H1N1 Influenza - Case Count 6/23/2009

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

[Original Document: LINK. EDITED.]


Main developments in past 24 hours

• 215 new cases were reported in EU and EFTA countries;
• Latvia has reported its first case;
• 1845 new cases were reported from non-EU and EFTA countries;
• The total of fatal cases worldwide is 239;
• Seven fatal cases have been reported by Canada, Dominican Republic and Argentina and Australia since yesterday.
  

This report is based on official information provided by the national public health websites, or through other official communication channels. An update on the number of confirmed cases as of 23 June, 17:00 hours CEST, is presented in Table 1 and Table 2.

Disclaimer: the number of confirmed cases reported is based on laboratory test results, except for the US. Depending on the national laboratory testing policies, the actual number of cases by country may therefore be higher.


Epidemiological update

The number of EU and EFTA countries reporting cases is today 28 out of 31.

In the past 24 hours, 215 cases were confirmed in 16 EU and EFTA countries, with UK as main reporting country with 132 new cases (Table 1).

Latvia has today reported its first case in a traveller returning from USA.

The cumulative number of cases in the EU and EFTA countries is now 4 459, including one death.

Outside of the EU and EFTA countries, a total of 50 475 cases, including 238 deaths, have been reported, representing an increase of 1 845 from yesterday (Table 2).


WHO Guidelines on Laboratory and Virology

The following text provides hyperlinks to useful guidelines published by WHO on laboratory and virology issue related to A(H1N1)v virus.

• Characteristics of the emergent influenza A (H1N1) viruses and recommendations for vaccine development 26 May 2009
• This summary provides an update on the characterization of available influenza A(H1N1)v viruses affecting humans and makes a recommendation on suitable viruses for development of vaccines against this emergent influenza A(H1N1)v virus infection.
• WHO information for Laboratory Diagnosis of New Influenza A (H1N1) Virus in Humans 21 May 2009
• This document provides information on the diagnostics available as of the above date for the human influenza A (H1N1) A/California/4/2009-like viruses. Further diagnostic information will be updated when available.
• Instructions for storage and transport of suspected or confirmed influenza A (H1N1) human and animal specimens and virus isolates 20 May 2009
• This is a collection of specifications and technical information that has to be taken into account when specimens of animal or human origin of suspected or confirmed cases of influenza A(H1N1)v virus are handled during storage and transport.
• Protocol for antiviral susceptibility testing by pyrosequencing 13 May 2009
• The WHO Collaborating Centre for influenza at CDC Atlanta, US, has made available the M2 and the NA-H274 detailed pyrosequencing protocols for antiviral susceptibility testing of influenza A(H1N1)v virus. These documents update and replace the protocols published on 29th April 2009.
• Sequencing primers and protocol 12 May 2009
• The WHO Collaborating Centre for influenza at CDC, Atlanta (US), has updated the sequencing primers and protocol. This update replaces the previous version published on 29 April 2009.
• Status of candidate vaccine virus development for the current Influenza A(H1N1) virus 9 May 2009
• For the current influenza A(H1N1)v virus, WHO Collaborating Centres for influenza (WHO CCs), Essential Regulatory Laboratories (ERLs) and other institutions are developing candidate vaccine viruses under the coordination of WHO. Once a vaccine virus is available, WHO will announce the availability on its website.
• Countries able to perform PCR to diagnose influenza A (H1N1) virus infection in humans 7 May 2009
• Based on performance in the WHO external quality assessment project (EQAP), National Influenza Centres (NICs) of the WHO Global Influenza Surveillance Network (GISN) and national influenza reference laboratories (NIRLs) in countries without NICs, fulfilling certain criteria, have been identified as having PCR capacity, with the necessary laboratory facility and consumables, to detect the influenza A(H1N1)v virus.
• Laboratory bio-risk management for laboratories handling human specimens suspected or confirmed to contain influenza A (H1N1) causing the current international epidemics 6 May 2009
• This document includes a bio-risk management checklist for laboratory managers and staff, and some recommendations addressing minimal/essential working conditions associated with specific manipulations in laboratory settings.
• Instruction on how to obtain CDC real-time RT-PCR kits for detection of influenza A(H1N1) 2 May 2009
• The WHO Collaborating Centre for influenza in CDC Atlanta (USA) has developed the primers and probes for the influenza A(H1N1)v virus included in the rRT-PCR kits. These also include detailed procedures as well as positive control materials.
• CDC protocol of real-time RTPCR for influenza A (H1N1) 30 April 2009
• CDC Atlanta has released the real-time reverse transcription – polymerase chain reaction (rRT-PCR) protocol for detection and characterization of influenza A(H1N1)v virus (version 2009). CDC emphasises that these protocols are made available under an emergency use authorization (EUA) and are not intended to be used for commercial development or for-profit testing.
• Instructions for shipments of swine influenza A(H1N1) specimens and virus isolates to WHO Collaborating Centres for influenza 28 April 2009
• WHO, through its Shipment Fund Project (SFP), will continue supporting shipments from any places where outbreaks of influenza A(H1N1)v virus infection occur. ‘World Courier’, WHO’s partner in the SFP, is on alert 24 hours / 7 days a week to provide support with those shipments.
• Viral gene sequences to assist update diagnostics for influenza A (H1N1) - GenBank accession numbers 28 April 2009
• The WHO Collaborating Centre for influenza in CDC Atlanta (US) has posted the full genome sequences of influenza A(H1N1)v virus – A/California/04/2009 – on the GenBank sequence database.
• Viral gene sequences to assist update diagnostics for influenza A (H1N1) 25 April 2009
• The full genome sequence of the newly identified influenza A(H1N1)v virus – A/California/04/2009 – has been made available by the WHO Collaborating Centre in CDC, Atlanta, on the GISAID sequence database.

Health care workers and the pandemic virus – Report from USA

The Centers for Disease Control and Prevention (CDC) in the United States has provided guidance for reducing the risk of transmission of influenza A(H1N1)v in health care settings in that country1 . At the same time as issuing these the CDC asked US State authorities for reports of health care professionals (HCP) with the novel influenza infection. There has now been the first report of that surveillance in the most recent issue of CDC’s Morbidity and Mortality Weekly Report (MMWR)  click here .

That publication described the results for 48 cases of A(H1N1)v in HCP. Two of these were hospitalised. Neither required intensive care. For 26 of the 48 there was information on risk factors associated with how the infection was acquired. For 13 of the 26 it was considered most likely that the infection had been acquired in a health care setting, in one case from another HCP and for the other 12 from a patient. There were 11 cases where CDC reported enough information on the use of personal protective equipment to comment on whether this had been adequate compared to what is recommended 1 and in only three of these was there a report of use of a mask or a respirator.

The authors concluded that there needed to be reinforcement of messages about infection control. The results were also mentioned and discussed on the CDC weekly media broadcast on June 18th 2. That mentioned that a difficult and controversial issue in the USA is whether to require or recommend N95 masks or to stick to surgical masks outside of higher risk settings (where aerosols are being generated). Even though there is a preference for respirators from the infection control specialists in the USA there is no consensus 2.

ECDC Comment:

In Europe there are concerns that the use of respirators may not be practical in routine settings3, and it is reported that there are concerns that this may

1. Centers for Disease Control and Prevention Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
2. CDC Telebriefing on Investigation of Human Cases of Novel Influenza A (H1N1) transcript http://www.cdc.gov/media/transcripts/2009/t090618.htm
3. Phin NF, Rylands AJ, Allan J, Edwards C, Enstone JE, Nguyen-Van-Tam JS.Personal protective equipment in an influenza pandemic: a UK simulation exercise. J Hosp Infect. 2009 Jan;71(1):15-21. Epub 2008 Nov 17
   

Table 1: Reported new confirmed cases and cumulative number of influenza A(H1N1)v as of 23 June 2009, 17:00 hours (CEST) in the EU and EFTA countries

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

1. Austria ... - 10 - ...
2. Belgium 1 - 31 - ...
3. Bulgaria ... - 2 - ...
4. Cyprus 1 - 5 - ...
5. Czech Republic ... - 7 - ...
6. Denmark 3 - 31 - ...
7. Estonia ... - 5 - ...
8. Finland 13 - 26 - ...
9. France ... - 150 - ...
10. Germany 23 - 301 - ...
11. Greece ... - 51 - ...
12. Hungary ... - 7 - ...
13. Iceland ... - 4 - ...
14. Ireland ... - 23 - ...
15. Italy 8 - 96 - ...
16. Latvia 1 - 1
17. Luxembourg 1 - 3 - ...
18. Netherlands 5 - 110 - ...
19. Norway 2 - 22 - ...
20. Poland ... - 13 - ...
21. Portugal ... - 6 - ...
22. Romania 1 - 19 - ...
23. Slovakia 1 - 4 - ...
24. Slovenia ... - 1 - ...
25. Spain 17 - 539 - ...
26. Sweden 1 - 55 - ...
27. Switzerland 5 - 32 - ...
28. United Kingdom 132 - 2905 - 1

• Total 215 - 4459 - 1

• Note: cases reported in the EU and EFTA countries correspond to the EWRS notifications by Member States or Ministry of Health websites.
• (*) Deaths are included in the cumulative number of confirmed cases
  

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

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

• EASTERN EUROPE AND CENTRAL ASIA

1. Montenegro ... - 1 - ...
2. Russian Federation ... - 3 - ...
3. Ukraine ... - 1 - ...

• MEDITERRANEAN AND MIDDLE-EAST

1. Algeria 1 - 2 - ...
2. Bahrain ... - 15 - ...
3. Egypt 6 - 40 - ...
4. Israel 77 - 346 - ...
5. Jordan 1 - 13 - ...
6. Kuwait 8 - 26 - ...
7. Lebanon ... - 12 - ...
8. Morocco 1 - 9 - ...
9. Occupied Palestinian Territory ... - 8 - ...
10. Oman ... - 3 - ...
11. Qatar 7 - 10 - ...
12. Saudi Arabia 5 - 39 - ...
13. Turkey ... - 20 - ...
14. United Arab Emirates ... - 2 - ...
15. Yemen 1 - 5 - ...

• AFRICA

1. Ethiopia ... - 2 - ...
2. South Africa ... - 1 - ...

• NORTH AMERICA

1. Canada 747 - 6457 - 15
2. Mexico ... - 7624 - 113
3. **USA ... - 21449 - 87

• CENTRAL AMERICA AND CARIBBEAN

1. Bahamas ... - 2 - ...
2. Barbados ... - 4 - ...
3. Bermuda ... - 2 - ...
4. British Virgin Islands ... - 1 - ...
5. Cayman Islands ... - 4 - ...
6. Costa Rica 39 - 188 - 1
7. Cuba ... - 15 - ...
8. Dominica ... - 1 - ...
9. Dominican Republic 6 - 99 - 2
10. El Salvador ... - 160 - ...
11. Guatemala 27 - 235 - 1
12. Honduras 10 - 118 - ...
13. Jamaica 4 - 19 - ...
14. ***Martinique ... - 1 - ...
15. ****Netherlands Antilles ... - 4 - ...
16. Nicaragua 45 - 189 - ...
17. Panama ... - 330 - ...
18. Suriname ... - 11 - ...
19. Trinidad-Tobago ... - 25 - ...

• SOUTH AMERICA

1. Argentina 95 - 1203 - 10
2. Bolivia 3 - 26 - ...
3. Brazil 25 - 240 - ...
4. Chile ... - 4315 - 4
5. Colombia 1 - 69 -  2
6. Ecuador ... - 95 - ...
7. Paraguay ... - 48 - ...
8. Peru 77 - 218 - ...
9. Uruguay 159 - 195 - ...
10. Venezuela ... - 92 - ...

• NORTH-EAST AND SOUTH ASIA

1. China 68 - 461 - ...
2. Hong Kong SAR 28 - 348 - ...
3. India ... - 50 - ...
4. Japan 43 - 892 - ...
5. Korea (South) 31 - 115 - ...
6. Macao 2 - 5 - ...
7. Sri Lanka 3 - 4 - ...
8. Taiwan ... - 61 - ...

• SOUTH-EAST ASIA

1. Laos PDR 1 - 2 - ...
2. Malaysia 35 - 58 - ...
3. Philippines ... - 445 - 1
4. Singapore 26 - 168 - ...
5. Thailand 71 - 589 - ...
6. Vietnam 7 - 56 - ...

• AUSTRALIA AND PACIFIC

1. *****Australia 124 - 2857 - 2
2. ***French Polynesia ... - 1 - ...
3. New Zealand 61 - 364 - ...
4. Papua New Guinea ... - 1 - ...
5. Samoa ... - 1 - ...

• TOTAL 1845 - 50475 - 238

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

(*) Deaths are included in the cumulative number of confirmed cases

(**) Cases in the US include both probable and confirmed cases. Cases reported from the US include confirmed cases from Puerto Rico.

(***) The cases in Martinique and French Polynesia were reported by France

(****) Three of the cases are reported to occur in a cruise ship in Curacao.

(*****) One Australian case reported from a cruise ship.

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