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Influenza A(H1N1)
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Current Phase of Alert in the WHO Global Influenza
Preparedness Plan
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Changes in
reporting requirements for pandemic (H1N1) 2009 virus infection
16 JULY 2009 |
GENEVA -- As the 2009 pandemic evolves, the data needed for risk assessment,
both within affected countries and at the global level, are also changing.
At this point,
further spread of the pandemic, within affected countries and to new
countries, is considered inevitable.
This assumption
is fully backed by experience. The 2009 influenza pandemic has spread
internationally with unprecedented speed. In past pandemics, influenza
viruses have needed more than six months to spread as widely as the new H1N1
virus has spread in less than six weeks.
The increasing
number of cases in many countries with sustained community transmission is
making it extremely difficult, if not impossible, for countries to try and
confirm them through laboratory testing. Moreover, the counting of individual
cases is now no longer essential in such countries for monitoring either the
level or nature of the risk posed by the pandemic virus or to guide
implementation of the most appropriate response measures.
Monitoring still
needed
This pandemic
has been characterized, to date, by the mildness of symptoms in the
overwhelming majority of patients, who usually recover, even without medical
treatment, within a week of the onset of symptoms. However, there is still an
ongoing need in all countries to closely monitor unusual events, such as
clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection,
clusters of respiratory illness requiring hospitalization, or unexplained or
unusual clinical patterns associated with serious or fatal cases.
Other potential
signals of change in the currently prevailing pattern include unexpected,
unusual or notable changes in patterns of transmission. Signals to be
vigilant for include spikes in rates of absenteeism from schools or
workplaces, or a more severe disease pattern, as suggested by, for example, a
surge in emergency department visits.
In general,
indications that health services are having difficulty coping with cases mean
that such systems are under stress but they may also be a signal of
increasing cases or a more severe clinical picture.
A strategy that
concentrates on the detection, laboratory confirmation and investigation of
all cases, including those with mild illness, is extremely
resource-intensive. In some countries, this strategy is absorbing most
national laboratory and response capacity, leaving little capacity for the
monitoring and investigation of severe cases and other exceptional events.
Regular updates
on newly affected countries
For all of these
reasons, WHO will no longer issue the global tables showing the numbers of
confirmed cases for all countries. However, as part of continued efforts to
document the global spread of the H1N1 pandemic, regular updates will be
provided describing the situation in the newly affected countries. WHO will
continue to request that these countries report the first confirmed cases
and, as far as feasible, provide weekly aggregated case numbers and
descriptive epidemiology of the early cases.
For countries
already experiencing community-wide transmission, the focus of surveillance
activities will shift to reporting against the established indicators for the
monitoring of seasonal influenza activity. Those countries are no longer
required to submit regular reports of individual laboratory-confirmed cases
and deaths to WHO.
Monitoring the virological characteristics of the pandemic virus will be
important throughout the pandemic and some countries have well-established
laboratory-based surveillance systems in place already for seasonal influenza
virus monitoring. Even in countries with limited laboratory capacity, WHO
recommends that the initial virological assessment
is followed by the testing of at least 10 samples per week in order to
confirm that disease activity is due to the pandemic virus and to monitor
changes in the virus that may be important for case management and vaccine
development.
Updated WHO
guidelines for global surveillance reflect in greater detail these
recommended changes, in line with reporting requirements set out in the
International Health Regulations.
Situation Reports
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6 May 2009
As of 16:00 GMT, 6 May 2009, 23 countries have officially reported 1893
cases of influenza A (H1N1) infection.
Mexico
has reported 942 laboratory confirmed human cases of infection, including 29
deaths. The United States
has reported 642 laboratory confirmed human cases, including two deaths.
The following countries have reported laboratory confirmed cases with no
deaths - Austria (1), Canada (165), China, Hong Kong Special Administrative
Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France
(5), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5),
Netherlands (1), New Zealand (5), Portugal (1), Republic of Korea (2), Spain
(73), Sweden (1), Switzerland (1) and the United Kingdom (28).
WHO is not recommending travel restrictions related to the outbreak of the
influenza A(H1N1) virus.
Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical
care. These recommendations are prudent measures which can limit the spread
of many communicable diseases, including influenza.
Further information on the situation will be available on the WHO website
on a regular basis.
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6 May 2009
As of 06:00 GMT, 6 May 2009, 22 countries have officially reported 1516
cases of influenza A (H1N1) infection.
Mexico
has reported 822 laboratory confirmed human cases of infection, including 29
deaths. The United States
has reported 403 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no
deaths - Austria (1), Canada (165), China, Hong Kong Special Administrative
Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2),
France (4), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5),
Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (2), Spain
(57), Switzerland (1) and the United Kingdom (27).
It is considered prudent for people who are ill to delay international
travel and for people developing symptoms following international travel to
seek medical attention, in line with guidance from national authorities.
Individuals are advised to wash hands thoroughly with soap and water on a
regular basis and should seek medical attention if they develop any symptoms of
influenza-like illness.
WHO advises no restriction of regular travel or closure of borders.
There is no risk of infection from this virus from consumption of
well-cooked pork and pork products.
Further information on the situation will be available on the WHO website
on a regular basis.
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5 May 2009
As of 16:00 GMT, 5 May 2009, 21 countries have officially reported 1490
cases of influenza A (H1N1) infection.
Mexico
has reported 822 laboratory confirmed human cases of infection, including 29
deaths. The United States
has reported 403 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no
deaths - Austria (1), Canada (140), China, Hong Kong Special Administrative
Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2),
France (4), Germany (9), Ireland (1), Israel (4), Italy (5), Netherlands (1),
New Zealand (6), Portugal (1), Republic of Korea (2), Spain (57), Switzerland
(1) and the United Kingdom (27).
It is considered prudent for people who are ill to delay international
travel and for people developing symptoms following international travel to
seek medical attention, in line with guidance from national authorities.
Individuals are advised to wash hands thoroughly with soap and water on a
regular basis and should seek medical attention if they develop any symptoms
of influenza-like illness.
WHO advises no restriction of regular travel or closure of borders.
There is no risk of infection from this virus from consumption of
well-cooked pork and pork products.
Further information on the situation will be available on the WHO website
on a regular basis.
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4 May 2009
As of 18:00 GMT, 4 May 2009, 21
countries have officially reported 1085 cases of influenza A (H1N1)
infection.
Mexico has reported 590
laboratory confirmed human cases of infection, including 25 deaths. The United States
has reported 286 laboratory confirmed human cases, including one death.
The following countries have reported
laboratory confirmed cases with no deaths - Austria (1), Canada (101), China,
Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1),
Denmark (1), El Salvador (2), France (4), Germany (8), Ireland (1), Israel
(4), Italy (2), Netherlands (1), New Zealand (6), Portugal (1), Republic of
Korea (1), Spain (54), Switzerland (1) and the United Kingdom (18).
It is considered prudent for people
who are ill to delay international travel and for people developing symptoms
following international travel to seek medical attention, in line with
guidance from national authorities. Individuals are advised to wash hands
thoroughly with soap and water on a regular basis and should seek medical
attention if they develop any symptoms of influenza-like illness.
WHO advises no restriction of regular
travel or closure of borders.
There is no risk of infection from
this virus from consumption of well-cooked pork and pork products.
Further information on the situation
will be available on the WHO website on a regular basis.
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4 May 2009
As of 06:00 GMT, 4 May 2009, 20
countries have officially reported 985 cases of influenza A (H1N1) infection.
Mexico has reported 590
laboratory confirmed human cases of infection, including 25 deaths. The
higher number of cases from Mexico
reflects ongoing testing of previously collected specimens. The United States
has reported 226 laboratory confirmed human cases, including one death.
The following countries have reported
laboratory confirmed cases with no deaths - Austria (1), Canada (85), China,
Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1),
Denmark (1), El Salvador (2), France (2), Germany (8), Ireland (1), Israel
(3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1),
Spain (40), Switzerland (1) and the United Kingdom (15).
There is no risk of infection from
this virus from consumption of well-cooked pork and pork products.
It is considered prudent for people
who are ill to delay international travel and for people developing symptoms
following international travel to seek medical attention, in line with
guidance from national authorities. Individuals are advised to wash hands
thoroughly with soap and water on a regular basis and should seek medical
attention if they develop any symptoms of influenza-like illness.
WHO advises no restriction of regular
travel or closure of borders.
Further information on the situation
will be available on the WHO website on a regular basis.
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3 May 2009
As of 1600 GMT, 3 May 2009, 18 countries have officially reported 898
cases of influenza A(H1N1) infection.
Mexico
has reported 506 confirmed human cases of infection, including 19 deaths. The
higher number of cases from Mexico
in the past 48 hours reflects ongoing testing of previously collected
specimens. The United States Government has reported 226 laboratory confirmed
human cases, including one death.
The following countries have reported laboratory confirmed cases with no
deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative
Region (1), Costa Rica (1), Denmark (1), France (2), Germany (8), Ireland
(1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of
Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15).
Further information on the situation will be available on the WHO website
on a regular basis.
WHO advises no restriction of regular travel or closure of borders.It is considered prudent for people who are ill
to delay international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from
national authorities.
Canada on 2 May
reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly
probable that the pigs were exposed to the virus from a Canadian farm worker
recently returned from Mexico,
who had exhibited flu-like symptoms and had contact with the pigs. There is
no indication of virus adaptation through transfer from human to pigs at this
time.
There is no risk of infection from this virus from consumption of
well-cooked pork and pork products.
Individuals are advised to wash hands thoroughly with soap and water on a
regular basis and should seek medical attention if they develop any symptoms
of influenza-like illness.
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Influenza A(H1N1) - update 11
3 May 2009
As of 0600 GMT, 3 May 2009, 17 countries have officially reported 787
cases of influenza A(H1N1) infection.
Mexico
has reported 506 confirmed human cases of infection, including 19 deaths. The
higher number of cases from Mexico
in the past 48 hours reflects ongoing testing of previously collected
specimens. The United States Government has reported 160 laboratory confirmed
human cases, including one death.
The following countries have reported laboratory confirmed cases with no
deaths - Austria (1), Canada (70), China, Hong Kong Special Administrative
Region (1), Costa Rica (1), Denmark (1), France (2), Germany (6), Ireland
(1), Israel (3), Netherlands (1), New Zealand (4), Republic of Korea (1),
Spain (13), Switzerland (1) and the United Kingdom (15).
Further information on the situation will be available on the WHO website
on a regular basis.
WHO advises no restriction of regular travel or closure of borders. It is
considered prudent for people who are ill to delay international travel and
for people developing symptoms following international travel to seek medical
attention, in line with guidance from national authorities.
Canada on 2 May reported
the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the
pigs were exposed to the virus from a Canadian farm worker recently returned
from Mexico,
who had exhibited flu-like symptoms and had contact with the pigs. There is
no indication of virus adaptation through transfer from human to pigs at this
time.
There is no risk of infection from this virus from consumption of
well-cooked pork and pork products.
Individuals are advised to wash hands thoroughly with soap and water on a
regular basis and should seek medical attention if they develop any symptoms
of influenza-like illness.
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Influenza A(H1N1) - update 10
2 May 2009
The situation
continues to evolve. As of 18:00 GMT+1, 2 May 2009, 16 countries have officially
reported 658 cases of influenza A(H1N1) infection.
Mexico has reported 397 confirmed human cases of
infection, including 16 deaths. The higher number of cases from Mexico
in the past 48 hours reflects ongoing testing of previously collected specimens.
The United States Government has reported 160 laboratory confirmed human
cases, including one death.
The following
countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada
(51), China, Hong Kong
Special Administrative Region (1), Costa Rica
(1), Denmark (1), France (2), Germany
(6), Israel (3), Netherlands (1), New
Zealand (4), Republic
of Korea (1), Spain (13), Switzerland
(1) and the United Kingdom
(15).
Further
information on the situation will be available on the WHO website on a
regular basis.
WHO advises no
restriction of regular travel or closure of borders. It is considered prudent
for people who are ill to delay international travel and for people
developing symptoms following international travel to seek medical attention,
in line with guidance from national authorities.
There is also no
risk of infection from this virus from consumption of well-cooked pork and
pork products. Individuals are advised to wash hands thoroughly with soap and
water on a regular basis and should seek medical attention if they develop
any symptoms of influenza-like illness.
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Influenza A(H1N1) - update 9
2 May 2009
The situation
continues to evolve. As of 06:00 GMT, 2 May 2009, 15 countries have
officially reported 615 cases of influenza A(H1N1) infection.
Mexico has reported 397 confirmed human cases of
infection, including 16 deaths. The 241 rise in cases from Mexico compared to 23:30GMT of 1
May reflects ongoing testing of previously collected specimens. The United
States Government has reported 141 laboratory confirmed human cases,
including one death.
The following
countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada
(34), China, Hong Kong
Special Administrative Region (1), Denmark
(1), France (1), Germany (4), Israel
(2), Netherlands (1), New Zealand (4), Republic
of Korea (1), Spain (13), Switzerland
(1) and the United Kingdom
(13).
Further
information on the situation will be available on the WHO website on a
regular basis.
WHO advises no
restriction of regular travel or closure of borders. It is considered prudent
for people who are ill to delay international travel and for people
developing symptoms following international travel to seek medical attention,
in line with guidance from national authorities.
There is also no
risk of infection from this virus from consumption of well-cooked pork and
pork products. Individuals are advised to wash hands thoroughly with soap and
water on a regular basis and should seek medical attention if they develop
any symptoms of influenza-like illness.
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Influenza A(H1N1) - update 8.1
1 May 2009
The situation
continues to evolve. As of 23:30 GMT, 1 May 2009, 13 countries have
officially reported 367 cases of influenza A(H1N1) infection.
The United States
Government has reported 141 laboratory confirmed human cases, including one
death. Mexico
has reported 156 confirmed human cases of infection, including nine deaths.
The following
countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada
(34), China, Hong Kong,
Special Administrative Region (1), Denmark
(1), Germany (4), Israel (2), Netherlands
(1), New Zealand (4), Spain (13), Switzerland
(1) and the United Kingdom
(8).
Further
information on the situation will be available on the WHO website on a
regular basis.
WHO advises no
restriction of regular travel or closure of borders. It is considered prudent
for people who are ill to delay international travel and for people
developing symptoms following international travel to seek medical attention,
in line with guidance from national authorities.
There is also no
risk of infection from this virus from consumption of well-cooked pork and
pork products. Individuals are advised to wash hands thoroughly with soap and
water on a regular basis and should seek medical attention if they develop
any symptoms of influenza-like illness.
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Influenza A(H1N1) - update 7
1 May 2009
The situation
continues to evolve rapidly. As of 06:00 GMT, 1 May 2009, 11 countries have
officially reported 331 cases of influenza A(H1N1) infection.
The United States
Government has reported 109 laboratory confirmed human cases, including one
death. Mexico
has reported 156 confirmed human cases of infection, including nine deaths.
The following
countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada
(34), Germany (3), Israel (2), Netherlands
(1), New Zealand (3), Spain (13), Switzerland
(1) and the United Kingdom
(8).
Further
information on the situation will be available on the WHO website on a
regular basis. WHO advises no restriction of regular travel or closure of
borders. It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from
national authorities.
There is also no
risk of infection from this virus from consumption of well-cooked pork and
pork products. Individuals are advised to wash hands thoroughly with soap and
water on a regular basis and should seek medical attention if they develop
any symptoms of influenza-like illness.
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Influenza A(H1N1) - update 6
30 April 2009
The situation continues to evolve rapidly. As of 17:00
GMT, 30 April 2009, 11 countries have officially reported 257 cases of
influenza A (H1N1) infection.
The United States Government has reported 109 laboratory
confirmed human cases, including one death. Mexico has reported 97 confirmed
human cases of infection, including seven deaths.
The following countries have reported laboratory confirmed
cases with no deaths - Austria
(1), Canada (19), Germany (3), Israel
(2), Netherlands (1), New Zealand (3), Spain
(13), Switzerland (1) and
the United Kingdom
(8).
Further information on the situation will be available on
the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of
borders. It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from
national authorities.
There is also no risk of infection from this virus from
consumption of well-cooked pork and pork products. Individuals are advised to
wash hands thoroughly with soap and water on a regular basis and should seek
medical attention if they develop any symptoms of influenza-like illness.
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Influenza A(H1N1) -
update 5
29 April 2009
The situation continues to evolve rapidly. As of 18:00
GMT, 29 April 2009, nine countries have officially reported 148 cases of
swine influenza A/H1N1 infection. The United States Government has reported
91 laboratory confirmed human cases, with one death. Mexico has reported 26 confirmed
human cases of infection including seven deaths.
The following countries have reported laboratory confirmed
cases with no deaths - Austria
(1), Canada (13), Germany (3), Israel
(2), New Zealand (3), Spain (4) and the United Kingdom (5).
Further information on the situation will be available on
the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of
borders. It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from national
authorities.
There is also no risk of infection from this virus from
consumption of well-cooked pork and pork products. Individuals are advised to
wash hands thoroughly with soap and water on a regular basis and should seek
medical attention if they develop any symptoms of influenza-like illness.
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Influenza A(H1N1) -
update 4
28 April 2009
The situation continues to evolve rapidly. As of 19:15
GMT, 28 April 2009, seven countries have officially reported cases of swine
influenza A/H1N1 infection. The United States Government has reported 64
laboratory confirmed human cases, with no deaths. Mexico has reported 26 confirmed
human cases of infection including seven deaths.
The following countries have reported laboratory confirmed
cases with no deaths - Canada
(6), New Zealand (3), the United Kingdom (2), Israel
(2) and Spain
(2).
Further information on the situation will be available on
the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of
borders. It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from
national authorities.
There is also no risk of infection from this virus from
consumption of well-cooked pork and pork products. Individuals are advised to
wash hands thoroughly with soap and water on a regular basis and should seek
medical attention if they develop any symptoms of influenza-like illness.
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Influenza A(H1N1) -
update 3
27 April 2009
The current situation regarding the outbreak of swine
influenza A(H1N1) is evolving rapidly. As of 27 April 2009, the United States
Government has reported 40 laboratory confirmed human cases of swine
influenza A(H1N1), with no deaths. Mexico has reported 26 confirmed
human cases of infection with the same virus, including seven deaths. Canada has reported six cases, with no deaths,
while Spain
has reported one case, with no deaths.
Further information on the situation will be available on
the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of
borders. It is considered prudent for people who are ill to delay
international travel and for people developing symptoms following
international travel to seek medical attention, in line with guidance from
national authorities.
There is also no risk of infection from this virus from
consumption of well-cooked pork and pork products. Individuals are advised to
wash hands thoroughly with soap and water on a regular basis and should seek
medical attention if they develop any symptoms of influenza-like illness.
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Influenza A(H1N1)
in the United States and Mexico
- update 2
26 April 2009
As of 26 April 2009, the United States Government has
reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California,
2 in Texas, 2 in Kansas
and 1 in Ohio).
All 20 cases have had mild Influenza-Like Illness with only one requiring
brief hospitalization. No deaths have been reported. All 20 viruses have the
same genetic pattern based on preliminary testing. The virus is being
described as a new subtype of A/H1N1 not previously detected in swine or
humans.
Also as of 26 April, the Government of Mexico has reported
18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is
continuing to clarify the spread and severity of the disease in Mexico.
Suspect clinical cases have been reported in 19 of the country's 32 states.
WHO and the Global Outbreak Alert and Response Network (GOARN)
are sending experts to Mexico
to work with health authorities. WHO and its partners are actively
investigating reports of suspect cases in other Member States as they occur,
and are supporting field epidemiology activities, laboratory diagnosis and
clinical management.
On Saturday, 25 April, upon the advice of the Emergency
Committee called under the rules of the International Health Regulations, the
Director-General declared this event a Public Health Emergency of
International Concern.
WHO is not recommending any travel or trade restrictions.
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Influenza-like
illness in the United States
and Mexico
24 April 2009
The United States Government has reported seven confirmed
human cases of Swine Influenza A/H1N1 in the USA
(five in California and two in Texas) and nine
suspect cases. All seven confirmed cases had mild Influenza-Like Illness
(ILI), with only one requiring brief hospitalization. No deaths have been
reported.
The Government of Mexico has reported three separate
events. In the Federal District of Mexico, surveillance began picking up
cases of ILI starting 18 March. The number
of cases has risen steadily through April and as of 23 April there are now
more than 854 cases of pneumonia from the capital. Of those, 59 have died. In
San Luis Potosi, in central Mexico, 24 cases of ILI,
with three deaths, have been reported. And from Mexicali,
near the border with the United States,
four cases of ILI, with no deaths, have been
reported.
Of the Mexican cases, 18 have been laboratory confirmed in
Canada as Swine Influenza
A/H1N1, while 12 of those are genetically identical to the Swine Influenza
A/H1N1 viruses from California.
The majority of these cases have occurred in otherwise
healthy young adults. Influenza normally affects the very young and the very
old, but these age groups have not been heavily affected in Mexico.
Because there are human cases associated with an animal
influenza virus, and because of the geographical spread of multiple community
outbreaks, plus the somewhat unusual age groups affected, these events are of
high concern.
The Swine Influenza A/H1N1 viruses characterized in this
outbreak have not been previously detected in pigs or humans. The viruses so
far characterized have been sensitive to oseltamivir,
but resistant to both amantadine and rimantadine.
The World Health Organization has been in constant contact
with the health authorities in the United
States, Mexico
and Canada in order to
better understand the risk which these ILI
events pose. WHO (and PAHO) is sending missions of experts to Mexico
to work with health authorities there. It is helping its Member States to
increase field epidemiology activities, laboratory diagnosis and clinical
management. Moreover, WHO's partners in the Global Alert and Response Network
have been alerted and are ready to assist as requested by the Member States.
WHO acknowledges the United
States and Mexico for their proactive
reporting and their collaboration with WHO and will continue to work with
Member States to further characterize the outbreak.
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