• WHO published revised clinical management guidance;
• Total of 423 fatal cases in Europe and EFTA countries and 6 169 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 10 November 2009 -16:00 hours CEST, for the world, and 11 November 2009 - 09:00 hours CEST, for Europe.


WHO published revised clinical management guidance


Based on a international consultation of experts in October 2009, the World Health Organization (WHO ) has now revised its clinical management guidelines for pandemic influenza. The revisions emphasise the need to begin treatment of suspect cases without laboratory confirmation as there are issues related to the laboratory confirmation. Early treatment of patients with severe or rapidly progressing illness and patients belonging to risk groups is recommended. Antibiotic treatment, oxygen therapy and critical care issues are also discussed in the guidelines. A clinical triage algorithm for ILI and pneumonia is provided for resource-poor settings.


Find the full WHO guidance document at: LINK


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 423 deaths have been reported (Table 2) and the number of deaths by week has being clearly increasing over the last 4 weeks. The latest available updates as of November 10, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 11 November 2009, 09:00 hours (CEST) in the EU and EFTA countries


[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (10.11.) ? ? ? ? ? ? ? ?
2. Belgium (05.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (04.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (05.11.) ? ? ? ? ? ? ? ?
6. Denmark (04.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (04.11.) ? ? ? ? ? ? ? ?
9. France (04.11.) ? 203 ? 625 ? 36 ? 131
10. Germany (09.11.) ? ? ? ? ? ? ? ?
11. Greece (04.11.) ? ? ? ? ? ? ? ?
12. Hungary (01.11.) ? ? - 68 ? ? ? ?
13. Iceland (30.10.) - 43 ? ? - 11 ? ?
14. Ireland (05.11.) ? 165 ? 665 ? 19 ? 54
15. Italy (10.11) ? ? - 184 ? ? ? 82
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (05.11.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (21.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (06.11.) ? 273 ? 611 ? 28 ? 69
22. Norway (04.11.) ? 69 ? 497 ? 4 ? 69
23. Poland (10.11.) ? ? ? ? ? ? ? ?
24. Portugal (04.11.) - 63 ? ? - 9 ? ?
25. Romania (08.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (05.11.) ? ? ? ? ? ? ? ?
29. Sweden (01.11.) ? 51 - 241 ? ? ? ?
30. Switzerland (01.11.) ? 6 - 33 ? ? ? ?
31. United Kingdom (a) (05.11.) - 848 ? ? - 172 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (691 cumulative hospitalisations), Wales (251) and Northern Ireland (495).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 11 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 10 November 2009, 16:00 hours CEST.


[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 8
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland 3 ? 5
  • France ? ? 57 (a)
  • Germany 3 ? 12
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 14
  • Italy 3 ? 34
  • Latvia ? ? 1
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 17
  • Norway ? ? 16
  • Portugal ? ? 5
  • Slovakia ? ? 1
  • Spain ? ? 73
  • Sweden ? ? 3
  • United Kingdom ? ? 155
    
    • Total 9 ? 423
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Belarus ? ? 7
  • Croatia 1 ? 2
  • Moldova 1 ? 4
  • Russia ? ? 15
  • Serbia ? ? 7
  • Ukraine ? ? 1
    
    • Total 2 ? 36
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 6
  • Egypt ? - 6
  • Iran ? ? 33
  • Iraq ? ? 7
  • Israel ? ? 39
  • Jordan ? ? 7
  • Kuwait ? ? 22
  • Lebanon ? ? 3
  • Occupied Palestinian Territory ? ? 2
  • Oman ? ? 25
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 7
  • Turkey 3 ? 30
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 3 ? 281
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 115
  • Mexico 35 ? 433
  • USA ? ? 1004
    
    • Total 35 ? 1552
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 23
  • Guatemala ? - 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 168
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 56
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 136
  • Ecuador ? ? 80
  • Paraguay ? ? 52
  • Peru ? ? 180
  • Uruguay ? ? 33
  • Venezuela ? ? 97
    
    • Total ? ? 2742
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 11
  • Bangladesh ? ? 6
  • China (Mainland) 14 ? 30
  • Hong Kong SAR China ? ? 39
  • India 17 - 502
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 8
  • South Korea 4 ? 52
  • Sri Lanka ? ? 1
  • Taiwan ? ? 27
    
    • Total 35 ? 706
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? - 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 39
    
    • Total ? ? 364
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 187
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 212
• TOTAL 84 ? 6592

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 30 in mainland France.
(?)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 12 November 2009, 09:00 hours CEST (ECDC, edited)

[Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 12 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Public Health Development on critical care services published;
• European Planning Assumptions for Pandemic 2009 published;
• Updates from EpiSouth included;
• GSK vaccine approved by US FDA;
• Total of 429 fatal cases in Europe and EFTA countries and 6 277 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 11 November 2009 -16:00 hours CEST, for the world, and 12 November 2009 - 09:00 hours CEST, for Europe.


The approaching pandemic pressures on critical care services in European hospitals - preparation is crucial


Countries in the southern hemisphere and the Americas have already experienced the first marked peaks of the 2009 pandemic. The greatest pressures were in hospitals and especially critical or intensive care. Already this autumn the first affected European countries are seeing the same and a few European countries are known to have made plans to significantly increase their capacity, for example for ventilating patients.


Reports on epidemiological and clinical presentation of influenza pandemic in other countries provide reliable estimates of the burden of disease, the effectiveness of treatment and best use of public health resources and likely outcomes for patients.


Recently ECDC attended a WHO global consultation to gather such information.


This Public Health development summarises some of the findings from that meeting and seven recent publications.


The main points include the need to keep primary and secondary care integrated (so that hospitals are not over burdened), to develop protocols for triaging sick patients, to increase critical care and especially ventilatory capacity and to ensure early use of antivirals as there is convincing observational evidence that this is effective in averting or mitigating severe disease.


Full Public health development will be published today on the ECDC website: LINK


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 429 deaths have been reported (Table 2) and the number of deaths by week has being clearly increasing over the last 3 weeks. The latest available updates as of November 11, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.


Other Updates

European Planning Assumptions for Pandemic 2009


Following a number of requests ECDC working with representatives of its Advisory Forum and WHO yesterday published recommended planning assumptions for this pandemic for clinical attack rate, hospitalisations (including use of intensive care) and deaths that apply to countries that did not experience a significant wave of infection over the summer.


The assumptions may also be applicable to other countries. To aid planning as far as is possible, data are expressed per 100 000 population but no allowance is made for the effect of countermeasures, which include vaccines and antivirals.


It is important to emphasise that the figures are not predictions. Rather like other planning assumptions they represent a reasonable worse case that European health services are advised to prepare for.


Closely related to this and contributing is a scientific review produced by WHO on the transmission dynamics and impact of pandemic influenza 2009 which will appear in the Weekly Epidemiological Record 2009: 84: 477-484.


EPISOUTH update


As of 09 November 2009, a total of 244 deaths among biologically confirmed A/H1N1/2009 cases have been reported in the EpiSouth region (Mediterranean and the Balkans).

• 86 new deaths were notified since 03 November 2009:
  
  • 4 in Bulgaria,
  • 2 in Egypt,
  • 5 in France,
  • 2 in Greece,
  • 4 in Israel,
  • 18 in Italy,
  • 2 in Jordan,
  • 2 in Palestine,
  • 4 in Serbia,
  • 19 in Spain,
  • 5 in Syria and
  • 20 in Turkey.

For weeks 44-45, influenza activity was high in Bulgaria and Italy, increasing in France, and Spain, moderate in Albania, Israel, Palestine, Romania and Serbia, Low in Croatia and Slovenia,


For more details please refer to the EpiSouth bulletin LINK


GSK vaccine approved by US FDA


The U.S. Food and Drug Administration approved a supplemental biologics license for GlaxoSmithKline?s (GSK) unadjuvanted influenza A(H1N1) pandemic vaccine.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 12 November 2009, 09:00 hours (CEST) in the EU and EFTA countries


[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (05.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (04.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (05.11.) ? ? ? ? ? ? ? ?
6. Denmark (11.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (04.11.) ? ? ? ? ? ? ? ?
9. France (04.11.) ? 203 ? 625 ? 36 ? 131
10. Germany (09.11.) ? ? ? ? ? ? ? ?
11. Greece (04.11.) ? ? ? ? ? ? ? ?
12. Hungary (01.11.) ? ? - 68 ? ? ? ?
13. Iceland (11.11.) ? ? - 170 ? ? ? 19
14. Ireland (05.11.) ? 165 ? 665 ? 19 ? 54
15. Italy (11.11) ? ? - 264 ? ? ? 116
16. Latvia (13.08.) ? ? - 1 ? ? ? ?
17. Liechtenstein (05.11.) ? ? ? ? ? ? ? ?
18. Lithuania (13.08.) ? ? ? ? ? ? ? ?
19. Luxembourg (21.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (06.11.) ? 273 ? 611 ? 28 ? 69
22. Norway (11.11.) ? 86 ? 623 ? 13 ? 75
23. Poland (10.11.) ? ? ? ? ? ? ? ?
24. Portugal (11.11.) - 121 ? ? - 17 ? ?
25. Romania (11.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (05.11.) ? ? ? ? ? ? ? ?
29. Sweden (01.11.) ? 51 - 241 ? ? ? ?
30. Switzerland (01.11.) ? 6 - 33 ? ? ? ?
31. United Kingdom (a) (05.11.) - 848 ? ? - 172 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (691 cumulative hospitalisations), Wales (251) and Northern Ireland (495).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 12 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 11 November 2009, 16:00 hours CEST.


[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 8
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland 1 ? 6
  • France ? ? 57 (a)
  • Germany ? ? 12
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 14
  • Italy 4 ? 38
  • Latvia ? ? 1
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 17
  • Norway ? ? 16
  • Portugal ? ? 5
  • Slovakia ? ? 1
  • Spain ? ? 73
  • Sweden ? ? 3
  • United Kingdom 1 ? 156
    
    • Total 6 ? 429
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan 2 ? 2
  • Belarus ? ? 7
  • Croatia ? ? 2
  • Moldova ? ? 4
  • Russia 1 ? 16
  • Serbia ? ? 7
  • Ukraine 13 ? 14
    
    • Total 16 ? 52
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? - 6
  • Egypt ? ? 6
  • Iran 25 ? 58
  • Iraq ? ? 7
  • Israel ? ? 39
  • Jordan ? ? 7
  • Kuwait 4 ? 26
  • Lebanon ? ? 3
  • Occupied Palestinian Territory ? ? 2
  • Oman ? ? 25
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 7
  • Turkey 6 ? 36
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 35 ? 316
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada 20 ? 135
  • Mexico 19 ? 452
  • USA ? ? 1004
    
    • Total 39 ? 1591
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? - 23
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 168
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 56
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia 5 ? 141
  • Ecuador 2 ? 82
  • Paraguay ? ? 52
  • Peru 3 ? 183
  • Uruguay ? ? 33
  • Venezuela 4 ? 101
    
    • Total 14 ? 2756
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 11
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 30
  • Hong Kong SAR China ? ? 39
  • India 3 ? 505
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 8
  • South Korea ? ? 52
  • Sri Lanka ? ? 1
  • Taiwan ? ? 27
    
    • Total 3 ? 709
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam 1 ? 40
    
    • Total 1 ? 365
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 187
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 212
• TOTAL 114 ? 6706

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 30 in mainland France.
(?)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 13 November 2009, 09:00 hours CEST (ECDC, edited)

[Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 13 November 2009, 09:00 hours CEST

Main developments in past 24 hours

• Weekly Influenza Surveillance Overview to be published today;
• Eurosurveillance updates published;
• Situation update ? Ukraine;
• CDC estimates number of cases infected with H1N1;
• Two studies on effectiveness of seasonal influenza vaccine againt pandemic influenza published;
• Total of 474 fatal cases in Europe and EFTA countries and 6 294 in the rest of the world have been reported up to date.

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 12 November 2009 -16:00 hours CEST, for the world, and 13 November 2009 - 09:00 hours CEST, for Europe.

Weekly Influenza Surveillance Overview
The ECDC Weekly Influenza Surveillance Overview will be published this afternoon and will be available at: LINK

Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 474 deaths have been reported (Table 2) and the number of deaths by week has being clearly increasing over the last 3 weeks. The latest available updates as of November 12, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.

Other Updates
Situation in Ukraine
From 18 October to 12 November, the Ministry of Health has reported a total of 1,253,558 cases of acute respiratory illness and 239 deaths. The majority of cases is concentrated in the Western oblasts in Ukraine, but spreads to Kyiv and other parts of the country. Influenza A(H1N1) has been identified in a number of samples in national laboratories and confirmed by the WHO?s reference laboratory in London. The last official number of laboratory confirmed A(H1N1) cases in Ukraine was 32 (data from 06/11/09).

CDC estimates number of cases infected with H1N1
CDC estimated that between 14 million and 34 million cases of influenza A(H1N1)v occurred between April and October 2009. The methods are described in detail in the attached documents and are based on laboratory surveillance, published hospitalization estimates and multipliers derived from previously published prevalence estimates.
The full CDC document is available at: LINK

Mexican study shows protective effect of seasonal influenza vaccine
A study published in the Lancet describes the first 63 479 notified pandemic influenza cases in Mexico up to 31st July, 2009 and analyzes risk and protective factors for infection, hospitalisation and fatal outcome. According to this study the risk of infection with influenza A(H1N1), verified mainly by rapid tests, was lower among people vaccinated for seasonal influenza.
The full article can be found at: LINK

A CDC study finds no protective effect of seasonal influenza vaccine
The CDC Mortality and Morbidity Weekly Report (MMWR) published an analysis on the effectiveness of the 2008-09 trivalent seasonal influenza vaccine against pandemic influenza H1N1. This case-cohort analysis was based on notifications data and did not show any vaccine effectiveness.
The full CDC report can be found at: LINK

Eurosurveillance update
In their paper H Nishiura et al. present a study comparing the risk of clinical attack rates between one- and two-dose vaccination schemes. They demonstrate that if the efficacies do not greatly vary between one- and two -dose schemes, a one-dose vaccination scheme may well be supported. Nevertheless, two-dose vaccination is shown to result in less morbidity if the vaccine efficacies are greatly diminished by reducing the dose. From the results the authors conclude that as long as the detailed efficacy estimates rest on theoretical assumptions, single-dose vaccination may only be sufficiently justified in a specific setting where the number of vaccines is extremely limited. (LINK)
A second paper in yesterday?s Eurosurveillance issue reports about an ongoing outbreak in pigs of infections with pandemic influenza A(H1N1)v virus in Norway. According to M Hofshagen et al. the first herd was confirmed positive on 10 October 2009 and as of 26 October, a total of 23 herds have been diagnosed as positive. The majority of the herds seem to have been infected by humans. Sequence analysis of pig viruses from the index farm shows that they are identical or virtually identical to human viruses from the same geographical region. Currently further investigations are being carried out to clarify the extent of the outbreaks in the rest of Norway and studies are underway to evaluate risk factors for the infection at farm level. (LINK)
A third paper by Columbier et al. reports on a notable surge in messages communicated through the Early Warning and Response System (EWRS) for the prevention and control of communicable diseases in the European Union recorded since the start of 2009 H1N1 influenza pandemic. In order to measure the impact of this increase on the reporting of other events, the authors compared the messages posted in the EWRS since April 2009 with those posted in the previous years (2004-2008). The analysis revealed that a ten-fold increase in messages was recorded during the pandemic period, from April to September 2009, and that the reporting of other threats dropped to a significantly low rate. They authors conclude that their results suggest an important impact on the notification process of events in case of a situation requiring extensive mobilisation of public health resources and emphasise the importance of keeping an appropriate balancing of resources during sustained emergencies, in particular in view of a possible second wave of pandemic influenza cases, to ensure prompt detection and reporting of potential concomitant emerging threats. (LINK)

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 13 November 2009, 09:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (12.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (04.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (12.11.) ? ? ? ? ? ? ? ?
6. Denmark (11.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (11.11.) ? ? ? ? ? ? ? ?
9. France (12.11.) ? ? ? ? ? 71 ? 188
10. Germany (10.11.) ? ? ? ? ? ? ? ?
11. Greece (11.11.) ? ? ? ? ? ? ? ?
12. Hungary (01.11.) ? ? - 68 ? ? ? ?
13. Iceland (11.11.) ? ? - 170 ? ? ? 19
14. Ireland (12.11.) ? 191 ? 785 ? 22 ? 65
15. Italy (11.11) ? ? - 264 ? ? ? 116
16. Latvia (12.11.) ? ? - 1 ? ? ? ?
17. Liechtenstein (11.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (21.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (06.11.) ? 273 ? 611 ? 28 ? 69
22. Norway (11.11.) ? 86 ? 623 ? 13 ? 75
23. Poland (10.11.) ? ? ? ? ? ? ? ?
24. Portugal (11.11.) - 121 ? ? - 17 ? ?
25. Romania (11.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ... ? ?
28. Spain (05.11.) ? ? ? ? ? ? ? ?
29. Sweden (01.11.) ? 51 - 241 ? ? ? ?
30. Switzerland (11.11.) ? 15 - 48 ? ? ? 11
31. United Kingdom (a) (12.11.) - 785 ? ? - 173 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (841 cumulative hospitalisations), Wales (327) and Northern Ireland (527).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 13 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 12 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 8
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland ? ? 6
  • France 2 ? 59 (a)
  • Germany 1 ? 13
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland 1 ? 15
  • Italy ? ? 38
  • Latvia ? ? 1
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands ? ? 17
  • Norway ? ? 16
  • Portugal ? ? 5
  • Slovakia ? ? 1
  • Spain 15 ? 88
  • Sweden 2 ? 5
  • United Kingdom 23 ? 180
    
    • Total 44 ? 474
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Croatia 1 ? 3
  • Moldova ? ? 4
  • Russia ? ? 16
  • Serbia 1 ? 8
  • Ukraine ? ? 14
    
    • Total 2 ? 54
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? - 6
  • Egypt ? ? 6
  • Iran ? ? 58
  • Iraq ? ? 7
  • Israel ? ? 39
  • Jordan ? ? 7
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Occupied Palestinian Territory ? ? 2
  • Oman ? ? 25
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 7
  • Turkey 4 ? 40
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 4 ? 320
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 135
  • Mexico ? ? 452
  • USA ? ? 1004
    
    • Total ? ? 1591
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? - 23
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 168
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 56
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 141
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 183
  • Uruguay ? ? 33
  • Venezuela 2 ? 103
    
    • Total 2 ? 2758
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 11
  • Bangladesh ? ? 6
  • China (Mainland) 6 ? 36
  • Hong Kong SAR China ? ? 39
  • India 3 ? 508
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 8
  • South Korea ? ? 52
  • Sri Lanka ? ? 1
  • Taiwan ? ? 27
    
    • Total 9 ? 718
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 40
    
    • Total ? ? 365
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 187
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 212
• TOTAL 61 ? 6768

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 32 in mainland France.
(?)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 16 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 16 November 2009, 09:00 hours CEST

• The number of deaths directly attributed by EU/EEA countries to pandemic influenza increased again in week 46;
• Total of 501 fatal cases in Europe and EFTA countries and 6 550 in the rest of the world have been reported up to date;
• WHO: Interim planning considerations for mass gatherings;
• WHO: Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 Virus;
• WHO: Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj).

Main developments in past 72 hours
This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 15 November 2009 -16:00 hours CEST, for the world, and 16 November 2009 - 09:00 hours CEST, for Europe.

Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 501 deaths have been reported (Table 2) and the number of deaths by week has been increasing over the last 4 weeks. In week The latest available updates as of November 15, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.

Weekly Influenza Surveillance Overview for Week 45
In the ECDC Weekly Influenza Surveillance Overview for Week 45 the data for twenty countries across the EU/EEA countries indicated an increasing trend in pandemic influenza seen in primary care. Seven countries (Bulgaria, Iceland, Ireland, Norway and Sweden) reported very high levels of intensity while Poland and part of the UK (Northern Ireland) reported high levels of intensity and 14 countries reported medium intensity. Fourteen other countries are reporting high or very high pandemic intensity.
Almost all influenza that are typed are of the pandemic virus A(H1N1). There remain very few influenza A(H3N2) viruses in circulation and no seasonal A(H1N1). In sentinel data between 40 and 50% of specimens show the influenza virus.
The full overview report is available at: LINK

Other Updates
WHO interim planning considerations for mass gatherings published
The World Health Organization (WHO) published interim planning considerations for mass gatherings in the context of pandemic (H1N1) 2009 influenza. The purpose of the documents is to outline key planning considerations for planners of mass gatherings and it should be used in conjunction with WHO?s ?Communicable disease alert and response for mass gatherings) document.
The WHO guidance document can be found at: LINK

Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj)
In the latest Weekly epidemiological report of the WHO, Health-related requirements and recommendations issued by the Ministry of Health of Saudi Arabia for entry visas for the Hajj and Umra seasons in 2009 were published. Among other issues these recommend that persons with underlying conditions increasing the risk of severe forms of pandemic influenza A(H1N1) disease and persons under the age of 12 and over the age of 65 to defer from defer from performing the Hajj this year (2009). For seasonal influenza vaccine and pandemic (H1N1) 2009 vaccine, Saudi Arabian embassies will address health authorities in all countries about the availability of vaccines for this year?s pilgrimage to Hajj. Where the vaccines are available in countries, proof of both vaccinations will be required by competent authorities before issuing visas. Where vaccines are not available, visas will be issued to pilgrims by the responsible health authority of each country.

Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 Virus
In the same issue, the WHO also summarizes some of the key observations from selected countries on hospitalization rates, mortality rates and risk groups that may inform preparations being made for the winter influenza season in countries of the northern hemisphere. In addition, members of the WHO informal mathematical modelling network for the 2009 influenza pandemic are working with their respective governments to estimate the reproductive rate (R0), attack rates, incubation period and generation time using data on pandemic influenza (H1N1) 2009 cases by date of onset, cases of influenzalike illness (ILI), rates of physician visits over time, and outbreak investigations in schools and other settings.
The full WHO report is available at: LINK

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 16 November 2009, 09:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (12.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (12.11.) ? ? ? ? ? ? ? ?
6. Denmark (11.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (13.11.) ? ? ? ? ? ? ? ?
9. France (12.11.) ? ? ? ? ? 71 ? 188
10. Germany (10.11.) ? ? ? ? ? ? ? ?
11. Greece (11.11.) ? ? ? ? ? ? ? ?
12. Hungary (08.11.) ? ? - 78 ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (12.11.) ? 191 ? 785 ? 22 ? 65
15. Italy (13.11) ? ? - 329 ? ? ? 167
16. Latvia (12.11.) ? ? - 1 ? ? ? ?
17. Liechtenstein (11.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (21.10.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (13.11.) ? 291 ? 909 ? 19 ? 91
22. Norway (11.11.) ? 86 ? 623 ? 13 ? 75
23. Poland (12.11.) ? ? ? ? ? ? ? ?
24. Portugal (11.11.) - 121 ? ? - 17 ? ?
25. Romania (11.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (12.11.) ? ? ? ? ? ? ? ?
29. Sweden (08.11.) ? 74 - 336 ? ? ? ?
30. Switzerland (11.11.) ? 15 - 48 ? ? ? 11
31. United Kingdom (a) (12.11.) - 785 ? ? - 173 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (841 cumulative hospitalisations), Wales (327) and Northern Ireland (527).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 16 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 15 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium 3 ? 11
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland 1 ? 7
  • France ? ? 59 (a)
  • Germany 3 ? 16
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 15
  • Italy 6 ? 44
  • Latvia ? ? 1
  • Luxembourg ? ? 1
  • Malta ? ? 3
  • Netherlands 5 ? 22
  • Norway 2 ? 18
  • Poland 1 ? 1
  • Portugal 1 ? 6
  • Slovakia ? ? 1
  • Spain ? ? 88
  • Sweden ? ? 5
  • United Kingdom 5 ? 185
    
    • Total 27 ? 501
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Croatia 1 ? 4
  • Kosovo 1 ? 1
  • Moldova 2 ? 6
  • Russia 3 ? 19
  • Serbia 1 ? 9
  • Ukraine .. ? 14
    
    • Total 8 - 62
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 6
  • Egypt 1 ? 7
  • Iran ? ? 58
  • Iraq .. ? 7
  • Israel 2 ? 41
  • Jordan 3 ? 10
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Occupied Palestinian Territory ? ? 2
  • Oman 2 ? 27
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria 6 ? 13
  • Turkey 20 ? 60
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 34 ? 354
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada 26 ? 161
  • Mexico 30 ? 482
  • USA 119 ? 1123
    
    • Total 175 ? 1766
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? - 7
  • Dominican Republic ? ? 22
  • El Salvador 2 ? 25
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total 2 ? 170
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia 1 ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 141
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 183
  • Uruguay ? ? 33
  • Venezuela ? ? 103
    
    • Total 1 ? 2759
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 11
  • Bangladesh ? ? 6
  • China (Mainland) 7 ? 43
  • Hong Kong SAR China 1 ? 40
  • India 6 ? 514
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia 7 ? 15
  • South Korea 12 ? 64
  • Sri Lanka ? ? 1
  • Taiwan ? ? 27
    
    • Total 33 ? 751
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? - 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 41
    
    • Total ? ? 366
• AUSTRALIA & PACIFIC
  
  • Australia 2 ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total 2 ? 214
• TOTAL 282 ? 7051

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 32 in mainland France.
(?)
-
--------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 17 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 17 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Updates from U.S.A. and Canada included;
• Study on hospitalized pandemic influenza patients in Melbourne published;
• Total of 515 fatal cases in Europe and EFTA countries and 6 577 in the rest of the world have been reported up to date;

This report is based on official information provided by the national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 16 November 2009 -16:00 hours CEST, for the world, and 17 November 2009 - 09:00 hours CEST, for Europe.


Updates from U.S.A. and Canada

From U.S. Centers for Disease Control and Prevention weekly influenza surveillance report: Week 44 (1-7 November 2009)

• Influenza activity decreased slightly in the U.S.
• 30.1% of specimens tested by collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the sixth consecutive week.
• Thirty-five influenza-associated paediatric deaths were reported.
• Twenty-six of these deaths were associated with 2009 influenza A (H1N1) virus infection, eight were associated with an influenza A virus for which the subtype was undetermined, and one was associated with an influenza B virus infection.
• The proportion of outpatient visits for influenza-like illness (ILI) was 6.7% which is above the national baseline of 2.3%.
• All regions reported ILI above region-specific baseline levels. Forty-six states reported geographically widespread influenza activity.
• Other news:
  
  • CDC released new estimates of 2009 influenza A (H1N1) cases, hospitalizations and deaths in the U.S. that occurred April- 17 October 2009.
    
    • Cases: Approximately 22 million;
    • Hospitalizations: Approximately 98,000;
    • Deaths: Approximately 3,900.
  • For details see LINK
• For more information:
  
  • U.S. Centers for Disease Control and Prevention ?What's New on the H1N1 Flu Site? LINK
  • U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report LINK
  • Overview of Influenza Surveillance in the United States LINK

From the Public Health Agency of Canada: Week 44 (1-7 November 2009)

• There was a considerable increase in the influenza activity level.
• More than 38% of influenza tests were positive.
• The Pandemic (H1N1) 2009 strain accounted for 99.8% of the positive influenza A subtyped specimens.
• The ILI consultation rate was almost 100 per 1,000 patient visits. 25 regions reported widespread activity and over 750 influenza outbreaks were reported. This increased activity occurred in almost all provinces and territories.
• There were 1,324 hospitalizations and 35 deaths reported from Pandemic (H1N1) 2009.
• The number of deaths was four times higher than the previous week.
• The activity levels reported during the previous weeks were even higher than the peak period of the first wave (the three first weeks of June, 2009).
• Other news:
  
  • Health Canada approved an unadjuvanted H1N1 flu vaccine for protection against the H1N1 flu virus.
    
    • The vaccine, Influenza A (H1N1) 2009 Pandemic Monovalent Vaccine (Without Adjuvant), is manufactured by Canada's pandemic vaccine supplier, GlaxoSmithKline.
• For more information:
  
  • Public Health Agency of Canada LINK
  • Public Health Agency of Canada FluWatch LINK

Other updates

Study on hospitalized pandemic influenza patients in Melbourne published
The Medical Journal of Australia published a study describing prospectively a case series of 112 patients hospitalized with pandemic influenza infections. The study highlights risk-factors for severe disease and the authors suggest there is a need to concentrate healthcare resources effectively in high-risk patient groups.
See full study at: LINK


Epidemiologic update
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. Since April 2009, a total 515 deaths have been reported (Table 2) and the number of deaths by week has been increasing over the last 4 weeks. In week The latest available updates as of November 16, 2009, at 16:00, on new and on confirmed fatal pandemic A(H1N1) cases outside the EU/EFTA area by country, are also presented in Table 2. The latest available updates on hospital admissions per Member State are presented in Table 1.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care by country as of 17 November 2009, 09:00 hours (CEST) in the EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (12.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (12.11.) ? ? ? ? ? ? ? ?
6. Denmark (11.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (13.11.) ? ? ? ? ? ? ? ?
9. France (12.11.) ? ? ? ? ? 71 ? 188
10. Germany (10.11.) ? ? ? ? ? ? ? ?
11. Greece (11.11.) ? ? ? ? ? ? ? ?
12. Hungary (08.11.) ? ? - 78 ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (12.11.) ? 191 ? 785 ? 22 ? 65
15. Italy (15.11) ? ? - 329 ? ... ? 167
16. Latvia (12.11.) ? ? - 1 ? ? ? ?
17. Liechtenstein (11.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (13.11.) ? 291 ? 909 ? 19 ? 91
22. Norway (11.11.) ? 86 ? 623 ? 13 ? 75
23. Poland (12.11.) ? ? ? ? ? ? ? ?
24. Portugal (11.11.) - 121 ? ? - 17 ? ?
25. Romania (16.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (12.11.) ? ? ? ? ? ? ? ?
29. Sweden (08.11.) ? 74 - 336 ? ? ? ?
30. Switzerland (11.11.) ? 15 - 48 ? ? ? 11
31. United Kingdom (a) (12.11.) - 785 ? ? - 173 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (841 cumulative hospitalisations), Wales (327) and Northern Ireland (527).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 17 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 16 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 11
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland ? ? 7
  • France ? ? 59 (a)
  • Germany ? ? 16
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 15
  • Italy 9 ? 53
  • Latvia ? ? 1
  • Luxembourg 1 ? 2
  • Malta ? ? 3
  • Netherlands ? ? 22
  • Norway 1 ? 19
  • Poland 1 ? 2
  • Portugal 1 - 7
  • Slovakia ? ? 1
  • Spain ? ? 88
  • Sweden ? ? 5
  • United Kingdom 1 ? 186
    
    • Total 14 ? 515
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Croatia ? ? 4
  • Kosovo ? ? 1
  • Moldova 1 ? 7
  • Russia ? ? 19
  • Serbia ? ? 9
  • Ukraine ? ? 14
    
    • Total 1 ? 63
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain 1 - 7
  • Egypt ? ? 7
  • Iran ? ? 58
  • Iraq 2 ? 9
  • Israel 5 ? 46
  • Jordan 1 ? 11
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Occupied Palestinian Territory 3 ? 5
  • Oman ? ? 27
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 13
  • Tunisia 2 ? 2
  • Turkey ? ? 60
  • United Arab Emirates ? ? 6
  • Yemen ? ? 17
    
    • Total 14 ? 368
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 161
  • Mexico ? ? 482
  • USA ? ? 1123
    
    • Total ? ? 1766
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? - 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 25
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 170
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 141
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 183
  • Uruguay ? ? 33
  • Venezuela 1 ? 104
    
    • Total 1 ? 2760
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 11
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 43
  • Hong Kong SAR China ? ? 40
  • India 9 ? 523
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 15
  • South Korea ? ? 64
  • Sri Lanka ? ? 1
  • Taiwan 2 ? 29
    
    • Total 11 ? 762
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? - 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 41
    
    • Total ? ? 366
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 214
• TOTAL 41 ? 7092

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 32 in mainland France.
(?)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 18 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 18 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Total of 543 fatal cases in Europe and EFTA countries and 6 624 in the rest of the world have been reported up to date;
• WHO report describes the first cases of 2009 A(H1N1) influenza viruses resistant to oseltamivir worldwide. Cases are few and hardly any are transmitting from human to human
• Pandemic A(H1N1) Influenza virus in Ukraine no different than elsewhere in Europe
• New Vaccines receive authorization First short term vaccine safety data provide no new safety concerns

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 17 November 2009 - 16:00 hours CEST, for the world, and 18 November 2009 - 09:00 hours CEST, for Europe.


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 543 deaths have been reported since April 2009 (Table 2). The number of weekly deaths has shown an increase over the last 4 weeks. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


Public Health Development

Oseltamivir-resistant pandemic (H1N1) 2009 influenza virus, October 2009
An article recently published by the WHO summarises the characteristics of 39 cases of 2009 A(H1N1) pandemic influenza viruses resistant to the neuraminidase inhibitor oseltamivir reported so far worldwide.
Almost all cases (29 out of 32 for whom this information was available) developed oseltamivir resistance after receiving oseltamivir treatment or prophylaxis.
A substantial number (n=7) of cases had immunosuppression, a known risk factor for developing oseltamivir resistance.
The authors of the WHO article recommends antiviral resistance testing to be considered for patients with persistent and complicated illness after 5 or more days of antiviral treatment and for patients presenting with an influenza-like illness despite having received antiviral prophylaxis.
In the context of the 2009 A(H1N1) influenza pandemic resistance to oseltamivir remains a very rare event.
No evidence of zanamivir resistance has been detected.
Resistance to the adamantenes (amantidine and rimantadine) is common for the pandemic virus.
WHO points out that the risk of emerging antiviral resistance is no reason for denying treatment with the neuraminidase inhibitors (oseltamivir and zanamivir) to those to for whom they are recommended while at the same time their use in prophylaxis should be very sparing."
More details can later today be found at: LINK


Other updates

Pandemic A(H1N1) Influenza virus in Ukraine no different than elsewhere in Europe
WHO yesterday released the first information on the genetic characterization of Influenza A virus strains collected from Ukraine.
The preliminary analysis by two different specialist laboratories shows that the virus is very similar to the other strains causing the current Influenza A(H1N1) pandemic elsewhere in Europe.
More details can be found at: LINK


New Vaccines receive marketing authorization
Two new pandemic vaccines, Panenza?, produced by Sanofi Pasteur, and Celtura?, produced by Novartis, have recently received marketing authorization in France and Germany, respectively. Sanofi Pasteur has filed a decentralized marketing authorization application for Panenza? in six European Union countries; Belgium, France (acting as ?Reference Member State?), Germany, Italy, Luxembourg and Spain. Authorizations in the other five countries will follow the authorization in France. Novartis continues to pursue registration in other countries including Japan and Switzerland.
Panenza? is a non-adjuvanted, egg-derived, inactivated monovalent influenza A(H1N1) 2009 vaccine containing 15 μg of hemagglutinin of influenza A/California/07/2009 (H1N1)v-like virus per dose. Clinical trials have been performed in France and Finland in adults and children aged 6 months of age and older. First immunogenicity and safety data have been presented to the French drug agency Afssaps (Agence fran?aise de s?curit? sanitaire des produits de sant?) before authorization.
Celtura? is an MF59? adjuvanted, cell-derived, inactivated monovalent influenza A(H1N1) 2009 vaccine containing 3.75 μg of hemagglutinin of influenza A/California/07/2009 (H1N1)v-like virus per dose. Clinical studies in more than 1,850 subjects evaluating safety and immunogenicity have been presented to the German drug agency Paul Ehrlich Institut before authorization. Previously, in the European Union, the European Commission has granted authorisation for three specific A(H1N1) vaccines following a positive scientific opinion issued by the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency (EMEA).
The products centrally authorised are Focetria? (Novartis), Pandemrix? (GlaxoSmithKline) and Celvapan? (Baxter). The vaccines are authorised for use in all Member States of the EU and the EEA (Iceland, Liechtenstein and Norway).
For further information including indications and doses in different age groups, see LINK
In addition, the National Regulatory Agency in Hungary previously has provided a national licence to a pandemic vaccine, Fluval P, produced by the Hungarian manufacturer Omninvest. For further information, see LINK


First short term vaccine safety data provide no new safety concerns
The first short-term safety data after initiation of the national vaccination campaigns are publicly available either in English or the local language on the list of web-pages below.
There are no safety concerns of clinical significance reported so far in addition to those described in the initial trials with either of the vaccines used in these countries; Celvapan and Pandemrix.
With both vaccines allergic reactions requiring medical attention have been reported and its important that healthcare professionals remember that, as with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of a serious allergic reaction and possibly a rare anaphylactic event following the administration of the vaccine

• L?gemiddelstyrelsen, Denmark (also in English) LINK
• Paul Ehrlich Institute, Germany (also in English) LINK
• IMB, Ireland LINK
• Statens Legemiddelverk, Norway LINK
• L?kemedelsverket, Sweden (also in English) LINK
• MHRA, United Kingdom LINK

These web-pages will be updated on a weekly basis

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 18 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (12.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (12.11.) ? ? ? ? ? ? ? ?
6. Denmark (11.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (17.11.) ? ? ? ? ? ? ? ?
9. France (12.11.) ? ? ? ? ? 71 ? 188
10. Germany (16.11.) ? ? ? ? ? ? ? ?
11. Greece (11.11.) ? ? ? ? ? ? ? ?
12. Hungary (08.11.) ? ? - 78 ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (12.11.) ? 191 ? 785 ? 22 ? 65
15. Italy (17.11) ? ? - 405 ? ? ? 205
16. Latvia (17.11.) ? ? - 1 ? ? ? ?
17. Liechtenstein (11.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (13.11.) ? 291 ? 909 ? 19 ? 91
22. Norway (11.11.) ? 86 ? 623 ? 13 ? 75
23. Poland (12.11.) ? ? ? ? ? ? ? ?
24. Portugal (11.11.) - 121 ? ? - 17 ? ?
25. Romania (16.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (12.11.) ? ? ? ? ? ? ? ?
29. Sweden (08.11.) ? 74 - 336 ? ? ? ?
30. Switzerland (11.11.) ? 15 - 48 ? ? ? 11
31. United Kingdom (a) (12.11.) - 785 ? ? - 173 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (841 cumulative hospitalisations), Wales (327) and Northern Ireland (527).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 18 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 17 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 11
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland 2 ? 9
  • France 11 ? 70 (a)
  • Germany 5 ? 21
  • Greece ? ? 5
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 15
  • Italy 5 ? 58
  • Latvia ? ? 1
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 22
  • Norway 2 ? 21
  • Poland 2 ? 4
  • Portugal ? ? 7
  • Slovakia ? ? 1
  • Spain ? ? 88
  • Sweden ? ? 5
  • United Kingdom 1 ? 187
    
    • Total 28 ? 543
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Croatia 1 ? 5
  • Kosovo ? ? 1
  • Moldova ? ? 7
  • Russia ? ? 19
  • Serbia 2 ? 11
  • Ukraine 1 ? 15
    
    • Total 4 - 67
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt ? ? 7
  • Iran ? ? 58
  • Iraq ? ? 9
  • Israel 2 ? 48
  • Jordan ? ? 11
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Morocco 1 ? 1
  • Occupied Palestinian Territory ? ? 5
  • Oman ? ? 27
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria 9 ? 22
  • Tunisia ? ? 2
  • Turkey 13 ? 73
  • United Arab Emirates ? ? 6
  • Yemen 1 ? 18
    
    • Total 26 ? 394
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 161
  • Mexico ? ? 482
  • USA ? ? 1123
    
    • Total ? ? 1766
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? - 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 25
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 170
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 141
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 183
  • Uruguay ? ? 33
  • Venezuela ? ? 104
    
    • Total ? ? 2760
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan 3 ? 14
  • Bangladesh ? ? 6
  • China (Mainland) 10 ? 53
  • Hong Kong SAR China ? ? 40
  • India 3 ? 526
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 15
  • Pakistan 1 ? 1
  • South Korea ? ? 64
  • Sri Lanka ? ? 1
  • Taiwan ? ? 29
    
    • Total 17 - 779
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 184
  • Vietnam ? ? 41
    
    • Total ? ? 366
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 214
• TOTAL 75 ? 7167

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 43 in mainland France.
(?)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 19 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 19 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Total of 549 fatal cases in Europe and EFTA countries and 6 747 in the rest of the world have been reported up to date;

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 18 November 2009 - 16:00 hours CEST, for the world, and 19 November 2009 - 09:00 hours CEST, for Europe.


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 549 deaths have been reported since April 2009 (Table 2). The number of weekly deaths has shown an increase over the last 4 weeks. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 19 November 2009, 09:00 hours (CEST) in EU and EFTA countries


[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (11.11.) ? ? ? ? ? ? ? ?
2. Belgium (12.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus (01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (12.11.) ? ? ? ? ? ? ? ?
6. Denmark (18.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (18.11.) ? ? ? ? ? ? ? ?
9. France (12.11.) ? ? ? ? ? 71 ? 188
10. Germany (18.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (08.11.) ? ? - 78 ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (12.11.) ? 191 ? 785 ? 22 ? 65
15. Italy (17.11) ? ? - 405 ? ? ? 205
16. Latvia (17.11.) ? ? - 1 ? ? ? ?
17. Liechtenstein (11.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (13.11.) ? 291 ? 909 ? 19 ? 91
22. Norway (18.11.) ? 89 ? 916 ? 24 ? 108
23. Poland (12.11.) ? ? ? ? ? ? ? ?
24. Portugal (18.11.) - 164 ? ? - 18 ? ?
25. Romania (18.11) ? ? ? ? ? ? ? ?
26. Slovakia (12.08.) ? 2 ? 33 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (12.11.) ? ? ? ? ? ? ? ?
29. Sweden (08.11.) ? 74 - 336 ? ? ? ?
30. Switzerland (11.11.) ? 15 - 48 ? ? ? 11
31. United Kingdom (a) (12.11.) - 785 ? ? - 173 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (841 cumulative hospitalisations), Wales (327) and Northern Ireland (527).


Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 19 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 18 November 2009, 16:00 hours CEST.


[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 1
  • Belgium ? ? 11
  • Bulgaria ? ? 5
  • Czech Republic ? ? 1
  • Finland ? ? 9
  • France ? ? 70 (a)
  • Germany 1 ? 22
  • Greece 3 ? 8
  • Hungary ? ? 5
  • Iceland ? ? 1
  • Ireland ? ? 15
  • Italy ? ? 58
  • Latvia ? ? 1
  • Lithuania 1 ? 1
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 22
  • Norway 1 ? 22
  • Poland ? ? 4
  • Portugal ? ? 7
  • Slovakia ? ? 1
  • Spain ? ? 88
  • Sweden ? ? 5
  • United Kingdom ? ? 187
    
    • Total 6 ? 549
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Bosnia and Herzegovina 1 - 1
  • Croatia ? ? 5
  • Kosovo ? ? 1
  • Moldova ? ? 7
  • Russia ? ? 19
  • Serbia 2 ? 13
  • Ukraine ? - 15
    
    • Total 3 ? 70
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt ? ? 7
  • Iran 42 ? 100
  • Iraq ? ? 9
  • Israel ? ? 48
  • Jordan ? ? 11
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 5
  • Oman ? ? 27
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 22
  • Tunisia ? ? 2
  • Turkey ? ? 73
  • United Arab Emirates ? ? 6
  • Yemen ? ? 18
    
    • Total 42 ? 436
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada 37 ? 198
  • Mexico ? ? 482
  • USA ? ? 1123
    
    • Total 37 ? 1803
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? - 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador 1 ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 5
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total 1 ? 171
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia 10 ? 151
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru 7 ? 190
  • Uruguay ? ? 33
  • Venezuela ? ? 104
    
    • Total 17 ? 2777
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India 4 ? 530
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 15
  • Pakistan ? ? 1
  • South Korea 18 ? 82
  • Sri Lanka ? ? 1
  • Taiwan ? - 29
    
    • Total 22 ? 801
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand 1 ? 185
  • Vietnam ? ? 41
    
    • Total 1 ? 367
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 19
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 214
• TOTAL 129 ? 7296

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 6 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 43 in mainland France.
(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 20 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 20 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Weekly Influenza Surveillance Overview to be published today;
• Eurosurveillance updates published;
• Total of 636 fatal cases in Europe and EFTA countries and 6 795 in the rest of the world have been reported up to date;
• Other updates: Safety of pandemic vaccines - WHO says results to date are encouraging

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 19 November 2009 - 16:00 hours CEST, for the world, and 20 November 2009 - 09:00 hours CEST, for Europe.


Weekly Influenza Surveillance Overview


The ECDC Weekly Influenza Surveillance Overview will be published this afternoon and will be available at: LINK


Eurosurveillance update

Differentiation of two distinct clusters among currently circulating Influenza A(H1N1)v viruses, march-september 2009


Analysis of all complete genome sequences of the pandemic influenza A(H1N1)v virus available as of 10 September 2009 revealed that two closely related but distinct clusters were circulating in most of the affected countries at the same time. The characteristic differences are located in genes encoding the two surface proteins - haemagglutinin and neuraminidase - and four internal proteins ? the polymerase PB2 subunit, nucleoprotein, matrix protein M1 and the non-structural protein NS1. Phylogenetic inference was demonstrated by neighbour joining, maximum likelihood and Bayesian trees analyses of the involved genes and by tree construction of concatenated sequences


Fereidouni SR, Beer M, Vahlenkamp T, Starick E. Differentiation of two distinct clusters among currently circulating influenza A(H1N1)v viruses, March-September 2009. Euro Surveill. 2009;14(46):pii=19409. Available online: LINK


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 636 deaths have been reported since April 2009 (Table 2). The number of weekly deaths has shown an increase over the last 4 weeks. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


Other updates

Safety of pandemic vaccines - WHO says results to date are encouraging


The World Health Organisation yesterday released their "Pandemic (H1N1) 2009 briefing note 16" discussing the safety of pandemic vaccines. The briefing discusses common side effects, GBS and deaths. To date, WHO has received vaccination information from 16 of around 40 countries conducting national H1N1 pandemic vaccine campaigns.
Detailed information can be found at: LINK


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 20 November 2009, 09:00 hours (CEST) in EU and EFTA countries


[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (19.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? - 4
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (18.11.) ? ? ? ? ? ? ? ?
7. Estonia (23.10.) ? ? - 11 ? ? ? ?
8. Finland (18.11.) ? ? ? ? ? ? ? ?
9. France (19.11.) ? ? ? ? ? 81 ? 245
10. Germany (18.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (18.11.) ? 182 ? 857 ? 20 ? 72
15. Italy (18.11) ? ? - 432 ? ? ? 216
16. Latvia (18.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (18.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (13.11.) ? 291 ? 909 ? 19 ? 91
22. Norway (18.11.) ? 89 ? 916 ? 24 ? 108
23. Poland (17.11.) ? ? ? ? ? ? ? ?
24. Portugal (18.11.) - 164 ? ? - 18 ? ?
25. Romania (19.11) ? ? ? ? ? ? ? ?
26. Slovakia (19.11.) ? 6 ? 39 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (19.11.) ? ? ? ? ? ? ? ?
29. Sweden (19.11.) ? 167 - 570 ? ? ? ?
30. Switzerland (18.11.) ? 13 - 84 ? ? ? 16
31. United Kingdom (a) (19.11.) - 783 ? ? - 180 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (969 cumulative hospitalisations), Wales (377) and Northern Ireland (545).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 20 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 19 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria 2 ? 3
  • Belgium 1 ? 12
  • Bulgaria ? ? 5
  • Czech Republic 1 - 2
  • Finland ? ? 9
  • France 6 ? 76 (a)
  • Germany 5 ? 27
  • Greece ? ? 8
  • Hungary 2 ? 7
  • Iceland ? ? 1
  • Ireland 1 ? 16
  • Italy 4 ? 62
  • Latvia ? ? 1
  • Lithuania ? ? 1
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 22
  • Norway 1 ? 23
  • Poland 1 ? 5
  • Portugal 1 ? 8
  • Slovakia ? ? 1
  • Spain 27 ? 115
  • Sweden 6 ? 11
  • Switzerland 1 ? 1
  • United Kingdom 28 ? 215
    
    • Total 87 ? 636
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? ? 5
  • Former Yugoslav Republic of Macedonia 1 ? 1
  • Kosovo ? ? 1
  • Moldova ? ? 7
  • Russia ? - 19
  • Serbia 3 ? 16
  • Ukraine ? ? 15
    
    • Total 4 ? 74
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt ? ? 7
  • Iran ? ? 100
  • Iraq ? ? 9
  • Israel ? ? 48
  • Jordan ? ? 11
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 5
  • Oman ? ? 27
  • Qatar ? ? 5
  • Saudi Arabia ? ? 66
  • Syria ? ? 22
  • Tunisia ? ? 2
  • Turkey ? ? 73
  • United Arab Emirates ? ? 6
  • Yemen ? ? 18
    
    • Total ? ? 436
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 198
  • Mexico 38 ? 520
  • USA ? ? 1123
    
    • Total 38 ? 1841
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica 1 ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total 1 ? 172
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 151
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela ? ? 104
    
    • Total ? ? 2777
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India 4 ? 534
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Mongolia ? ? 15
  • Pakistan ? ? 1
  • South Korea ? - 82
  • Sri Lanka ? ? 1
  • Taiwan ? ? 29
    
    • Total 4 ? 805
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 185
  • Vietnam ? ? 41
    
    • Total ? ? 367
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand 1 ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total 1 ? 215
• TOTAL 135 ? 7431

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 48 in mainland France.
(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 23 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 23 November 2009, 09:00 hours CEST


Main developments in past 72 hours

• The number of confirmed deaths reported by EU & EFTA countries as due to the pandemic rose by two thirds in one week to 169;
• Routine surveillance reports from primary care indicate that almost all European countries reported intensity above baseline levels. Seventeen countries showed increasing trends mostly counties in Eastern Europe. But some countries are now reported decreasing trends;
• EMEA?s Committee on Human Medical Products has strengthened its previous statement that a single injection of the vaccines Focetria and Pandemrix may be sufficient to protect children over age 10 and adults to age sixty;
• EMEA also sees no evidence to date that any of the licensed vaccines have side effects more than those expected from the clinical trials;
• A mutation in the Haemagglutinin gene of the pandemic virus has been reported from Norway;
• Two clusters of possible transmission of oseltamivir resistant Pandemic Influenza A(H1N1)v among hospitalized patients in the United Kingdom and United States;
• Episouth update from countries of the Mediterranean and the Balkans included.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 22 November 2009 - 16:00 hours CEST, for the world, and 23 November 2009 - 09:00 hours CEST, for Europe.


Epidemiologic update

The Weekly Influenza Surveillance Report


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 670 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


The Weekly Influenza Surveillance Overview was published in November 20th for week 46/2009, Twenty seven countries reported epidemiological data, the highest total to date this pandemic.


For the activity intensity indicator?national network levels for ILI and/or ARI? Italy, Norway and Sweden reported very high intensity; Bulgaria, Denmark, Germany, Iceland, Ireland, Lithuania, Luxembourg, Poland and Portugal reported high intensity; medium intensity was reported by 14 countries and one country reported low intensity.


For the geographic spread indicator, increases were noted compared to the previous week with 15 countries reporting widespread activity. Nine countries reported regional activity.


The other countries reported sporadic or no activity.


Seventeen countries reported an increasing trend of influenza activity compared to twenty in the previous week. Countries in Central and Eastern Europe were especially experiencing rising trends. Seven countries, Belgium, Bulgaria, Iceland, Ireland, Luxembourg, Norway and parts of the UK (Northern Ireland), reported decreasing trends.
Belgium, Iceland and the UK (Northern Ireland), reported decreasing trends in week 45 as well. In most countries where influenza activity has risen above baseline levels, the most affected group includes those younger than 15 years.


Virological data indicate that there remains very viruses apart from the pandemic strain. The proportion of sentinel specimens that are confirmed influenza is 45%, a high level normally only seen during the peaks of previous winter influenza epidemics.


Pandemic Vaccine Information from EMEA


EMEA?s Committee on Human Medical Products (CHMP) met through last week and considered the latest data from the experience with the pandemic vaccines. Its conclusion are summarised in a Press Release issued on November 20th. The Committee concluded that the data on Focetria (Novartis) and Pandemrix (GSK) indicate that a single dose of these vaccines is able to trigger an immune response likely to be sufficient to give protection against the H1N1 pandemic influenza in older children, adolescents and younger adults. For both vaccines, a single dose may be used in persons aged between 10 and 60 years. Pandemrix may also be used as a single dose in the elderly. For certain groups, such as younger children and immunocompromised patients, the recommendation remains that two doses should be given, to ensure that their immune system responds adequately to the vaccination. Further data will become available in the coming months.


Data on Celvapan (Baxter) are still being assessed.


The CHMP also concluded that Focetria and Pandemrix can be co-administered with non-adjuvanted seasonal flu vaccines. EMEA also noted that the safety profile of H1N1 pandemic influenza vaccines is being continuously monitored by itself and in Member States. This post marketing surveillance is based on about 5 million people who have been vaccinated so far in Europe. To date, the side effects reported have mainly been mild symptoms such as fever, nausea, headache, allergic reactions and injection site reactions, confirming the safety profile of the three vaccines.


A very small number of cases of Guillain-Barr? syndrome and foetal death have been reported in patients previously vaccinated with a pandemic vaccine. EMEA is still in the process of gathering all relevant information and evaluating the data. However, on the basis of the available information it concludes there is no evidence to link these to the vaccines.


Other updates

Mutation in the Haemagglutinin gene of pandemic Influenza A(H1N1)v reported from Norway


The Norwegian Institute of Public Health reported on 20 November 2009 the detection of a mutation in the viruses affecting three cases of severe pandemic Influenza A(H1N1)v infection . Overall approximately 70 influenza viruses from ill patients have been sequenced in Norway, including six from patients who died.


The three viruses with this mutation were isolated from the first two fatal cases of pandemic influenza in Norway and one patient with severe respiratory disease. The two fatal cases , who were not epidemiologically linked, died in July and August, 2009.


Based on the currently available information it appears that the mutated virus is not circulating in the Norwegian population, but may the result of a spontaneous change occurring in severely ill patients [1].


In a note responding to the report from Norway WHO reported that worldwide, a similar mutation has been was detected in viruses from several other countries, with the earliest detection reported in April.


In addition to Norway, the mutation has been observed in Brazil, China, Japan, Mexico, Ukraine and the USA.[2]


1. LINK
2. LINK

ECDC comment:


The amino acid change in the haemagglutinin HA1 gene at position 222 (225 in influenza H3 numbering) from aspartic acid (D) to glycine (G) observed, may influence receptor binding specificity and therefore has the potential to affect the pathogenicity of the virus. This might allow the mutated virus to infect tissues deeper in the respiratory tract, although the receptor binding preferences have not been determined yet.


Currently, there is no evidence about the consequences of this mutation on the biological properties of the virus. In addition, if the receptor preference of the mutated virus corresponds to the deeper airways, this most likely will tend to reduce the likelihood for easy human-to-human spread.


A likely explanation of this finding is that it is an adaptive mutation of the virus. At this moment there is no indication of change in the virulence of the circulating pandemic Influenza A(H1N1)v virus.


The virus with this mutation remains sensitive to oseltamivir and zanamivir.



Studies show that the currently available vaccines confer protection.



Continued close virological monitoring in particular of severe cases, is needed to elucidate any potential relationship between the mutation and the clinical outcome of infection.


Two clusters of possible transmission of oseltamivir resistant Pandemic Influenza A(H1N1)v among hospitalized patients, United Kingdom and United States

UK: Nine Pandemic Influenza A(H1N1)v confirmed cases have been reported amongst patients on a hospital ward in Wales.[3] Five of these cases are determined to be resistant to oseltamivir, one is sensitive and for three resistance status is currently unknown. The cluster is in a group of patients with haematological problems which result in immuno-suppression either because of the disorder or the chemotherapy given to treat the disorder. Although further epidemiological investigation is underway, it would seem likely that transmission of oseltamivir-resistant H1N1 virus has taken place.


Further follow-up of cases and their close contacts both on the ward and in the community is underway to ascertain if there is evidence of transmission.


The virus remains sensitive to the other licensed neuraminidase inhibitor zanamivir which is being used as an alternative antiviral and to which patients are responding.[3]

USA: Four patients at a hospital in North Carolina who developed influenza in October were found to have oseltamivir resistant pandemic influenza A(H1N1) [4]. The cluster was detected when the patients did not respond to oseltamivir treatment. Three of the four patients have died. All of the patients were located in a ward for people with cancer or severe blood disorders. All were severely ill and were highly susceptible to infections.


Preliminary genetic evidence suggests that the virus spread among patients at the hospital.


The U.S. Centers for Disease Control and Prevention (CDC) is testing virus samples from the patients at Duke to see whether they're indistinguishable from one another.


In addition to investigating the hospital cluster, state and federal epidemiologists are trying to determine whether oseltamivir resistant influenza is circulating elsewhere in North Carolina.


3. LINK
4. LINK

ECDC comment:


Oseltamivir resistance to influenza viruses is well documented in immunosuppressed individuals and can develop quickly if oseltamivir is being given. It is likely to be associated with the high viral load which may occur during infection in these patients. In addition, immunosuppressed people may be more susceptible to infection (i.e., a smaller exposure may result in infection in these patients). It is thus not surprising that spread of resistant virus may occur from patients in whom resistance is more likely to develop during treatment to patients who are very susceptible, especially in a confined setting such as a hospital ward.


The range of manifestations (e.g., asymptomatic, mild, severe) of influenza infection, such as observed with the 2009 A(H1N1) pandemic, makes it difficult, if not impossible, to determine if any given patient or healthcare worker is carrying virus. Thus, people in contact with an index patient can innocently spread influenza to other patients.


Unvaccinated healthcare workers and visitors in contact with these patients may be at risk for being infected with this resistant strain. At this time it is difficult to predict the likelihood of spread of this resistant strain into the community through these people or another means. The conditions under which these clusters occurred are likely to be present at other medical centres throughout the EU. That is, transmission of influenza in the community with immunocompromised patients in healthcare settings receiving either prophylactic or therapeutic oseltamivir.


Thus, member states should remain vigilant for similar clusters now and in the future. Unless oseltamivir resistance becomes more common, it remains appropriate to use oseltamivir for the treatment and prophylaxis of influenza in the UK, the US and elsewhere. Treatment failure is a reason to consider alternative treatment and to test a viral isolate for resistance.



The continuous surveillance for resistance from a sample of isolates taken from community infections should be maintained in countries where resources for testing are available.


Countries without resistance testing capacity should send samples elsewhere for testing on a periodic basis. The best ways to prevent the spread of antiviral susceptible and antiviral resistant influenza in the healthcare setting and between healthcare settings and the community is to ensure healthcare workers are immunized and that there is strict adherence to infection control procedures.


EPISOUTH update


EPISOUTH is a European Commission funded project, whose aim is to create a framework of collaboration on epidemiological issues in order to improve communicable diseases surveillance, communication and training across the countries of the Mediterranean and the Balkans. As per June 2009, the EpiSouth Network counts 26 Countries (9 EU and 17 non-EU).


Excerpts from the bulletin 87 (11th Nov-17th Nov) is published here:


As of 17 November 2009, a total of 382 deaths among biologically confirmed A/H1N1/2009 cases have been reported in the EpiSouth region. 138 new deaths were reported since 10 November 2009: 1 in Bosnia and Herzegovina (1st), 4 in Croatia, 3 in Egypt, 9 in Israel, 15 in France, 25 in Italy, 4 in Jordan, 1 in Kosovo (1st),1 in Morocco (1st), 4 in Palestine, 4 in Serbia,15 in Syria 2, in Tunisia (1st) and 50 in Turkey.


Influenza activity is globally on the rise across Southern Europe and the Balkans. For week 45, influenza activity was high in Croatia, Serbia and Turkey. Bosnia and Herzegovina reported its first death from influenza A/H1N1/2009. Kosovo reported its first A/H1N1/2009 confirmed death.


As of 17 November 2009, Palestine had 7 fatalities.


Israel reported widespread, medium influenza activity for week 45.
Morocco reported its first death on 13 November 2009 from influenza A/H1N1 in Oujda (North-east).


Community transmission of A/H1N1/2009 influenza virus has been established in Tunisia. The country experiences an increasing epidemic trend since the beginning of November. Tunisia reported its first 2 deaths from influenza A/H1N1/2009 during week 46.


The full EPISOUTH bulletin can be accessed at: LINK


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 23 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (19.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ?- ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (18.11.) ? ? ? ? ? ? ? ?
7. Estonia (20.11.) ? ? ? ? ? ? ? ?
8. Finland (20.11.) ? ? ? ? ? ? ? ?
9. France (19.11.) ? ? ? ? ? 81 ? 245
10. Germany (18.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (18.11.) ? 182 ? 857 ? 20 ? 72
15. Italy (21.11.) ? ? - 489 ? ? ? 241
16. Latvia (18.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (18.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (20.11.) ? 359 ? 1270 ? 38 ? 134
22. Norway (18.11.) ? 89 ? 916 ? 24 ? 108
23. Poland (17.11.) ? ? ? ? ? ? ? ?
24. Portugal (18.11.) - 164 ? ? - 18 ? ?
25. Romania (19.11) ? ? ? ? ? ? ? ?
26. Slovakia (19.11.) ? 6 ? 39 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (19.11.) ? ? ? ? ? ? ? ?
29. Sweden (19.11.) ? 167 - 570 ? ? ? ?
30. Switzerland (18.11.) ? 13 - 84 ? ? ? 16
31. United Kingdom (a) (19.11.) - 783 ? ? - 180 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (969 cumulative hospitalisations), Wales (377) and Northern Ireland (545).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 23 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 22 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium ? ? 12
  • Bulgaria ? ? 5
  • Czech Republic ? ? 2
  • Denmark 2 ? 2
  • Finland 3 ? 12
  • France 8 ? 84 (a)
  • Germany 3 ? 30
  • Greece ? ? 8
  • Hungary ? ? 7
  • Iceland ? ? 1
  • Ireland ? ? 16
  • Italy 8 ? 70
  • Latvia ? ? 1
  • Lithuania ? ? 1
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands 6 ? 28
  • Norway ? ? 23
  • Poland ? ? 5
  • Portugal 3 ? 11
  • Slovakia ? ? 1
  • Spain ? ? 115
  • Sweden ? ? 11
  • Switzerland ? ? 1
  • United Kingdom 1 ? 216
    
    • Total 34 ? 670
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 7
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? ? 5
  • Former Yugoslav Republic of Macedonia ? ? 1
  • Kosovo 1 ? 2
  • Moldova 1 - 8
  • Russia ? ? 19
  • Serbia ? ? 16
  • Ukraine ? ? 15
    
    • Total 2 ? 76
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt 3 ? 10
  • Iran ? ? 100
  • Iraq ? ? 9
  • Israel ? ? 48
  • Jordan ? ? 11
  • Kuwait ? ? 26
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory 2 ? 7
  • Oman ? ? 27
  • Qatar 2 ? 7
  • Saudi Arabia 4 ? 70
  • Syria ? ? 22
  • Tunisia ? ? 2
  • Turkey 20 ? 93
  • United Arab Emirates ? ? 6
  • Yemen ? ? 18
    
    • Total 31 ? 467
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada 52 ? 250
  • Mexico 53 ? 573
  • USA ? ? 1123
    
    • Total 105 ? 1946
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 38
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 172
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 151
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela 3 ? 107
    
    • Total 3 ? 2780
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India 19 ? 553
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Maldives 1 ? 1
  • Mongolia 2 - 17
  • Pakistan ? ? 1
  • South Korea ? ? 82
  • Sri Lanka 4 ? 5
  • Taiwan ? ? 29
    
    • Total 26 ? 831
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 185
  • Vietnam ? ? 41
    
    • Total ? ? 367
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 215
• TOTAL 201 ? 7632

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 56 in mainland France.
(?)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 24 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 24 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Updates from U.S.A. and Canada included;
• Total of 690 fatal cases in Europe and EFTA countries and 7 170 in the rest of the world have been reported up to date.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 23 November 2009 - 16:00 hours CEST, for the world, and 24 November 2009 - 09:00 hours CEST, for Europe.

Updates from U.S.A. and Canada

From U.S. Center s for Disease Control and Prevention weekly influenza surveillance report: Week 45 (8-14 November 2009)

• Influenza activity decreased slightly in the U.S.
• 3,106 (28.8%) specimens tested and reported to CDC/Influenza Division were positive for influenza. Over 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the seventh consecutive week.
• Twenty-one influenza-associated pediatric deaths were reported. Fifteen of these deaths were associated with 2009 influenza A (H1N1) virus infection, and six were associated with influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was 5.5% which is above the national baseline of 2.3%.
• Forty-three states reported geographically widespread influenza activity, Puerto Rico and seven states reported regional influenza activity, the District of Columbia reported local influenza activity, and Guam and the U.S. Virgin Islands reported sporadic influenza activity.
• Because of the U.S. Thanksgiving holiday, the week 46 report will be released on Monday, 30 November 2009.
• Other news:
  
  • Four patients at Duke University Medical Center in Durham, N.C., who developed influenza in October, were found to have oseltamivir resistant Pandemic Influenza A(H1N1)v.
  • The cluster was detected when the patients did not respond to oseltamivir treatment. Three of the four patients have died.
• For more information:
  
  • U.S. Centers for Disease Control and Prevention ?What's New on the H1N1 Flu Site? : LINK
  • U.S. Centers for Disease Control and Prevention Weekly Influenza Surveillance Report: LINK
  • Overview of Influenza Surveillance in the United States: LINK

From the Public Health Agency of Canada:

• The activity level remained similar to the previous week.
• The Pandemic (H1N1) 2009 strain accounted for nearly 100% of the positive influenza A subtyped specimens this week.
• The ILI consultation rate was 91 consultations per 1,000 patient visits which was lower for a second consecutive week.
• The intensity in the population was high with 1,674 hospitalizations, 261 ICU admissions and 84 deaths reported.
• Numbers of new deaths were more than two times higher than previous week.
• 184 laboratory-confirmed influenza-associated paediatric hospitalizations and 1 death were reported through the Immunisation Monitoring Program Active (IMPACT) network.
• The number of hospitalizations and deaths increased, but the proportion of positive influenza tests was comparable and the national ILI consultation rate and the number of influenza outbreaks reported decreased.
• Other news:
  
  • Public Heath Canada (PHAC) is investigating a greater rate of anaphylaxis after immunisation with a specific lot of pandemic influenza vaccine (Arepanrix, Lot Number A80CA007A, only used in Canada) than with other lots of the same vaccine. GlaxoSmithKline, which produces the vaccine, notified all consignees to immediately stop the vaccination program with this lot and to put this lot under quarantine pending the outcome of the investigation.
• For more information:
  
  • Public Health Agency of Canada: LINK
  • Public Health Agency of Canada FluWatch: LINK

Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 690 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 24 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (19.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (18.11.) ? ? ? ? ? ? ? ?
7. Estonia (20.11.) ? ? ? ? ? ? ? ?
8. Finland (20.11.) ? ? ? ? ? ? ? ?
9. France (19.11.) ? ? ? ? ? 81 ? 245
10. Germany (20.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (18.11.) ? 182 ? 857 ? 20 ? 72
15. Italy (23.11) ? ? - 496 ? ? ? 248
16. Latvia (21.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (18.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (20.11.) ? 359 ? 1270 ? 38 ? 134
22. Norway (18.11.) ? 89 ? 916 ? 24 ? 108
23. Poland (23.11.) ? ? ? ? ? ? ? ?
24. Portugal (18.11.) - 164 ? ? - 18 ? ?
25. Romania (23.11) - 10 ? ? - 5 ? ?
26. Slovakia (19.11.) ? 6 ? 39 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (19.11.) ? ? ? ? ? ? ? ?
29. Sweden (19.11.) ? 167 - 570 ? ? ? ?
30. Switzerland (18.11.) ? 13 - 84 ? ? ? 16
31. United Kingdom (a) (19.11.) - 783 ? ? - 180 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (969 cumulative hospitalisations), Wales (377) and Northern Ireland (545).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 24 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 23 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium ? ? 12
  • Bulgaria ? ? 5
  • Czech Republic 1 ? 3
  • Denmark 1 ? 3
  • Finland ? ? 12
  • France ? ? 84 (a)
  • Germany 4 ? 34
  • Greece ? ? 8
  • Hungary ? ? 7
  • Iceland ? ? 1
  • Ireland ? ? 16
  • Italy 6 ? 76
  • Latvia ? ? 1
  • Lithuania ? ? 1
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 28
  • Norway ? ? 23
  • Poland 4 ? 9
  • Portugal 3 ? 14
  • Romania 1 ? 1
  • Slovakia ? ? 1
  • Spain ? ? 115
  • Sweden ? ? 11
  • Switzerland ? ? 1
  • United Kingdom ? ? 216
    
    • Total 20 ? 690
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus 13 ? 20
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? ? 5
  • Former Yugoslav Republic of Macedonia ? ? 1
  • Kosovo ? - 2
  • Moldova ? ? 8
  • Russia ? ? 19
  • Serbia ? ? 16
  • Ukraine ? ? 15
    
    • Total 13 ? 89
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt 1 ? 11
  • Iran ? ? 100
  • Iraq 1 ? 10
  • Israel 3 ? 51
  • Jordan ? ? 11
  • Kuwait 1 ? 27
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory 2 ? 9
  • Oman ? ? 27
  • Qatar ? ? 7
  • Saudi Arabia 11 ? 81
  • Syria 28 ? 50
  • Tunisia ? ? 2
  • Turkey ? ? 93
  • United Arab Emirates ? ? 6
  • Yemen 4 ? 22
    
    • Total 51 ? 518
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 250
  • Mexico ? ? 573
  • USA 142 - 1265
    
    • Total 142 ? 2088
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica 2 ? 40
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total 2 ? 174
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 151
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela ? ? 107
    
    • Total ? ? 2780
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India ? ? 553
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Maldives ? - 1
  • Mongolia ? ? 17
  • Pakistan ? ? 1
  • South Korea ? ? 82
  • Sri Lanka ? ? 5
  • Taiwan ? ? 29
    
    • Total ? ? 831
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 185
  • Vietnam ? ? 41
    
    • Total ? ? 367
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 215
• TOTAL 228 ? 7860

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 56 in mainland France.
(?)
-
-------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 25 November 2009, 09:00 hours CEST (ECDC, edited)

[Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 25 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• WHO publication on health requirements for pilgrims travelling to Hajj reviewed;
• Total of 714 fatal cases in Europe and EFTA countries and 7 195 in the rest of the world have been reported up to date.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 24 November 2009 - 16:00 hours CEST, for the world, and 25 November 2009 - 09:00 hours CEST, for Europe.


Public Health Development

Mass gatherings during H1N1 2009 pandemic ? an example of Hajj event


Soon estimated more than 2,5 million Muslims from over 160 countries are expected to participate in the annual Hajj ?a pilgrimage to Mecca, Saudi Arabia. This year the Hajj will be taking place in the midst of a pandemic. A recent WHO publication in the Weekly Epidemiological Record describes in detail all the travel requirements that the Saudi Authorities are making for pilgrims that are going to participate in the event so as to reduce the risk to their health. The publication also mentions potential implications for home countries of participants after the event.
The full ECDC review will be available today at: LINK


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 714 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


Other updates


According to Ukrainian media sources the World Health Organization (WHO) has pledged to provide 5 million doses of pandemic vaccine to Ukraine.


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 25 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (19.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (08.11) ? ? ? ? ? ? ? ?
4. Cyprus(01.11) ? ? ? ? ? ? ? 4
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (18.11.) ? ? ? ? ? ? ? ?
7. Estonia (20.11.) ? ? ? ? ? ? ? ?
8. Finland (20.11.) ? ? ? ? ? ? ? ?
9. France (23.11.) ? ? ? 305 - 101 ? ?
10. Germany (23.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (18.11.) ? 182 ? 857 ? 20 ? 72
15. Italy (24.11) ? ? - 519 ? ? ? 269
16. Latvia (23.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (18.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (20.11.) ? 359 ? 1270 ? 38 ? 134
22. Norway (18.11.) ? 89 ? 916 ? 24 ? 108
23. Poland (23.11.) ? ? ? ? ? ? ? ?
24. Portugal (18.11.) - 164 ? ? - 18 ? ?
25. Romania (23.11) - 10 ? ? - 5 ? ?
26. Slovakia (19.11.) ? 6 ? 39 ? 0 ? 0
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (19.11.) ? ? ? ? ? ? ? ?
29. Sweden (19.11.) ? 167 - 570 ? ? ? ?
30. Switzerland (18.11.) ? 13 - 84 ? ? ? 16
31. United Kingdom (a) (19.11.) - 783 ? ? - 180 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (969 cumulative hospitalisations), Wales (377) and Northern Ireland (545).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 25 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 24 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium ? ? 12
  • Bulgaria ? ? 5
  • Czech Republic ? ? 3
  • Denmark 2 ? 5
  • Finland ? ? 12
  • France 1 ? 85 (a)
  • Germany 7 ? 41
  • Greece ? ? 8
  • Hungary ? ? 7
  • Iceland ? ? 1
  • Ireland ? ? 16
  • Italy 6 ? 82
  • Latvia ? ? 1
  • Lithuania 1 ? 2
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 28
  • Norway ? ? 23
  • Poland 4 ? 13
  • Portugal ? ? 14
  • Romania 1 ? 2
  • Slovakia ? ? 1
  • Slovenia 2 ? 2
  • Spain ? ? 115
  • Sweden ? ? 11
  • Switzerland ? ? 1
  • United Kingdom ? ? 216
    
    • Total 24 ? 714
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 20
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? ? 5
  • Former Yugoslav Republic of Macedonia ? - 1
  • Kosovo ? ? 2
  • Moldova 2 ? 10
  • Russia ? ? 19
  • Serbia ? ? 16
  • Ukraine ? ? 15
    
    • Total 2 ? 91
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt ? ? 11
  • Iran ? ? 100
  • Iraq ? ? 10
  • Israel 1 ? 52
  • Jordan ? ? 11
  • Kuwait ? ? 27
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 9
  • Oman ? ? 27
  • Qatar 1 ? 8
  • Saudi Arabia ? ? 81
  • Syria ? ? 50
  • Tunisia ? ? 2
  • Turkey 19 ? 112
  • United Arab Emirates ? ? 6
  • Yemen ? ? 22
    
    • Total 21 ? 539
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 250
  • Mexico ? - 573
  • USA ? ? 1265
    
    • Total ? ? 2088
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 40
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 174
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil ? ? 1368
  • Chile ? ? 140
  • Colombia ? ? 151
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela ? ? 107
    
    • Total ? ? 2780
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India 2 ? 555
  • Japan ? ? 28
  • Macao SAR China ? - 2
  • Maldives ? ? 1
  • Mongolia ? ? 17
  • Pakistan ? ? 1
  • South Korea ? ? 82
  • Sri Lanka ? ? 5
  • Taiwan ? ? 29
    
    • Total 2 ? 833
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand ? ? 185
  • Vietnam ? ? 41
    
    • Total ? ? 367
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 189
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 215
• TOTAL 49 ? 7909

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 57 in mainland France.
(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 26 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 26 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Summary of experience from first wave in UK published;
• Total of 734 fatal cases in Europe and EFTA countries and 7 499 in the rest of the world have been reported up to date.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 25 November 2009 - 16:00 hours CEST, for the world, and 26 November 2009 - 09:00 hours CEST, for Europe.


The UK synthesis of the pandemic (H1N1) 2009 first wave


The Health Protection Agency (HPA) has published a ?synthesis? describes the epidemiology of the ?first wave? of the pandemic in the UK and the public health response to it.(1) There is an extensive description of the containment process which the UK health authorities undertook through April to the end of June but it is the epidemiology and impact which is now of more importance to the rest of Europe especially for countries now experiencing their own first wave. It needs to be remembered that both seasonal and pandemic influenza transmits more easily in the winter months.
The HPA report is only for England (population around 51.5 million).
During the first wave the HPA estimated that between 144,000 and 670,000 people (mid-estimate of 320,000) fell ill. However, this varied considerably by age group and region. People aged 24 years and younger were many more times likely to become infected than adults >65 years. Using modelled estimates, London and the West Midlands accounted for 30% and 12%, respectively, of reported cases. Most people experienced a mild, typical influenza-like illness and the number of deaths in the first wave was fewer than would be expected in a typical influenza season. However, severe cases occurred and the percentage of cases that ended up in hospital ranged from 1.3% to 2.5%.
Risk of hospitalisation and death was much higher in the presence of one or more risk conditions, particularly chronic renal disease, immunosuppression and chronic neurological disease. Equally though a minority of those hospitalised and dying were without any risk factors. Among the different age groups rates were higher for infants (children less than one year of age) and adults >65 years, compared with other age groups.
Focal investigations of the first cases and their household contacts during the containment phase found that the secondary household virologically confirmed attack rate was 7%. However, this rate was four times higher in children (less than 16 years) than adults and >90% lower among household contacts who received antiviral prophylaxis during the containment activities.
Pandemic (H1N1) 2009 was the dominant influenza strain (there were hardly any other influenzas) and among more than 1000 pandemic viruses from patients only three patients had isolates resistant to oseltamivir.
Perhaps the most interesting findings are from the initial serological studies which found that a many more people, especially children were infected with the pandemic virus than had been thought.
The first results indicate that, overall, about 15% of children in England were infected during the first wave. In London and the West Midlands the estimated cumulative incidence of infection in children <15 years of age and young adults aged 15-24 years was about 25% and 21%, respectively.

In one school outbreak up to a third of the children without symptoms whose serum was tested for signs of infection were found to have been silently infected.

The relevance of these finding for other countries in Europe is that they can be used to improve our risk assessment and to revise planning assumptions (2,3). ECDC has done the latter working with the UK and other EU countries as well as with the WHO (3). It is important to not that these represent a reasonable worse case scenarios. Specifically they do not represent a prediction. They UK experience also reinforces the ECDC advice that hospitals and especially intensive care will be the most burdened part of the health care sector. Finally the significant number of silent infections combined with the fact that many older people possess some residual immunity suggest that EU countries may only experience one major pandemic wave this winter (of course for countries like Spain and the UK that had a summer wave this will be their second wave).(2) Though that wave will be a tough one for the hospital health services in particular.
1. Health Protection Agency summary: LINK
2. ECDC Risk Assessment November 2009: LINK
3. ECDC Revised Planning Assumptions for Europe: LINK


Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 734 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.


Other updates

ESCMID concerned that scepticism and deliberate misinformation is leading to low vaccine uptake


Whilst rates of pandemic influenza increase in intensity and geographical spread across Europe, the roll out of the vaccination campaigns is receiving mixed levels of uptake and opposition from anti-vaccine campaigners that puts at risk public health and lives, says the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
See full ESCMID press release at: LINK


Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 26 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (19.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (22.11) ? ? ? ? ? ? ? ?
4. Cyprus(23.11) ? ? ? ? ? ? ? 6
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (25.11.) ? ? ? ? ? ? ? ?
7. Estonia (25.11.) ? ? ? ? ? ? ? ?
8. Finland (20.11.) ? ? ? ? ? ? ? ?
9. France (23.11.) ? ? ? 305 - 101 ? ?
10. Germany (24.11.) ? ? ? ? ? ? ? ?
11. Greece (18.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (11.11.) ? 31 ? 170 ? 7 ? 19
14. Ireland (18.11.) ? 182 ? 857 ? 20 ? 72
15. Italy (25.11) ? ? - 526 ? ? ? 276
16. Latvia (24.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (18.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (20.11.) ? 359 ? 1270 ? 38 ? 134
22. Norway (23.11.) ? 60 ? 1102 ? 13 ? 127
23. Poland (23.11.) ? ? ? ? ? ? ? ?
24. Portugal (25.11.) - 148 ? ? - 20 ? ?
25. Romania (23.11) - 10 ? ? - 5 ? ?
26. Slovakia (25.11.) ? 13 - 51 ? ? ? ?
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (19.11.) ? ? ? ? ? ? ? ?
29. Sweden (19.11.) ? 167 - 570 ? ? ? ?
30. Switzerland (18.11.) ? 13 - 84 ? ? ? 16
31. United Kingdom (a) (19.11.) - 783 ? ? - 180 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (969 cumulative hospitalisations), Wales (377) and Northern Ireland (545).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 26 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 25 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium ? ? 12
  • Bulgaria ? ? 5
  • Czech Republic ? ? 3
  • Denmark ? ? 5
  • Estonia 1 ? 1
  • Finland ? ? 12
  • France ? ? 85 (a)
  • Germany 5 ? 46
  • Greece ? ? 8
  • Hungary ? ? 7
  • Iceland ? ? 1
  • Ireland ? ? 16
  • Italy 3 ? 85
  • Latvia 2 ? 3
  • Lithuania ? ? 2
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 28
  • Norway 2 ? 25
  • Poland 2 ? 15
  • Portugal 2 ? 16
  • Romania ? ? 2
  • Slovakia ? ? 1
  • Slovenia ? ? 2
  • Spain ? ? 115
  • Sweden ? ? 11
  • Switzerland ? ? 1
  • United Kingdom 3 ? 219
    
    • Total 20 ? 734
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 20
  • Bosnia and Herzegovina ? ? 1
  • Croatia 6 - 11
  • Former Yugoslav Republic of Macedonia ? ? 1
  • Kosovo ? ? 2
  • Moldova ? ? 10
  • Russia ? ? 19
  • Serbia 1 ? 17
  • Ukraine 3 ? 18
    
    • Total 10 ? 101
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt ? ? 11
  • Iran 40 ? 140
  • Iraq ? ? 10
  • Israel ? ? 52
  • Jordan ? ? 11
  • Kuwait ? ? 27
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 9
  • Oman ? ? 27
  • Qatar ? ? 8
  • Saudi Arabia ? ? 81
  • Syria ? ? 50
  • Tunisia ? ? 2
  • Turkey ? ? 112
  • United Arab Emirates ? ? 6
  • Yemen ? ? 22
    
    • Total 40 ? 579
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada 29 - 279
  • Mexico 16 ? 589
  • USA ? ? 1265
    
    • Total 45 ? 2133
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 40
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 174
• SOUTH AMERICA
  
  • Argentina ? ? 600
  • Bolivia ? ? 57
  • Brazil 160 ? 1528
  • Chile 8 ? 148
  • Colombia 9 ? 160
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela ? ? 107
    
    • Total 177 ? 2957
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 53
  • Hong Kong SAR China ? ? 40
  • India 5 ? 560
  • Japan ? - 28
  • Macao SAR China ? ? 2
  • Maldives ? ? 1
  • Mongolia 1 ? 18
  • Pakistan ? ? 1
  • South Korea 22 ? 104
  • Sri Lanka ? ? 5
  • Taiwan 1 ? 30
    
    • Total 29 ? 862
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 4
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 18
  • Thailand 2 ? 187
  • Vietnam ? ? 41
    
    • Total 2 ? 369
• AUSTRALIA & PACIFIC
  
  • Australia 1 ? 190
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total 1 ? 216
• TOTAL 324 ? 8233

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 57 in mainland France.
(?.)
-
------

[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 27 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]

ECDC DAILY UPDATE

Pandemic (H1N1) 2009 Update 27 November 2009, 09:00 hours CEST


Main developments in past 24 hours

• Episouth update included;
• Selection bias may explain seasonal vaccine?s protection in previously published study;
• Total of 825 fatal cases in Europe and EFTA countries and 7 627 in the rest of the world have been reported up to date.

This report is based on official information provided by national public health websites or through other official communication channels. An update on the number of confirmed fatal cases is presented in Table 2 - as of 26 November 2009 - 16:00 hours CEST, for the world, and 27 November 2009 - 09:00 hours CEST, for Europe.

Epidemiologic update


All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 825 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.

Other updates

Selection bias may explain seasonal vaccine?s protection in previously published study


In a letter to the British medical journal, Canadian researchers argue that the protective effect of seasonal vaccine against pandemic influenza seen in a study from Mexico City is due to selection bias and an incorrect analytic technique used in the study.
The BMJ letter is available at: LINK

Episouth update


EPISOUTH is a project, with the objective to create a framework of collaboration on epidemiological issues in order to improve communicable diseases surveillance, communication and training across the countries of the Mediterranean and the Balkans.
As per June 2009, the EpiSouth Network counts 26 Countries (9 EU and 17 non-EU). European Commission funds this project, which is also supported by the Italian Ministry of Health.
Excerpts from the bulletin 87 (11th Nov-17th Nov) is published here:
As of 23 November 2009, a total of 498 deaths among biologically confirmed A/H1N1/2009 cases have been reported in the EpiSouth region (Mediterranean and the Balkans). 116 new deaths were reported since 17 November 2009: A 1st death in FYRO Macedonia, 1 new death in Egypt, 1 in Kosovo, 2 in Palestine, 7 in Serbia, and 20 in Turkey.
For week 46, influenza activity was high in Serbia, and Turkey; medium in: Albania, Croatia, and Israel; increasing in Tunisia.
For more details please refer to the EpiSouth bulletin: LINK

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 27 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (26.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (22.11) ? ? ? ? ? ? ? ?
4. Cyprus(23.11) ? ? ? ? ? ? ? 6
5. Czech Republic (19.11.) ? ? ? ? ? ? ? ?
6. Denmark (25.11.) ? ? ? ? ? ? ? ?
7. Estonia (25.11.) ? ? ? ? ? ? ? ?
8. Finland (26.11.) - 23 ? ? - 8 ? ?
9. France (24.11.) ? 43 - 357 ? ? ? ?
10. Germany (25.11.) ? ? ? ? ? ? ? ?
11. Greece (15.11.) ? ? ? ? ? ? ? ?
12. Hungary (18.11.) - 2 ? ? ? ? ? ?
13. Iceland (26.11.) ? 5 ? 180 ? 1 ? 20
14. Ireland (25.11.) ? 211 ? 941 ? 18 ? 77
15. Italy (26.11) ? ? - 572 ? ? ? 303
16. Latvia (25.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (26.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (20.11.) ? 359 ? 1270 ? 38 ? 134
22. Norway (23.11.) ? 60 ? 1102 ? 13 ? 127
23. Poland (23.11.) ? ? ? ? ? ? ? ?
24. Portugal (25.11.) - 148 ? ? - 20 ? ?
25. Romania (23.11) - 10 ? ? - 5 ? ?
26. Slovakia (25.11.) ? 13 - 51 ? ? ? ?
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (26.11.) ? ? ? ? ? ? ? ?
29. Sweden (22.11.) ? 206 - 836 ? ? ? ?
30. Switzerland (26.11.) ? 23 - 127 ? ? ? 30
31. United Kingdom (a) (19.11.) - 753 ? ? - 154 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (1104 cumulative hospitalisations), Wales (411) and Northern Ireland (558).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 27 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 26 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium 1 ? 13
  • Bulgaria ? ? 5
  • Czech Republic 3 ? 6
  • Denmark ? ? 5
  • Estonia ? ? 1
  • Finland 4 ? 16
  • France 11 ? 96 (a)
  • Germany 6 ? 52
  • Greece 4 ? 12
  • Hungary ? ? 7
  • Iceland 1 ? 2
  • Ireland 1 ? 17
  • Italy 6 ? 91
  • Latvia ? ? 3
  • Lithuania ? ? 2
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 28
  • Norway ? ? 25
  • Poland 1 ? 16
  • Portugal 1 ? 17
  • Romania ? ? 2
  • Slovakia ? ? 1
  • Slovenia ? ? 2
  • Spain 20 ? 135
  • Sweden 4 ? 15
  • Switzerland 2 ? 3
  • United Kingdom 26 ? 245
    
    • Total 91 ? 825
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 20
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? - 11
  • Former Yugoslav Republic of Macedonia ? ? 1
  • Kosovo ? ? 2
  • Moldova 1 ? 11
  • Russia ? ? 19
  • Serbia ? ? 17
  • Ukraine ? ? 18
    
    • Total 1 ? 102
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Bahrain ? ? 7
  • Egypt 2 ? 13
  • Iran ? ? 140
  • Iraq ? ? 10
  • Israel 3 ? 55
  • Jordan 3 ? 14
  • Kuwait ? ? 27
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 9
  • Oman ? ? 27
  • Qatar ? ? 8
  • Saudi Arabia ? ? 81
  • Syria ? ? 50
  • Tunisia ? ? 2
  • Turkey 49 ? 161
  • United Arab Emirates ? ? 6
  • Yemen ? ? 22
    
    • Total 57 ? 636
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? - 279
  • Mexico ? ? 589
  • USA ? ? 1265
    
    • Total ? ? 2133
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 40
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 26
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 174
• SOUTH AMERICA
  
  • Argentina 10 ? 610
  • Bolivia ? ? 57
  • Brazil ? ? 1528
  • Chile ? ? 148
  • Colombia ? ? 160
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela 6 ? 113
    
    • Total 16 ? 2973
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) 51 ? 104
  • Hong Kong SAR China 1 ? 41
  • India ? ? 560
  • Japan ? - 28
  • Macao SAR China ? ? 2
  • Maldives ? ? 1
  • Mongolia ? ? 18
  • Pakistan ? ? 1
  • South Korea ? ? 104
  • Sri Lanka ? ? 5
  • Taiwan ? ? 30
    
    • Total 52 ? 914
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia 1 ? 5
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore 1 ? 19
  • Thailand ? ? 187
  • Vietnam ? ? 41
    
    • Total 2 ? 371
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 190
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 216
• TOTAL 219 ? 8452

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 68 in mainland France.
(?)
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[Giuseppe]

Re: Pandemic Influenza H1N1 2009, European Centre of Diseases Prevention and Control (ECDC) Situation Updates (since Sep. 26, 2009)

Pandemic (H1N1) 2009 Update 30 November 2009, 09:00 hours CEST (ECDC, edited)

[Source Full PDF Document: LINK. EDITED.]
ECDC DAILY UPDATE
Pandemic (H1N1) 2009 Update 30 November 2009, 09:00 hours CEST

Main developments in past 72 hours

• Influenza activity is high in 27 EU countries and 13 countries report a rising trend;
• More mutations have been reported by EU countries, with a few in the haemagglutinin gene at location 222;
• A total of 858 fatal cases in Europe and EFTA countries and 7 710 in the rest of the world have been reported up to date.

This report is based on official information provided by national public health websites or through other official communication channels. Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 30 November 2009, 09:00 hours (CEST) in EU and EFTA countries are in Table 1. An update on the number of confirmed fatal cases is presented in Table 2 - as of 29 November 2009 - 16:00 hours CEST, for the world, and 30 November 2009 - 09:00 hours CEST, for Europe.

Epidemiologic update
The Weekly Influenza Surveillance Report
All 27 EU and 4 EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza. A total of 858 deaths have been reported since April 2009 (Table 2). Since week 41 the numbers of deaths each has shown a steady increase almost doubling every fortnight over the last six weeks, although there was only a 6% increase in week 47, compared to the previous week. While the most deaths have to date been in Western Europe there are increasing numbers of deaths being reported from Central and Eastern Europe. Latest new and confirmed fatal pandemic (H1N1) cases outside the EU/EFTA area are presented in Table 2 as well. Available updates on hospital admissions, per Member State, can be found in Table 1.
The Weekly Influenza Surveillance Overview was published on November 27th for week 47/2009.
Twenty four countries reported epidemiological data, the highest total to date for this pandemic. For the activity intensity indicator?national network levels for ILI and/or ARI? Sweden reported very high intensity; Bulgaria, Denmark, Estonia, Germany, Greece, Iceland, Ireland, Latvia, Luxembourg, Norway, Poland and Spain reported high intensity; medium intensity was reported by 9 countries. For the geographic spread indicator, increases were noted compared to the previous week with 16 countries reporting widespread activity. Seven countries reported regional activity. One country reported local activity. Thirteen countries reported an increasing trend of influenza activity compared to seventeen in the previous week. Countries in Central and Eastern Europe were especially experiencing rising trends. Six countries - Belgium, Bulgaria, Iceland, Ireland, Norway, Netherlands and parts of the UK (Northern Ireland and Wales), reported decreasing trends. Belgium, Bulgaria, Iceland, Ireland, Norway and the UK (Northern Ireland) reported decreasing trends in week 46 as well.
In most countries where influenza activity has risen above baseline levels, the most affected group includes those younger than 15 years.
Virological data indicate very few influenza strains apart from the pandemic strain were identified. The proportion of sentinel specimens that are confirmed influenza is 44%, a high level normally only seen during the peaks of previous winter influenza epidemics.

Other updates
Mutations in the haemagglutinin HA1 gene D222G
Following initial reports from Norway, WHO has noted that a spontaneous mutation in the haemagglutinin gene D222G has been observed in at least seven countries world-wide (1).
These spontaneous mutations have been detected retrospectively following genetic sequencing.
They were first detected in April and were seen in Mexico and the USA and so are not a recent phenomenon (1,2).
Finnish and French virologists reported another three cases last week (3). As in a number of the cases the viruses were reported from two patients with very severe illness who died.
WHO and ECDC are currently assessing the public health significance of this mutation (1,2). It is unclear whether the mutation is especially pathogenic or whether it is somehow selected for in very ill patients. However there is no evidence that the virus is transmitting, none of the patients are reported to be connected to each other and the mutation is not spreading in Europe.
As further sequencing is undertaken reports of its detection in other European countries can be expected.

• WHO Public health significance of virus mutation detected in Norway November 20th 2009 LINK
• WHO virtual press conference 26 November (transcript) LINK
• INVS Communiqu? de presse Grippe A (H1N1) 2009 : le point en France m?tropolitaine le 27 novembre 2009 LINK

Table 1: Reported number of confirmed Pandemic (H1N1) 2009 influenza cases admitted to hospitals and intensive care, by country, as of 30 November 2009, 09:00 hours (CEST) in EU and EFTA countries
[Country - (date of report) - Number of cases currently hospitalised - Cumulative number of cases admitted in hospitals - Number of cases currently in intensive care - Cumulative number of cases admitted to intensive care]

1. Austria (18.11.) ? ? ? ? ? ? ? ?
2. Belgium (26.11.) ? ? ? ? ? ? ? ?
3. Bulgaria (22.11) ? ? ? ? ? ? ? ?
4. Cyprus(23.11) ? ? ? ? ? ? ? 6
5. Czech Republic (26.11.) ? ? ? ? ? ? ? ?
6. Denmark (25.11.) ? ? ? ? ? ? ? ?
7. Estonia (25.11.) ? ? ? ? ? ? ? ?
8. Finland (27.11.) - 4 ? ? - 7 ? ?
9. France (24.11.) ? 43 - 357 ? ? ? ?
10. Germany (26.11.) ? ? ? ? ? ? ? ?
11. Greece (15.11.) ? ? ? ? ? ? ? ?
12. Hungary (22.11.) ? ? ? ? ? ? ? ?
13. Iceland (26.11.) ? 5 ? 180 ? 1 ? 20
14. Ireland (25.11.) ? 211 ? 941 ? 18 ? 77
15. Italy (27.11) ? ? - 600 ? ? ? 315
16. Latvia (25.11.) ? ? ? ? ? ? ? ?
17. Liechtenstein (26.11.) ? ? ? ? ? ? ? ?
18. Lithuania (04.11.) ? ? ? ? ? ? ? ?
19. Luxembourg (16.11.) ? ? ? ? ? 0 ? 0
20. Malta (04.09.) ? ? - 46 ? ? ? 1
21. Netherlands (27.11.) ? 289 ? 1587 ? 29 ? 167
22. Norway (25.11.) ? 60 ? 1102 ? 13 ? 127
23. Poland (23.11.) ? ? ? ? ? ? ? ?
24. Portugal (25.11.) - 148 ? ? - 20 ? ?
25. Romania (23.11) - 10 ? ? - 5 ? ?
26. Slovakia (25.11.) ? 13 - 51 ? ? ? ?
27. Slovenia (10.08.) ? ? ? ? ? ? ? ?
28. Spain (26.11.) ? ? ? ? ? ? ? ?
29. Sweden (22.11.) ? 206 ? 836 ? ? ? ?
30. Switzerland (26.11.) ? 23 - 127 ? ? ? 30
31. United Kingdom (a) (26.11.) - 753 ? ? - 154 ? ?

Note: Data for the EU and EFTA countries correspond to the Ministry of Health or surveillance centre websites.
(?) denotes no information readily available in official sources.
(a) Data includes all probable cases for England only. Does not include Scotland (1104 cumulative hospitalisations), Wales (411) and Northern Ireland (558).

Table 2. Reported number of new and cumulative confirmed fatal Pandemic (H1N1) 2009 influenza cases in EU and EFTA countries, as 30 November 2009, 09:00 hours CEST, and in the rest of the world by country, as of 29 November 2009, 16:00 hours CEST.
[Country - Number of new fatal cases since previous national update - Cumulative number of fatal cases]

• EU AND EFTA COUNTRIES
  
  • Austria ? ? 3
  • Belgium ? ? 13
  • Bulgaria ? ? 5
  • Czech Republic 2 ? 8
  • Denmark ? ? 5
  • Estonia ? ? 1
  • Finland ? ? 16
  • France 8 ? 104 (a)
  • Germany 7 ? 59
  • Greece ? ? 12
  • Hungary 1 ? 8
  • Iceland ? ? 2
  • Ireland ? ? 17
  • Italy 2 ? 93
  • Latvia ? ? 5
  • Lithuania ? ? 2
  • Luxembourg ? ? 2
  • Malta ? ? 3
  • Netherlands ? ? 36
  • Norway ? ? 25
  • Poland ? ? 16
  • Portugal ? ? 18
  • Romania 1 ? 3
  • Slovakia ? ? 1
  • Slovenia ? ? 2
  • Spain ? ? 135
  • Sweden ? ? 15
  • Switzerland ? ? 3
  • United Kingdom 1 ? 246
    
    • Total 22 ? 858
• OTHER EUROPEAN COUNTRIES & CENTRAL ASIA
  
  • Azerbaijan ? ? 2
  • Belarus ? ? 20
  • Bosnia and Herzegovina ? ? 1
  • Croatia ? - 11
  • Former Yugoslav Republic of Macedonia 1 ? 3
  • Kosovo ? ? 7
  • Moldova ? ? 11
  • Russia ? ? 19
  • Serbia ? ? 17
  • Ukraine ? ? 18
    
    • Total 1 ? 109
• MEDITERRANEAN AND MIDDLE-EAST
  
  • Algeria ? ? 3
  • Bahrain ? ? 7
  • Egypt 7 ? 20
  • Iran ? ? 140
  • Iraq ? ? 10
  • Israel ? ? 55
  • Jordan ? ? 14
  • Kuwait ? ? 27
  • Lebanon ? ? 3
  • Morocco ? ? 1
  • Occupied Palestinian Territory ? ? 9
  • Oman ? ? 27
  • Qatar ? ? 8
  • Saudi Arabia ? ? 81
  • Syria ? ? 50
  • Tunisia ? ? 2
  • Turkey ? ? 161
  • United Arab Emirates ? ? 6
  • Yemen ? ? 22
    
    • Total 7 ? 646
• AFRICA
  
  • Ghana ? ? 1
  • Madagascar ? ? 1
  • Mauritius ? ? 8
  • Mozambique ? ? 2
  • Namibia ? ? 1
  • Sao Tome & Principe ? ? 2
  • South Africa ? ? 91
  • Sudan ? ? 1
  • Tanzania ? ? 1
    
    • Total ? ? 108
• NORTH AMERICA
  
  • Canada ? ? 309
  • Mexico ? ? 610
  • USA ? ? 1265
    
    • Total ? ? 2184
• CENTRAL AMERICA & CARIBBEAN
  
  • Bahamas ? ? 4
  • Barbados ? ? 3
  • Cayman Islands ? ? 1
  • Costa Rica ? ? 40
  • Cuba ? ? 7
  • Dominican Republic ? ? 22
  • El Salvador ? ? 27
  • Guatemala ? ? 18
  • Honduras ? ? 16
  • Jamaica ? ? 6
  • Nicaragua ? ? 11
  • Panama ? ? 11
  • Saint Kitts and Nevis ? ? 1
  • Saint Lucia ? ? 1
  • Suriname ? ? 2
  • Trinidad-Tobago ? ? 5
    
    • Total ? ? 175
• SOUTH AMERICA
  
  • Argentina 3 ? 613
  • Bolivia 1 ? 58
  • Brazil ? ? 1528
  • Chile ? ? 148
  • Colombia ? ? 160
  • Ecuador ? ? 82
  • Paraguay ? ? 52
  • Peru ? ? 190
  • Uruguay ? ? 33
  • Venezuela 1 ? 114
    
    • Total 5 ? 2978
• NORTH-EAST & SOUTH ASIA
  
  • Afghanistan ? ? 14
  • Bangladesh ? ? 6
  • China (Mainland) ? ? 104
  • Hong Kong SAR China ? ? 41
  • India 8 - 569
  • Japan ? ? 28
  • Macao SAR China ? ? 2
  • Maldives ? ? 1
  • Mongolia ? ? 18
  • Pakistan ? ? 1
  • South Korea ? ? 104
  • Sri Lanka ? ? 5
  • Taiwan ? ? 30
    
    • Total 8 ? 923
• SOUTH-EAST ASIA
  
  • Brunei Darussalam ? ? 1
  • Cambodia ? ? 5
  • Indonesia ? ? 10
  • Laos Peoples Democratic Republic ? ? 1
  • Malaysia ? ? 77
  • Philippines ? ? 30
  • Singapore ? ? 19
  • Thailand ? ? 187
  • Vietnam ? ? 41
    
    • Total ? ? 371
• AUSTRALIA & PACIFIC
  
  • Australia ? ? 190
  • Cook Islands ? ? 1
  • Marshall Islands ? ? 1
  • New Zealand ? ? 20
  • Samoa ? ? 2
  • Solomon Islands ? ? 1
  • Tonga ? ? 1
    
    • Total ? ? 216
• TOTAL 43 ? 8568

(a) Deaths reported from France include 1 in Guyana, 9 in New Caledonia, 7 in the French Polynesia, 7 in the Reunion, 1 in Martinique, 2 in Mayotte, 1 in Guadeloupe and 76 in mainland France.
(?)
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