Recieved the updated WHO report on Swine Flu worldwide listed below:
ProMED-AHEAD Digest Monday, April 27 2009 Volume 2009 : Number 124
In this issue:
PRO/AH/EDR> Influenza A (H1N1) "swine flu": Worldwide
See the end of the digest for information on how to retrieve back issues.
Date: Mon, 27 Apr 2009 12:41:00 -0400 (EDT)
Subject: PRO/AH/EDR> Influenza A (H1N1) "swine flu": Worldwide
INFLUENZA A (H1N1) "SWINE FLU": WORLDWIDE
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
****This is a revised and expanded version of yesterday?s
?Influenza A (H1N1) virus, human: worldwide? ? ProMED****
In this update:
 WHO latest information
 WHO declares health emergency
 Lab biosafety guidelines
 WHO update -- North America
 USA - CDC update (NYC confirmed, Ohio confirmed case)
 Canada -- Nova Scotia confirmed, British Columbia: suspected
 New Zealand, France, Israel: suspected
 Europe: 1st confirmed case ? Spain
: Mon 27 Apr 2009
WHO Epidemic and Pandemic Alert and Response (EPR)
WHO is coordinating the global response to human cases of swine
influenza A (H1N1) and monitoring the corresponding threat of an
influenza pandemic. Information on this page tracks the evolving
situation and provides access to both technical guidelines and
information useful for the general public.
Interim WHO guidance for the surveillance of human infection with
swine influenza A(H1N1) virus [pdf 146kb]
27 April 2009
Swine flu illness in the United States and Mexico - update 2
26 April 2009 [see below]
 Date: Sat 25 Apr 2009
Source: WHO declares health emergency
Date: Associated Press [edited]
WHO declares swine flu crisis a health emergency
The World Health Organization has declared the swine flu outbreak in
North America a "public health emergency of international concern".
The decision means countries around the world will be asked to step up
reporting and surveillance of the disease implicated in dozens of
human deaths in Mexico and at least 8 non fatal cases in the USA. WHO
fears the outbreak could spread to other countries and is calling for
a coordinated response to contain it.
WHO director-general Margaret Chan made the decision late on Saturday
after consulting influenza experts during an emergency meeting. She
earlier told reporters the outbreak had "pandemic potential." But her
agency held off raising its pandemic alert level, citing the need for
"It would be prudent for health officials within countries to be alert
to outbreaks of influenza-like illness or pneumonia, especially if
these occur in months outside the usual peak influenza season," Chan
told reporters by telephone from Geneva, where she convened an
emergency meeting of influenza experts. "Another important signal is
excess cases of severe or fatal flu-like illness in groups other than
young children and the elderly, who are usually at highest risk during
normal seasonal flu," she said. Several Latin American and Asian
countries have already started surveillance or screening at airports
and other points of entry.
At least 62 people have died from severe pneumonia caused by a
flu-like illness in Mexico, WHO says. Some of those who died are
confirmed to have a unique flu type that is a combination of bird,
pig, and human viruses. The virus is genetically identical to one
found in California. US authorities said 8 people were infected with
swine flu in California and Texas, and all recovered. So far, no other
countries have reported suspicious cases, according to WHO [but see
below]. But the French government said suspected cases are likely to
occur in the coming days because of global air travel. A French
government crisis group began operating Saturday. The government has
already closed the French school in Mexico City and provided French
citizens there with detailed instructions on precautions.
Chilean authorities ordered a sanitary alert that included airport
screening of passengers arriving from Mexico. No cases of the disease
have been reported so far in the country, deputy health minister
Jeanette Vega said, but those showing symptoms will be sent to a
hospital for tests.
In Peru, authorities will monitor travelers arriving from Mexico and
the USA and people with flu-like symptoms will be evaluated by health
teams, Peru's Health Ministry said.
Brazil will "intensify its health surveillance in all points of entry
into the country," the Health Ministry's National Health Surveillance
Agency said in a statement. Measures will also be put in place to
inspect cargo andluggage, and to clean and disinfect aircraft and
ships at ports of entry.
Some Asian nations enforced checks Saturday on passengers from Mexico.
Japan's biggest international airport stepped up health surveillance,
while the Philippines said it may quarantine passengers with fevers
who have been to Mexico. Health authorities in Thailand and Hong Kong
said they were closely monitoring the situation. Asia has fresh
memories of an outbreak of severe acute respiratory syndrome, or SARS,
which hit countries across the
region and severely crippled global air travel. Indonesia, China,
Thailand, Vietnam and other countries have also seen a number of human
deaths from H5N1 bird flu, the virus that researchers have until now
fingered as the most likely cause of a future pandemic.
The Dutch government's Institute for Public Health and Environment has
advised any traveler who returned from Mexico since April 17 and
develops a fever over 101.3 degrees Fahrenheit (38.5 Celsius) within 4
days of arriving in the Netherlands to stay at home. The Polish
Foreign Ministry has issued a statement that recommends that Poles
postpone any travel plans to regions where the outbreak has occurred
until it is totally contained. The Stockholm-based European Center for
Disease Prevention and Control said earlier Saturday it shared the
concerns about the swine flu cases and stood ready to lend support in
any way possible. [One case now confirmed in Spain ? see below].
WHO's emergency committee, called together Saturday for the first time
since it was created in 2007, draws on experts from around the world.
They may decide that the outbreak constitutes an international public
health emergency. If so, they will consider whether WHO should
recommend travel advisories, trade restrictions or border closures and
raise its pandemic alert level.
[byline: Maria Cheng]
 Lab biosafety
Date: Fri 24 Apr 2009
Source: CDC. Swine influenza A (H1N1) virus biosafety guidelines for
Swine influenza A (H1N1) virus biosafety guidelines for laboratory workers
This guidance is for laboratory workers who may be processing or
performing diagnostic testing on clinical specimens from patients with
suspected swine influenza A (H1N1) virus infection, or performing
Check these websites for further information and updates:
The Association of Public Health Laboratories (APHL) swine influenza web
page can be found at
ProMED-mail rapporteur Brent Barrett
 WHO update - North America
Date: 26 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR)
Swine flu illness in the United States and Mexico - update [26 Apr 2009]
As of [26 Apr 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. Suspected
clinical cases have been reported in 19 of the country's 32 states.
WHO and the Global Alert and Response Network (GOARN) are sending experts
to Mexico to work with health authorities. WHO and its partners are
actively investigating reports of suspect cases in other member states as
they occur, and are supporting field epidemiology activities, laboratory
diagnosis and clinical management.
On Saturday, [25 Apr 2009], 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
WHO is not recommending any travel or trade restrictions.
Daily updates will we posted on the WHO swine influenza website
 USA - CDC update (NYC confirmed, Ohio confirmed case)
Date: 26 Apr 2009
Source: CDC Swine flu investigation website
Human cases of swine influenza A (H1N1) virus infection have been
identified in the United States. Human cases of swine influenza A (H1N1)
virus infection also have been identified internationally. The current US
case count is provided below.
US human cases of swine flu infection
State: No. of laboratory confirmed cases
California: 7 cases
Kansas: 2 cases
New York City: 8 cases
Ohio: 1 case
Texas: 2 cases
Total count: 20 cases
Investigations are ongoing to determine the source of the infection and
whether additional people have been infected with swine influenza viruses.
CDC is working very closely with officials in states where human cases of
swine influenza A (H1N1) have been identified, as well as with health
officials in Mexico, Canada and the World Health Organization. This
includes deploying staff domestically and internationally to provide
guidance and technical support. CDC has activated its Emergency Operations
Center to coordinate this investigation.
Laboratory testing has found the swine influenza A (H1N1) virus susceptible
to the prescription antiviral drugs oseltamivir and zanamivir and has
issued interim guidance for the use of these drugs to treat and prevent
infection with swine influenza viruses. CDC also has prepared interim
guidance on how to care for people who are sick and interim guidance on the
use of face masks in a community setting where spread of this swine flu
virus has been detected. This is a rapidly evolving situation and CDC will
provide new information as it becomes available.
 Canada -- Nova Scotia confirmed, British Columbia suspected
Date: 26 Apr 2009
Source: CJFW FM
Nova Scotia confirms 4 cases of swine flu in province
Health authorities in Nova Scotia are confirming 4 cases of swine flu in
the province. The province's public health officer, Dr Robert Strang, says
the 4 infected people in the Windsor area are recovering from the illness.
All of them had what he describes as "mild" cases of the flu.
Sources say British Columbia has found a pair of cases but it is not yet
clear if they have a link to Mexico.
Canadian officials are planning a briefing today in Ottawa on the swine flu
situation, which WHO has declared to be a "public health emergency of
 Spain, New Zealand, France, Israel: suspected
Date: 26 Apr 2009
Source: Yahoo News / Associated Press
Nations from New Zealand to France also reported suspected cases and some
warned citizens against travel to North America while others planned
quarantines, tightened rules on pork imports, and tested airline passengers
A senior WHO official said the agency's emergency committee will
meet for a second time on Tuesday [28 Apr 2009] to examine the extent to
which the virus has spread before deciding whether to increase the pandemic
alert beyond phase 3. The same strain of the A/H1N1 swine flu virus has
been detected in several locations in Mexico and the United States, and it
appears to be spreading directly from human to human, said Keiji Fukuda,
WHO's assistant director-general in charge of health security.
Mexico's health minister says the disease has killed up to 86 people and
likely sickened up to 1400 since [13 Apr 2009]. US officials say the virus
has been found in New York, California, Texas, Kansas, and Ohio, but so far
no fatalities have been reported.
Governments including China, Russia, and Taiwan began planning to put
anyone with symptoms of the deadly virus under quarantine. Others were
increasing their screening of pigs and pork imports from the Americas or
banning them outright despite health officials' reassurances that it was
safe to eat thoroughly cooked pork. Some nations issued travel warnings for
Mexico and the United States.
WHO's emergency committee is still trying to determine exactly how the
virus has spread, Fukuda said. "Right now we have cases occurring in a
couple of different countries and in multiple locations," he said. "But we
also know that in the modern world that cases can simply move around from
single locations and not really become established."
New Zealand said that 10 students who took a school trip to Mexico "likely"
had swine flu.
Israel said a man who had recently visited Mexico had been
hospitalized while authorities try to determine whether he had the disease.
French Health Ministry officials said 4 possible cases of swine flu in 2
regions are currently under investigation. All recently returned from Mexico.
Spain's Health Ministry said 3 people who just returned from Mexico
were under observation in hospitals in the northern Basque region, in
south eastern Albacete and the Mediterranean port city of Valencia.
[Now confirmed ? see below].
Hong Kong and Taiwan said visitors who came back from flu-affected areas
with fevers would be quarantined. China said anyone experiencing flu-like
symptoms within 2 weeks of arrival from an affected area had to report to
authorities. A Russian health agency said any passenger from North America
running a fever would be quarantined until the cause of the fever is
Tokyo's Narita airport installed a device to test the temperatures of
passengers arriving from Mexico.
Indonesia increased surveillance at all entry points for travelers with
flu-like symptoms -- using devices at airports that were put in place years
ago to monitor for severe acute respiratory syndrome, or SARS, and bird
flu. It said it was ready to quarantine suspected victims if necessary.
Hong Kong and South Korea warned against travel to the Mexican capital and
3 affected provinces. Italy, Poland, and Venezuela also advised their
citizens to postpone travel to affected areas of Mexico and the United States.
The virus is usually contracted through direct contact with pigs, but
Joseph Domenech, chief of animal health service at UN Food and Agriculture
Agency in Rome, said all indications were that the virus is being spread
through human-to-human transmission. No vaccine specifically protects
against swine flu, and it is unclear how much protection current human flu
vaccines might offer.
Russia banned the import of meat products from Mexico, California, Texas
and Kansas. South Korea said it would increase the number of its influenza
virus checks on pork products from Mexico and the U.S.
[byline: Frank Jordans]
 Europe: 1st confirmed case ? Spain
Date: 27 Apr 2009
Source: CBC Canada
Case confirmed in Spain. Returning from Mexico.
[The media feeding frenzy is very reminiscent of the early days of SARS --
an apparently highly contagious novel viral febrile respiratory infection
cropping up in multiple locations, with many unknowns as to the origin of
the virus and what will happen next.
To summarize the status of confirmed cases and suspected cases as best as
one can (given the exponential growth of press releases and press
interviews leading to thousands of newswires): There are presently 20
confirmed cases in the United States involving 5 States -- California (7),
Kansas (2), New York City (8), Ohio (1) and Texas (2). Of these, only one
has been hospitalized and all have been relatively mild and self-limited
infections. There have been no fatalities attributable to this novel H1N1
virus infection in the USA reported as of today (26 Apr 2009). In Mexico
there have been over 1400 reported cases in 19 of 32 States, with 81 (or 86
depending upon the source) reported fatalities. (This number of fatalities
has not altered significantly from the ProMED-mail posting on this outbreak
earlier today (see Influenza A (H1N1) virus, swine, human - N America (03)
20090426.1566). There have been 6 cases confirmed in Canada, 4 in Nova
Scotia, 2 in British Columbia -- all 6 cases have been mild with self
limited illnesses. In addition to the confirmed cases in North America,
there are suspected cases reported from New Zealand, Spain, France, Israel
- -- all involving travellers returning from Mexico. At this point in time,
any individual with a history of travel to a location with known confirmed
cases of the novel H1N1 virus who develops an influenza like illness (ILI)
is considered a suspected cases until results from laboratory testing are
available. One would expect the volume of reports of suspected cases to
grow, as more and more travellers return to their countries of origin, with
a proportion of them having ILIs -- a well observed illness following
In an earlier posting, this moderator pointed out that the reported cases
in Mexico were hospitalized pneumonia cases, with surveillance data coming
from inpatient facilities. In contrast, the information on the reported
cases in the USA involved surveillance data coming from outpatient
facilities. This difference in sentinel reporting sites biases reported
cases in Mexico to be more severe cases as they are cases that were severe
enough to merit hospitalization. In turn, the use of outpatient sentinel
surveillance sites in the USA leads to a bias selecting milder cases --
those that do not require hospitalization. One suspects that once the
countries heighten ILI surveillance to include both inpatient as well as
outpatient facilities, these disparities will lessen. One also suspects
that the true number of cases in Mexico is significantly higher than the
currently reported approximately 1500 cases, which would further lower the
calculated case fatality rate (CFR). (Information on the actual number of
reported cases in Mexico is not readily available on the Ministry of Health
website, so all figures are estimates based on earlier figures provided in
CDC and WHO reports and on newswire reports. Hopefully these figures will
be available on a regularly updated basis to permit following the course of
Based on the currently available information, the novel H1N1 virus involved
in these outbreaks has genetic material from human viruses (permitting
human to human transmission), avian influenza viruses, and swine influenza
viruses. For years the scientific community has been speculating that new
influenza strains might arise when an avian influenza virus infects swine
that are also coinfected with human influenza viruses. This coinfection in
the same host, along with a possible 3rd coinfection of a swine influenza
virus, has been felt to offer the potential for reassortment of the genetic
material of the viruses, that might ultimately produce a virus that is
novel to humans, and can infect humans and be transmitted between them. -
Influenza A (H1N1) virus, human: worldwide 20090426.1577
Influenza A (H1N1) virus, human - New Zealand, susp 20090426.1574
Influenza A (H1N1) virus, human - N America (04) 20090426.1569
Influenza A (H1N1) virus, human - N America (03) 20090426.1566
Influenza A (H1N1) virus, human - N America (02) 20090425.1557
Influenza A (H1N1) virus, human - N America 20090425.1552
Acute respiratory disease - Mexico, swine virus susp 20090424.1546
Influenza A (H1N1) virus, swine, human - USA (02): (CA, TX) 20090424.1541
Influenza A (H1N1) virus, swine, human - USA: (CA) 20090422.1516
Influenza A (H1N1) virus, swine, human - Spain 20090220.0715
Influenza A (H1N1) virus, swine, human - USA (TX) 20081125.3715
Influenza A (H2N3) virus, swine - USA 20071219.4079
Influenza, swine, human - USA (IA): November 2006 20070108.0077]
End of ProMED-AHEAD Digest V2009 #124