**Update**Novel Influenza A/H1N1 (Swine Flu) Pandemic

**Update Thursday 10 August 2009**

The current figures from the European Centre for Disease Prevention and Control (ECDC) as of August 25, 2009:
 In the EU and EFTA Countries: 43 245 cases including 93 deaths
 Outside EU and EFTA countries: 211 702 cases including 2501 deaths
 Bringing the Global number to: 254 947 cases including 2594 deaths

All 31 EU/EFTA countries have confirmed cases.

A full break down and daily updated situational report can be found at the ECDC website

**Update Thursday 11 June 2009** The WHO officially upgraded the level of influenza pandemic alert from phase 5 to phase 6. Margaret Chan, Director General of the WHO, said in a statement to the Press that "the world is now at the start of the 2009 influenza pandemic." As of 11 June 2009, nearly 30,000 confirmed cases have been reported in 74 countries. This is the earliest that any pandemic has ever been spotted and the level of preparedness has been raised so high. While in the summer months the spread will be slower and less agressive "further spread is considered inevitable" said the head of the WHO.

"On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met."

**Update Monday 18 May 2009** 39 Countries have officially reported cases of type A/H1N1 novel influenza. This brings the total number of cases worldwide to 8,480. Only the United States (4), Canada (1), Mexico (66) and Costa Rica (1) have reported deaths so far. Still no travel restrictions have been put in place however, all non-essential travel to Mexico is being advised against by the WHO and European institutions.

**Update Friday 15 May 2009** 34 Countries have officially reported cases of type A/H1N1 novel influenza. This brings the total number of cases worldwide to 7520. Only the United States (3), Canada (1), Mexico (60) and Costa Rica (1) have reported deaths so far. Still no travel restrictions have been put in place however, all non-essential travel to Mexico is being advised against by the WHO and European institutions.

Member States have been stockpiling the antivirals Oseltamivir and Zanamivir to help to slow the spread if necessary, however, the majority of cases have recovered quickly, without the need for antiviral drugs.

**Update Monday 05 May 2009** 24 countries have officially reported 2371 cases of influenza A (H1N1) infection.

Mexico has reported 1112 laboratory confirmed human cases of infection, including 42 deaths. The United States has reported 896 laboratory confirmed human cases, including two deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (201), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (10), Guatemala (1), Ireland (1), Israel (6), Italy (5), Netherlands (2), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (81), Sweden (1), Switzerland (1) and the United Kingdom (32).

To read the Royal College of Physicians Guidance for hospital medical specialities on management during a pandemic influenza outbreak please click here.

**Update Monday 05 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).

**Update Tuesday 28 April 2009** on the advice of the Emergency Committee, established in compliance with the International Health Regulations (2005), on Swine Flu, the WHO Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.

To view what the alert levels mean, please click here.

**Update Monday 27 April 2009** Three European countries (Spain, France, Scotland/UK) have reported a total of 12 persons under investigation for swine influenza virus infection. All of them have a history of travel to Mexico.

Commissioner Androulla Vassiliou, DG Health and Consumer Protection, warned ministers and the press that all non-essential travel to the United States and Mexico should be discouraged. "Personally, I’d try to avoid non-essential travel to the areas which are reported to be in the centre of the cluster in order to minimise the personal risk and to reduce the potential risk to spread the infection to other people," the Commissioner said.

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All 20 cases in the United States have caused a mild Influenza-like Illness (ILI) 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.

The Mexican Government has reported three separate events. The Federal District of Mexico City started to pick up cases of ILI on 18 March. The number rose throughout April and as of 23 April there are over 854 cases of pneumonia in 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, 20 have been laboratory confirmed in Canada as A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.

The Mexican Minister of Health announced in a press release on 24 April 2009 that 68 persons had died following severe pneumonia, and of these 20 had been laboratory confirmed to be of the novel viral strain. The ILI can cause a lowering of the immune system capability and a susceptibility to pneumonia. Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks as well as the unusual age groups affected (young adults), these events are of high concern.

Laboratory testing has found the A/H1N1 virus to react to the prescription antiviral drugs oseltamivir and zanamivir that can help to slow the infection and help to prevent spread.

Currently the advice being offered to people by the Centres for Disease Prevention and Control (CDC) and the US state Department is simple preventative advice such as regularly washing one’s hands and covering one’s nose when one sneezes.

On Saturday, 25 April, the Director-General of the World Health Organisation declared this event a Public Health Emergency of International Concern but did not not recommend any travel or trade restrictions. The WHO was in agreement that in order to raise the threat level from level 3, more information is needed.

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses have been documented.

One case has been reported so far in the EU (in Spain) and the European Centre for Disease Control and Prevention (ECDC) is remaining on full alert for any further cases occurring in Europe. Commissioner Vassiliou will brief foreign ministers today, 27 April, in Luxembourg and the Czech Presidency intends to hold an emergency meeting with heads of state as soon as possible.

For more information

 Please visit the ECDC website
 Please visit the CDC website
 Please visit the WHO website

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 Preparing the EU against health emergencies - generic guidance
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