Pandemic Still Increasing

The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time. Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends.

This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.

In addition to surveillance information, WHO is relying on the results of special research and clinical studies and other data provided by countries directly through frequent expert teleconferences on clinical, virological and epidemiological aspects of the pandemic, to gain a global overview of the evolving situation. In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.

As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly. This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community. Some of the pandemic disease patterns differ from seasonal influenza, where fatal disease occurs most often in the elderly (>65 years old).

However, the full picture of the pandemic's epidemiology is not yet fully clear because in many countries, seasonal influenza viruses and pandemic (H1N1) 2009 viruses are both circulating and the pandemic remains relatively early in its development. Although the risk factors for serious pandemic disease are not know definitively, risk factors such as existing cardiovascular disease, respiratory disease, diabetes and cancer currently are considered risk factors for serious pandemic (H1N1) 2009 disease.

Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with an augmented risk of severe pandemic disease in several countries. A recent report suggests obesity may be another risk factor for severe disease. Similarly, there is accumulating evidence suggesting pregnant women are at higher risk for more severe disease.

A few preliminary reports also suggest increased risk of severe disease may be elevated in some minority populations, but the potential contributions of cultural, economic and social risk factors are not clear. The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be able to revise its estimate of pandemic vaccine supply once it has the new yield information.

Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials. These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose. Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.
Source : WHO
Photo : Daylife.com

Transferred to Pigs

In a new twist to the deadly swine flu pandemic, it has been found that the strain of influenza, A/H1N1, can now be transferred from humans to pigs, and can spread rapidly in a trial pig population. For the study, Dr Thomas Vahlenkamp and a team of virologists from the Friedrich-Loeffler-Institut in Greifswald-Insel Riems, Germany, experimentally infected five pigs with the strain of swine flu, which is causing the current human pandemic.

They found that, within four days, the virus had spread to three un-infected pigs housed with the infected ones, and all pigs were showing clinical signs of swine flu. "Although in the early stages of the swine flu pandemic there were worries that humans would catch the virus from pigs, this has so far not been documented and pigs and other animals have not been involved in the current spread of A/H1N1 influenza in humans," said Vahlenkamp, He added:

"However, with the increasing numbers of human infections, a spill over of this human virus to pigs is becoming more likely. The prevention of human-to-pig transmissions should have a high priority in order to avoid involvement of pigs in the epidemiology of this pandemic". Although the virus spread quickly to the non-infected pigs, it did not spread to five chickens that were housed together with the pigs.



Thus, the researchers concluded that while the virus can pass from humans to pigs, it does not pass from pigs to chickens. The experiments were done under strict containment conditions (Biosafety Level BSL3+), to prevent any further transmission of the virus from the infected pigs. The scientists recommend that persons who are suspected of having swine flu should not be allowed to have contact with pigs.

In addition, regulatory bodies should decide on appropriate restriction measures for swine holdings where A/H1N1 infection is detected. Experiments are underway to determine whether currently available vaccines may be able to provide pigs with a certain immunity to stop a potential spread of the virus. The study has been published in Journal of General Virology.

Sources : Daylife.com
Photo : Daylife.com

Dr Margaret Chan

President Calderon, Minister Cordova, Governor Canto, Secretary Sebelius, Minister Aglukkaq, honourable ministers, distinguished participants, ladies and gentleman,

Let me thank the ministries of health of Mexico, the United States of America, and Canada for organizing this high-level meeting. Our special thanks to the government of Mexico for hosting this meeting. President Calderon, your leadership in managing the H1N1 outbreak in Mexico is commendable.

The fact that we are gathered here in Cancun, Mexico, reaffirms a statement consistently made by WHO since the new H1N1 virus was first detected. Recommendations to avoid travel to Mexico, or to any other country or area with confirmed cases, serve no purpose. They do not protect the public. They do not contain the outbreak. And they do not prevent further international spread.

We are in phase 6 – that is, we are in the early days of the 2009 influenza pandemic. As we see today, with well over 100 countries reporting cases, once a fully fit pandemic virus emerges, its further international spread is unstoppable. Influenza pandemics are remarkable events because they spread throughout a world population that is either largely or entirely susceptible to infection. They tend to hit a given area in the epidemiological equivalent of a tidal wave.

In densely populated areas, we see a steep increase in the number of cases, with a sharp peak, followed by a steep decline. Once the virus has swept through a susceptible population, transmission may continue, but at a much lower intensity. In more sparsely populated areas, the peak may be flatter. Aggressive control measures can also flatten the epidemiological peak somewhat, but only for a while.

Mexico, and especially Mexico City, experienced this tidal wave of cases, and its peak, back in April. Other countries, where the virus was introduced later, are experiencing it now. More countries will see this pattern in the months to come. But the worst for Mexico should be over now, at least during this first wave of spread. Our presence here is an expression of confidence. Mexico is a safe, as well as a beautiful and warmly gracious, place to visit.

Ladies and gentlemen,

When a new infectious agent causes an outbreak, it is nearly always the first country affected that suffers the most. New diseases are, by definition, poorly understood as they emerge. The first country affected will, quite literally, not know what hit it in the early days of an outbreak. Decisions, from the doctor at the hospital bed to the head of state, have to be made quickly and decisively in an emergency situation characterized by considerable scientific uncertainty.

Mexico was the first country to experience a widespread outbreak. Mexico bore the brunt of these consequences at a time when the new virus had not yet been identified and nothing was known about the disease it causes. Mexico gave the world an early warning, and it also gave the world a model of rapid and transparent reporting, aggressive control measures, and generous sharing of data and samples.

Canada and the United States supported the early control measures in Mexico, and then followed this model of transparent reporting and generous collaboration as their own outbreaks began to spread. WHO and the international community have much to thank these three countries for setting a precedent that, up to now, nearly every country has followed.

Thanks to this collaboration, we have some answers that can help us greatly right now, as countries do everything possible to protect their populations, mitigate the health effects, and prepare for whatever might lie ahead. What do we know? As I have said before, we have good reason to believe that this pandemic will be of moderate severity, at least in its early days.

We have seen some social disruption, especially when schools or camps have had to close, bringing added demands on parents and their employers. Most health systems have coped well, though some have reported some strains on staff, hospitals beds, laboratories and resources. But we need to watch very carefully what happens during the current winter season in the Southern Hemisphere.

We are still seeing a largely reassuring clinical picture. The overwhelming majority of patients experience mild symptoms and make a full recovery within a week, often in the absence of any form of medical treatment. Research published last week confirms that this pattern, in which most patients experience mild influenza-like illness, has also been seen in Mexico.

Most cases of severe and fatal infection continue to occur in people with underlying medical conditions. We are getting, day-by-day, better data on the specific conditions that place patients at heightened risk. Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.

But there are some exceptions that must be the focus of particular concern. For reasons that are poorly understood, some deaths are occurring in perfectly healthy young people. Moreover, some patients experience a very rapid clinical deterioration, leading to severe, life-threatening viral pneumonia that requires mechanical ventilation.

In keeping our populations informed, we face a difficult challenge. We cannot be alarmist, as this risks flooding emergency wards with the worried well, creating disruptively high demands for staff, hospitals, and laboratories. I am sure you will agree: health services need to stay fit for genuinely severe cases. At the same time, if we are overly reassuring, patients in genuine need of treatment, where rapid emergency care can make a life-and-death difference, may be lulled into waiting too long.

Last week, Mexican researchers published clinical profiles of early H1N1 cases in the New England Journal of Medicine. As noted, the full clinical spectrum of this disease is not yet fully understood. We do not fully understand the predictive factors for severe or fatal infections.

However, as more and more data become available, we are getting a better grip on warning signs that can signal the need for urgent medical care. Symptoms of concern include difficulty in breathing, shortness of breath, chest pain and severe or persistent vomiting.

In adults, a high fever that lasts for more than three days is a warning sign, particularly when accompanied by a general worsening of the patient’s condition. Lethargy in a child, that is, a child that has difficulty waking up or is no longer alert, or is not playing, is a warning sign.

For a pandemic of moderate severity, this is one of our greatest challenges: helping people to understand when they do not need to worry, and when they do need to seek urgent care. This is one key way to help save lives.

Ladies and gentlemen,

Between the extremes of panic and complacency lies the solid ground of vigilance. This meeting is all about vigilance: taking stock of what we have learned, and preparing for whatever surprises this capricious new virus delivers next. Constant, random mutation is the survival mechanism of the microbial world. Like all influenza viruses, H1N1 has the advantage of surprise on its side.

We have the advantages of science, and of rational and rigorous investigation, on our side, supported today by tools for data collection, analysis, and communication that are unprecedented in their power. We have another advantage on our side, as exemplified by this meeting: collaboration and solidarity. It is my sincere wish that this meeting will take us some big steps forward in building our collective defences against a threat shared by all.

Thank you.

Sources : WHO

The Navy Cadet

Bangkok governor Sukhumbhant Boribhat, center, sprays water as other workers use the brooms to sweep the floor in a campaign to clean up the city to fight against swine flu at a Buddhist temple in Bangkok, Thailand Monday, June 29, 2009. The Thai Health Ministry has confirmed 80 new cases of swine flu, most of them students in Bangkok.

A navy cadet was the third person to die from the influenza A(H1N1) virus in Thailand, the Public Health Ministry said on Monday. The 21-year-old navy cadet was obese, which caused him to have weak lungs, health permanent secretary Praj Boonyawongwirojana said. His condition had deteriorated on Sunday, and he died on Monday morning, the head of the Department of Medical Services Dr Rewat Wisarutvej said.

Thai workers clean escalators at a shopping mall in Bangkok, Thailand, on Thursday, June 18, 2009. Thailand's Public Health Ministry has confirmed 95 new cases of swine flu, bringing the country's total to 405 cases, officials said Wednesday.

Surapon Chatwanit, head of Somdej Phranangjao Sirikit Hospital in Chonburi, said the cadet was admitted there last Monday. He had penumonia and tested postitive for the H1N1 virus. The ministry also reported 41 new cases of influenza A infection on Monday, raising the total number to 1,330 in Thailand. Eighteen of the patients remained in hospital. Prior to the death of the naval cadet, a 40-year-old woman died on June 20 at a private hospital in Bangkok and a 42-year-old man who was an engineer died on June 27 from the virus.

Source : Bangkok Post.com
Photo : Daylife.com

Six more people in Indonesia

The H1N1 flu virus has been detected in six more people in Indonesia, taking the total number of cases in the country to eight, Health Minister Siti Fadila Supari said Sunday. "There are six new positive cases. Three of the infected people are Australians and the rest are Indonesians," she said. The Australians have been identified by the Health Ministry as GC, MT and JA, while the local residents are AG, TP and AM.

"AG and TP had just returned from their holidays in Singapore while AM returned from Australia. They are now under treatment at the Sulianti Saroso Hospital for Infectious Diseases in North Jakarta," Siti said. All the Australians are receiving medical treatment at the Sanglah General Hospital in Denpasar, Bali. The three Australians were on board the same plane as another H1N1 patient identified as BM, later identified as British tourist Bobbi Masoner.

Masoner, currently residing in Australia, was one of the first two people in Indonesia to be infected by the H1N1 virus. The other was a pilot from Jakarta identified as WA. Masoner has reportedly recovered from the illness and has since left hospital. Siti said residents should heighten their awareness of the virus and report to the nearest extraordinary occurrence (KLB) command post if they suspect they or a family member may be infected with the disease.

"Residents may also call 021-4257125, send a fax to 021-42877588 or send an email to poskoklbp2pl@yahoo.com," she said. Director General of Disease Control and Environmental Health at the health ministry, Tjandra Yoga Aditama, said in a press release that all the patients were in good condition and receiving top care. "The global fatality rate is 0.4 percent, which means that 99.6 percent of infected individuals can be properly treated and survive," he said.

"Between 92 and 95 percent of the patients have also recovered without any treatment in hospital. Several countries have also decided that *stable' H1N1 patients do not need to go to the hospital." Tjandra said on a global scale, there had been nearly 60,000 reported cases, with 263 fatalities. The World Health Organization (WHO) has raised its warning level from 5 to 6, officially bringing the outbreak of the disease to pandemic level. The previous global flu pandemic level was issued 41 years ago, when the Hong Kong flu of 1968 killed around 1 million people.

The first announcement of the flu outbreak was documented in Mexico on April 13, and since then there have been more than 1,000 cases of swine flu in humans detected there. The majority of fatalities in Mexico have occurred in young adults, a characteristic of the flu.

Source : Jakarta Post
Photo : Daylife.com

Thailand Confirmed

Authorities confirmed on Saturday that a woman and a man have died in the past week from A(H1N1) flu, the country's first victims - while Australia (photo) recorded its fifth flu fatality.A 40-year-old Thai woman died June 20 at a Bangkok hospital, while a 42-year-old Thai man died Saturday at a hospital in Chon Buri province, Public Health Ministry Deputy Permanent Secretary Dr Paichai Warachit said. It appeared that she meant Pattaya, which is in Chon Buri.

Paichai said her office was only told late Friday about the woman's death. It was unclear where the two contracted the virus, and the ministry refused to identify them. "It is confirmed that the two patients died because of the H1N1 virus and also because they had pneumonia." Dr Paichai said.

She said she did not know why news of the initial victim had been withheld. The Public Health Ministry refused to say why it had covered up the news of the first victim. Authorities had announced all week that that the only Thai suffering from a serious case of the flu had recovered. That statement now appears to be inoperative.

The government, including Prime Minister Abhisit Vejjajiva, has repeatedly denied that it has censored news of the flu outbreak. But the public health ministry admitted that it withheld initial news of the flu so that the public would not panic. Officials have repeatedly underplayed and withheld news of the disease.

The Public Health Ministry said more than 1,200 people have contracted swine flu as of Saturday, including seven Navy cadets. Most have recovered, though 16 remain in the hospital. None was in critical condition - at least according to ministry officials. Public Health Minister Witthaya Kaewparadai said on Saturday that the public should not panic. It was not clear why he felt there was a chance of panic. "Authorities are taking all measures to contain the virus," which first hit the country six weeks ago, the minister claimed.

Source : Bangkok Post
Photo : Daylife.com

Scotland

The rate of patients seeing their GP with suspected flu has doubled in a week in Scotland as cases of the H1N1 virus grow, figures showed yesterday. Health Protection Scotland (HPS) revealed that the number of people going to their doctor with flu-like symptoms leapt from 15 to 32 per 100,000 people by the end of last week.

Very few cases of flu are normally seen during the summer months, leading experts to believe the jump in GP visits is down to increased cases of the H1N1 virus circulating. Yesterday, a further 53 cases of swine flu were confirmed by labs in Scotland, taking the total number to 739.

A further 306 cases were also confirmed in England. More than 3,000 cases have now been diagnosed across the UK. Rates of flu-like illness are based on figures from GP "spotter" practices covering around 8 per cent of the Scottish population. Dr Martin Donaghy, medical director of HPS, said it was hard to say how many cases of flu would normally be expected during the summer.

"We don't continue collecting the data over the summer months, so we've got no benchmark to compare routinely because flu virtually disappears. "But because of the swine flu situation, we have continued the survey and are picking up these rates now." He said it was difficult to know what would happen next in terms of flu rates. "Usually in summer, flu will go but this is an unusual event."

Dr Donaghy said they would continue to use the GP tracker system from now until next summer, and maybe beyond. The majority of new cases diagnosed in Scotland yesterday – 47 – were in the Greater Glasgow and Clyde region. Four people with the virus are still being treated in hospital. The Scottish Government also revealed that the primary-two class at St Helen's Primary School in Condorrat had been told to stay at home after two pupils were confirmed with the virus.

Yesterday it also emerged that hospitals in the UK's worst affected swine flu region in the West Midlands have set up assessment bays to ease the strain on A&E departments after visits by people worried they may have the virus leapt by some 25 per cent. In Scotland, Dr Donaghy said that guidance given to GPs and hospitals also advised separating patients with flu symptoms from other patients as far as possible.

Doctors have urged patients who think they have flu not to just turn up at surgeries, while some GPs have notices on practice doors telling people to alert staff if they might have flu so they can be kept away from other patients. "The basis of all infection control is to separate out 'clean from dirty'. If people have infection, that is good practice anyway," Dr Donaghy said. It was also possible patients turning up to hospital with flu-like symptoms would be asked to wait elsewhere to other people.

NHS Greater Glasgow and Clyde, which has seen the largest number of confirmed cases in Scotland, said it had planned to respond to pandemic flu. "These include plans to implement a package of appropriate infection-control measures designed to limit the spread of the virus," a spokeswoman said. "These measures include nursing flu cases apart from other patients in line with national guidance."

Source: The Scotsman
Photo : Daylife.com

Indonesia

The Health Ministry confirmed Wednesday the first two swine flu cases in the country. Health Minister Siti Fadilah Supari said lab test results revealed the patients, one in Jakarta and the other in Bali, had contracted the new strain of H1N1 influenza virus. A 37-year-old Indonesian pilot, identified only as WA, was admitted to the Sulianti Saroso Hospital in North Jakarta last Friday. He visited Australia on June 14 and Hong Kong on June 18.

“He is still in the isolation room although he is in good condition,” Siti was quoted by Kompas.com as saying. Another swine flu case was found in the Sanglah General Hospital in Bali. The patient is a British tourist identified as BM, who was admitted to the hospital on June 20. “A lab test result found her H1N1 positive,” Siti said. She urged the people to remain cautious because the HiN1 virus had been spreading relatively fast from Australia.

Sources : Jakarta Post.com
Photo : Daylife.com

Philippines

A 49-year-old woman died of heart attack at her home in Metro Manila on Friday, but a throat swab indicated she was infected with the Influenza A(H1N1) virus, making her death the first in the Philippines related to swine flu. Health Secretary Francisco Duque III, who announced the woman’s death at yesterday’s briefing, stressed that the death was not caused by the virus but could have been aggravated by it.

The woman’s death and the rise in the number of swine flu cases in the country and elsewhere have prompted the Department of Health (DOH) to gear up for a possible virulent strain of the virus. Dr. Yolanda Oliveros, director of the Center for Disease Prevention and Control, said a second wave of the virus would take place if the virus mutated into a “more virulent and more fatal” strain.

As of yesterday, the number of A(H1N1) cases stood at 445 after 17 more people, including two foreigners, were confirmed to have the virus. The World Health Organization has declared a flu pandemic. As of Friday, it said more than 44,200 cases had been reported worldwide with 180 deaths, mostly in Mexico and the United States.

“We would like to emphasize that globally and locally, the overwhelming majority of cases only experience mild symptoms and eventually make a rapid and full recovery, often even without any form of medical intervention,” Duque said. Of the 445 confirmed cases, 84 percent or 374 have already fully recovered, the DOH said.

The woman came home from work on June 17, complaining of weakness, according to a DOH investigation. She did not report for work the next day and went into self-medication (taking paracetamol) as she experienced dry cough, fever and chills. On the morning of June 19, she skipped breakfast. She was restless and complained of difficulty in breathing. She died shortly before a doctor arrived.

Australia

An Australian with swine flu has died, it was announced today. The 26-year-old Aboriginal man had multiple serious ailments, so authorities say they cannot be sure whether it was the virus that killed him. If it did, he could be the first person in the Asia-Pacific to die from swine flu. Australia has recorded the highest tally of swine flu cases in the region, reaching 2,330 today.

The Australian fatality was from the impoverished Aborigine minority in a remote desert community. He died in a hospital in the southern city of Adelaide. South Australia state Health Minister John Hill says the man was diagnosed with swine flu yesterday. It is not yet known what caused the patient’s death, or where he became infected with the flu.

Sources : Ireland Online
Photo : Daylife.com

What about severity?

At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.

The moderate assessment reflects that:

• Most people recover from infection without the need for hospitalization or medical care.
• Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
• Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.

WHO is concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.

Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known.

Sources : Who

Photo : Daylife.com

The New Influenza

An unidentified American student from the private Pacific Ridge School in Carlsbad, California, left, celebrates by posing for photos with a Chinese nurse after he was released from quarantine in Yichang, central China's Hubei province Thursday June 18, 2009. The students who were quarantined in the central Chinese city after some of their classmates were diagnosed with swine flu have been cleared for release, an employee of the city's swine flu command center said Thursday. (AP Photo)

What is the new influenza A(H1N1)?

This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses.

How do people become infected with the virus?

The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.

There are no known instances of people getting infected by exposure to pigs or other animals.

The place of origin of the virus is unknown.

What are the signs and symptoms of infection?

Signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea. Sources : WHO, Photo : Daylife.com

What do I do now?

Men in medical suits work inside the AdImmune flu vaccine manufacturing facility in Taichung June 18, 2009. The company, which officially opened its facility on Thursday, is one of the many pharmaceutical companies in the world that are developing a vaccine for the H1N1 (influenza A) flu virus.

What do I do now? What actions should I look for in my community?

Stay informed. Go to reliable sources of information, including your Ministry of Health, to learn what you can do to protect yourself and stay updated as the pandemic evolves. Community-specific information is available from local or national health authorities. You can also continue to visit the WHO web site for simple prevention practices and general advice.

WHO is not recommending travel restrictions nor does WHO have evidence of risk from eating cooked pork.

Sources : WHO

Frequently Asked Questions

Here are answers to frequently asked questions about how you can identify and protect you and your family from the new strain of swine flu.

Q: What are the flu's symptoms?

A: The symptoms are similar to regular seasonal influenza and include fever, coughing, sore throat, body aches, headaches and chills. The U.S. Centers for Disease Control and Prevention says there may be cases involving diarrhea and vomiting.

Those with chronic diseases, such as heart disease or diabetes, may be at higher risk of developing serious conditions if infected with the new flu.

Q: What should I do if a case of the flu is confirmed in my neighborhood?

A: According to government guidelines released Saturday, individuals are advised to avoid crowded places and to wear face masks in such places. It also calls for covering your mouth and nose with a handkerchief or tissue when coughing, washing hands with soap for more than 15 seconds and gargling.

Companies and schools are advised to mitigate risk of infection by allowing employees and students to commute by bicycle and to avoid rush-hour travel.

Q: What if flu symptoms should appear?

A: First, call high-fever consultation center) at your local public health center.

Q: What about treatment?

A: The main cure for swine flu A(H1N1) virus infection is an antiviral medicine, Tamiflu or Relenza. Tamiflu is widely used for seasonal influenza. The government says it has a sufficient stockpile of the medicine to handle a possible pandemic.

Tamiflu is highly effective if taken within 48 hours of the onset of symptoms. Even after 48 hours, it is still effective if to a lesser degree. When taking Relenza, special aspiration equipment is required.

Many people infected with the current swine flu virus, including those confirmed in Japan, show only mild symptoms. In many cases overseas, infected individuals have recovered without any extraordinary treatment. In most cases, the CDC advises people to stay home and get a lot of rest.

What can I do?

What can I do to protect myself from catching influenza A(H1N1)?

The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

avoid touching your mouth and nose;

clean hands thoroughly with soap and water

cleanse them with an alcohol-based hand rub on a regular basic

especially if touching the mouth and nose, or surfaces that are potentially contaminated avoid close contact with people who might be ill;

reduce the time spent in crowded settings if possible;

improve airflow in your living space by opening windows,

practice good health habits including adequate sleep, eating nutritious
food, and keeping physically active.

What about using a mask? What does WHO recommend?

If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards.

If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

Sources : WHO
Photo : Daylife

What is phase 6?

Phase 6 is a pandemic, according to the WHO definition.

WHO pandemic phase descriptions [pdf 456kb] Pandemic influenza preparedness and response

What about severity?

At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.

The moderate assessment reflects that:

• Most people recover from infection without the need for hospitalization or medical care.
• Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
• Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.

WHO is concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.

Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known. WHO.

Nearly 30,000 cases

THE World Health Organization declared a swine flu pandemic yesterday – the first global flu epidemic in 41 years – as infections in the United States, Europe, Australia, South America and elsewhere climbed to nearly 30,000 cases. The long-awaited pandemic announcement is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. WHO will now ask drugmakers to speed up production of a swine flu vaccine.

The declaration will also prompt governments to devote more money toward efforts to contain the virus. WHO chief Dr Margaret Chan made the announcement yesterday after the UN agency held an emergency meeting with flu experts. Chan said she was moving the world to phase 6 – the agency’s highest alert level – which means a pandemic, or global epidemic, is under way. On Wednesday, WHO said 74 countries had reported nearly 27,737 cases of swine flu – there were 12 cases in Ireland – including 141 deaths. Chan described the virus as "moderate." According to WHO’s pandemic criteria, a global outbreak has begun when a new flu virus begins spreading in two world regions.

The agency has stressed that most cases are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities – especially in poorer countries. About half of the people who have died from swine flu were previously young and healthy – people who are not usually susceptible to flu. Swine flu is also crowding out regular flu viruses. Both features are typical of pandemic flu viruses. The last pandemic – the Hong Kong flu of 1968 – killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year.

Swine flu is also continuing to spread during the start of summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but swine flu is proving to be resilient.

Sources http://www.irishexaminer.com/ Photo Daylife.com

First Global Flu Epidemic

The World Health Organization told its member nations it was declaring a swine flu pandemic Thursday — the first global flu epidemic in 41 years — as infections climbed in the United States, Europe, Australia, South America and elsewhere. In a statement sent to health officials, WHO said it decided to raise the pandemic warning level from phase 5 to 6 — its highest alert — after holding an emergency meeting with its flu experts.

WHO chief Dr. Margaret Chan was expected to make a formal announcement on the pandemic later Thursday.The long-awaited pandemic decision is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. It will trigger drugmakers to speed up production of a swine flu vaccine and prompt governments to devote more money toward efforts to contain the virus.

"At this early stage, the pandemic can be characterized globally as being moderate in severity," WHO said in the statement, urging nations not to close borders or restrict travel and trade. WHO also told countries it was in "close dialogue" with flu vaccine makers and it believed the firms would work "to ensure the largest possible supply of pandemic vaccine in the months to come."

Flu vaccine makers like GlaxoSmithKline PLC and Sanofi-Aventis have been working since last month on a swine flu vaccine. GlaxoSmithKline spokesman Stephen Rea said the company was ready to start making swine flu vaccine in large quantities once it finished its regular flu vaccine production in July.

On Wednesday, WHO said 74 countries had reported nearly 27,737 cases of swine flu, including 141 deaths. The agency has stressed that most cases have been mild and required no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities — especially in poorer countries.

Still, about half of the people who have died from swine flu, also known by its scientific name H1N1, were previously young and healthy — people who are not usually susceptible to flu.Swine flu is also continuing to spread during the start of summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but swine flu is proving to be resilient.

The last pandemic — the Hong Kong flu of 1968 — killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year. Many health experts say WHO's pandemic declaration could have come weeks earlier but the agency became bogged down by politics. In May, several countries urged WHO not to declare a pandemic, fearing it would cause social and economic turmoil. Despite WHO's hopes, raising the epidemic alert to the highest level will almost certainly spark some panic about spread of swine flu.

Fear has already gripped Argentina, where thousands worried about swine flu flooded into hospitals this week, bringing emergency health services in Buenos Aires, the capital, to the brink of collapse. Last month, a bus arriving in Argentina from Chile was stoned by people who thought a passenger on it had swine flu. Chile has the most swine flu cases in South America.

In Hong Kong on Thursday, the government ordered all kindergartens and primary schools closed for two weeks after a dozen students tested positive for swine flu — a move that some health experts would consider an overreaction.

In the United States, where there have been more than 13,000 cases and at least 27 deaths from swine flu, officials at the U.S. Centers for Disease Control and Prevention said the move would not change how the U.S. tackled swine flu.

The U.S. government has already taken steps like increasing availability of flu-fighting medicines and authorizing $1 billion for the development of a new vaccine against the novel virus. In addition, new cases seem to be declining in many parts of the country, U.S. health officials say, as North America moves out of its traditional winter flu season.

India confirmed 5 cases

Hyderabad city of India's southern Andhra Pradesh state confirmed five cases of H1N1 influenza including one cured, officials said on Saturday. L V Subramanyam, the state's principal secretary, said that there were four cases confirmation now, apart from one confirmation which already have successfully cured and sent them back home. So with these four and one before about five cases have been confirmed for H1N1 influenza from Hyderabad area. Subramanyam added that there was no cause for panic as the cases were successfully identified and quarantined.

He said, there's no need for any panic because the number has come. He was actually happy that they able to successfully identify them and quarantine them so that the infection that was possible for the community has been prevented. Reportedly a four-and-a-half year old girl has been tested positive for influenza in Hyderabad. It is believed that the virus has been transmitted to the girl through her brother, who was tested positive earlier this week.

Although H1N1 swine flu appears mild, it affects mostly older children and young adults, and experts worry it could change into a more dangerous form. The spread of H1N1 flu in Australia, Britain, Chile, Japan and Spain has nudged the world closer to a pandemic, the World Health Organization said on Tuesday.

The new strain, commonly known as swine flu, has infected 21,940 people in 69 countries, killing 125 of them, according to the WHO. Mexico, the United States and Canada have borne the brunt of the illness. Work continues on developing a vaccine. To declare a full pandemic the WHO would have to confirm sustained spread of the virus in one country in another region besides the America.

Chile

A Chilean man has died from H1N1 flu, Chile's Public Health Institute said on Tuesday June 2, the first death in the South American country from the new virus that has killed more than 100 people worldwide. Chile had so far confirmed 312 other cases of H1N1 by late on Monday, two of whom continue to be in serious condition. The Chilean minister of health convened a news conference to formally announce the specifics regarding the death.

Chilean Health Minister Alvaro Erazo said, the dead confirmed, by the Institute of Public Health, in regards to a patient of 37 years of age, who died on Monday at 4:15 in the morning, in the regional hospital of Puerto Montt, and that in accordance with the clinical evaluation, and the antecedents of the case that were compiled over the last two days, and confirmed today at 1 pm by the Institute of Public Health, that this was the first death from the influenza here in Chile.

The victim, Fernando Vera Maldonado, died in the southern city of Puerto Montt, located roughly 1,000 kms south of Santiago.

The spread of H1N1 flu in Australia, Britain, Chile, Japan and Spain has nudged the world closer to a pandemic, the World Health Organization said on Tuesday. The new flu -- a mixture of swine, bird and human viruses -- remains most prevalent in North America but has infected nearly 19,000 people in 64 countries, according to the WHO's latest toll, which tends to lag behind national figures but is considered more reliable.

Arazo took time at the news conference to underscore the importance of addressing the early signs of the flu. "It's worth repeating that with these exceptional cases, the most important is that when the symptoms of fever, coughing, as this patient suffered from, and above all high fever, people must report themselves to health centers," he said. Before the Chilean death was confirmed, the WHO had put the global death toll from H1N1 at 117. Most of those killed have been in Mexico. Reuters

Singapore confirmed its 12th

Singapore has confirmed its 12th case of Influenza A (H1N1-2009). The patient is an 18-year-old Singaporean male. He went to Melbourne on 16 May and returned to Singapore on Emirates EK405 on 1 June at 2350 hours. He was seated at row 18. He was sent to hospital at about 12 noon today by ambulance via 993. Laboratory results confirmed his infection at 1925 hours on 4 June and he was admitted to the Communicable Disease Centre. Contact tracing is ongoing for the 12th confirmed case.

Healt Dept. advises the public to avoid non-essential travel to these affected areas Such as Melbourne and the State of Victoria in Australia, Kobe and Osaka in Japan and Chile, USA, Canada and Mexico. For people who are unable to avoid travelling to affected areas, they should:

• · Avoid crowded areas and contact with anyone who appears unwell.
• · Maintain high standards of personal hygiene at all times.

• Wash hands regularly and thoroughly with soap and water.
• especially before touching the eyes, nose or mouth.
• Turn quickly away from anyone near if they are about to cough or sneeze.
• Cover the nose and mouth with a piece of tissue when coughing or sneezing.
• Dispose of the tissue paper properly in the dust bin after use.

Health Dept. also advised travellers to see a doctor as soon as possible if they feel unwell overseas and refrain from travelling until certified fit by the doctor.


Sources : Flu.Gov.SG
Foto : digital Journy

World Health Assembly

In view of the threat posed by the current outbreak of new influenza A (H1N1), the Director-General of the World Health Organization convened a High-Level Consultation for all Member States at the start of the Sixty-second World Health Assembly.

The consultation provided an opportunity for Member States to share experiences, to discuss lessons learnt, and to highlight the challenges that now confront the world community. The list of main speakers and programme is given in the Annex. As at 18 May 2009, 40 countries have officially reported 8829 laboratory-confirmed cases of new influenza A (H1N1) infection.

Countries reporting the largest number of confirmed cases include:

• The United States of America 4714
• Mexico 3103
• Canada 496
• Japan 125
• Spain 103
• Great Britain and Northern Ireland 101

Together these six countries account for 97.9% of the total number of confirmed cases. A total of 74 new influenza A (H1N1) infection-related deaths have been reported from four countries :

• Mexico 68
• United States of America 4
• Canada 1
• Costa Rica 1

The majority of deaths have occurred in persons below 60 years of age. The virus is transmitted sufficiently easily from person-to-person to sustain institutional and community outbreaks and to spread regionally. Most cases of new influenza A (H1N1) infection seem to be mild and self-limited and do not require admission to hospital. However, severe illness and death have been reported in a small proportion of cases.

In seasonal influenza, the overwhelming majority of severe morbidity and mortality occur in persons of 65 years of age or more. However, with new influenza A (H1N1), a substantial proportion of the cases of severe illness and death has occurred among young and previously healthy adults.

In addition, severe illness and deaths have also been reported in adults with underlying medical conditions including: chronic lung or cardiovascular disease, diabetes, immunodeficiencies and obesity. Moreover, pregnant women may be at increased risk of complications from new influenza A. WHO.

China

China's Health Ministry on Tuesday confirmed a fourth case of swine flu on the Chinese mainland .Chinese state television (CCTV) broadcast video of the man, found in Southern China's Guangdong province.The 59-year-old man, with the last name of Yang, had earlier arrived in Hong Kong after travelling from the US on a flight via South Korea.

He then took a train to China's Guangdong Province. While on board the train, he showed symptoms of having contracted swine flu, including a fever, CCTV said.Yang was taken to a hospital in Guangdong, where he was quarantined. Health officials, speaking to CCTV, said that 80 percent of the people who had come into contact with him had been traced.

Meanwhile, in Shandong, CCTV said a patient, named Lu, who had been quarantined for one week showing symptoms of swine flu had been released. Officials and his family members celebrated his release from hospital, CCTV said.China has had seven cases of the virus, four on the mainland and three in its territory Hong Kong. None have become seriously ill. APTN.

New York City

Swine flu has become deadly.

The Queens assistant principal stricken with the now-deadly H1N1 virus succumbed to the illness late today, the first known fatality in the city from the disease, hospital officials said. Mitchell Wiener, 55, died at 6:17 p.m., just hours after his family optimistically told The Post his condition had stabilized. The somber news came as city officials ordered five more schools closed today in an attempt to stop the spread of the deadly virus - bringing the total number to 11 citywide that will be shuttered this week.

"We were treating him very aggressively," said Flushing Hospital spokesman Ole Pedersen. "He was in critical condition. His family was saying that he had not, in fact, deteriorated, which was true, but he was still extremely critical." Wiener is the sixth person in the US to die from the highly contagious disease. The assistant principal at IS 238 in Jamaica Estates first fell ill more than a week ago, but didn't seek help at the hospital until his symptoms became severe early Wednesday morning. Since that time, he had been in a medically induced coma and on a ventilator.

Just hours before his death, his wife, Bonnie, said there were hopeful signs. "There's no change," she told The Post earlier today. "He's stabilized. They're just giving him supporting care and hoping the treatment will kick in." The additional schools ordered closed today, all in Queens, are IS 158Q in Bayside, Our Lady of Lourdes, a private parochial school in Queens Village, and IS 25Q, World Journalism Preparatory School and PS 233Q, all of which share the same Flushing campus. "We think it will help stop transmissions throughout the city," the mayor said today.

Coy Jones, the mother of an 8-year-old girl at Our Lady of Lourdes, said, "I thought it was over a week or two ago, and now it's back worse than ever," The decision to close the schools was made after high numbers of students at each building reported flu-like symptoms.

At IS 158Q, 41 students out of a total population of 1,127 reported the symptoms, the Health Depart ment said. At the three- school IS 25Q complex, 27 felt sick out of a total of 825 students, and at Our Lady of Lourdes, 37 students were ill out of a total population of 424. "In my class, five people have been sick," said 14-year-old Ethan Kim, an eighth-grader at IS 158Q. "I know one class had over 20 people out. A lot of my friends' parents pulled their kids out."

Anne Marie Karcinski has a daughter at IS 25Q and a son at St. Francis Prep, site of the first known swine flu outbreak in the city. "This is the second time for us, to have to go through that," she said. The closures announced today will remain in effect for a minimum of five days. Six schools were already under closure before today: JHS 74Q in Bayside; PS 107Q in Flushing; IS 238Q in Jamaica; PS 16Q in Corona; IS 5Q in Elmhurst; IS 318K in Williamsburg, Brooklyn.

Health officials were at a loss to explain why the outbreaks have occurred overwhelmingly in Queens. "We could see similar activity in the other boroughs," said Dr. Scott Harper, an epidemiologist with the Health Department. "We just don't know." Harper urged parents with sick kids to keep them out of school until a full day without symptoms had gone by.

The mayor's handling of the swine flu crisis drew criticism today from city comptroller Bill Thompson, who's running for mayor. "We went from 'This is a crisis' to 'Don't pay attention' to 'OK, it's a crisis again,' " Thompson said. Additional reporting by Matthew Nestel.
joe.mollica@nypost.com

Malaysia second swine flu case

Malaysia on Saturday confirmed its second case of swine flu, a female student who was on the same flight as a 21-year-old man whom authorities a day earlier announced had tested positive. "Malaysia has a second case of the A(H1N1) influenza, which was confirmed by the Institute of Medical Research this morning," the health ministry's deputy director general Ramlee Rahmat told reporters. "She is a student.

She was on the same flight as the first case (and) she is a friend of the first case," he added. "She was admitted to the Penang hospital yesterday. She is in a stable condition and her fever has subsided." Ramlee said the student's family had been placed in home quarantine but were healthy. Five family members who live with the 21-year-old man, the first confirmed case Friday, were previously placed under home quarantine. Officials have urged people not to be alarmed amid fears that more people have been exposed to the disease. The government has urged all passengers who travelled on the same Malaysian Airlines flight as the two infected people to contact the ministry.

Ramlee said that there were 192 passengers and 15 crew members on Malaysian airlines flight MH091 from Newark in the United States to Kuala Lumpur that arrived on May 13. It was not a code-sharing flight (with Indonesian carrier Garuda) as announced Friday, he said. "We are prepared to handle an outbreak.

It is good that we have discovered the two cases," Ramlee said. Malaysian health authorities have installed 20 thermal scanners at the country's entry points to help detect possible cases of the virus. The latest WHO data showed 7,520 people in 34 countries were confirmed to have caught the A(H1N1) virus.