America's North Shore Journal

First, the lat­est on the Ukraine:

17 Novem­ber 2009 — Pre­lim­i­nary tests reveal no sig­nif­i­cant changes in the pan­demic (H1N1) 2009 virus based on inves­ti­ga­tions of sam­ples taken from patients in Ukraine. Analy­ses are being per­formed by two WHO influenza col­lab­o­rat­ing cen­tres as part of the global influenza sur­veil­lance network.

Pre­lim­i­nary genetic sequenc­ing shows that the virus is sim­i­lar to the virus used for pro­duc­tion of the pan­demic influenza vac­cine, recon­firm­ing the vaccine's effi­cacy at this time.

Addi­tional ques­tions about the pan­demic virus cir­cu­lat­ing in Ukraine will be answered as more data is available.

WHO com­mends the gov­ern­ment of Ukraine for its open shar­ing of sam­ples to inform global mon­i­tor­ing of the virus for signs of change.

A total of 34 sam­ples were analysed inde­pen­dently by the WHO Col­lab­o­rat­ing Cen­tre for Ref­er­ence and Research on Influenza, Mill Hill in Lon­don, UK, and the WHO Col­lab­o­rat­ing Cen­tre for the Sur­veil­lance, Epi­demi­ol­ogy and Con­trol of Influenza in Atlanta, Geor­gia, USA.

WHO

As of 8 Novem­ber 2009, world­wide more than 206 coun­tries and over­seas ter­ri­to­ries or com­mu­ni­ties have reported lab­o­ra­tory con­firmed cases of pan­demic influenza H1N1 2009, includ­ing over 6250 deaths.

As many coun­tries have stopped count­ing indi­vid­ual cases, par­tic­u­larly of milder ill­ness, the case count is likely to be sig­nif­i­cantly lower than the actual num­ber of cases that have occurred. WHO is actively mon­i­tor­ing the progress of the pan­demic through fre­quent con­sul­ta­tions with the WHO Regional Offices and mem­ber states and through mon­i­tor­ing of mul­ti­ple sources of data.

The win­ter influenza sea­son, which began unusu­ally early across much of the North­ern Hemi­sphere, shows early signs of peak­ing in parts of North Amer­ica but is inten­si­fy­ing across much of Europe and Cen­tral and East­ern Asia.

In North Amer­ica, Canada reported sharp increases in rates of influenza-like-illness (ILI), detec­tions of pan­demic H1N1 virus, and school out­breaks over the past three weeks as pan­demic activ­ity con­tin­ues to spread west to east. In the United States, influenza trans­mis­sion remains geo­graph­i­cally wide­spread and intense but largely unchanged since the pre­vi­ous report­ing week; rates of hos­pi­tal­iza­tions among per­sons aged 0–4 years, 5–17 years, and 18–49 years have now exceeded those seen dur­ing recent pre­vi­ous influenza sea­sons. Dis­ease activ­ity may have peaked in the ear­lier affected south­ern and south east­ern parts of the United States. In Mex­ico, influenza activ­ity remains geo­graph­i­cally wide­spread with a sig­nif­i­cant wave of cases reported since early Sep­tem­ber, most notably from cen­tral and south­ern Mexico.

In Europe and Cen­tral Asia, over­all influenza trans­mis­sion con­tin­ues to inten­sify through­out the con­ti­nent as pan­demic activ­ity spreads east­ward. At least 10 coun­tries of West­ern Europe (Ice­land, Poland, Roma­nia, Bel­gium, Ger­many, the Nether­lands, Nor­way, Spain, Swe­den and the United King­dom) now report that the pro­por­tion of sen­tinel sam­ples test­ing pos­i­tive for influenza exceeded 20% con­sis­tent with active cir­cu­la­tion of pan­demic influenza viruses. High to very high inten­sity of res­pi­ra­tory dis­eases with con­cur­rent cir­cu­la­tion of pan­demic H1N1 2009 was also reported in the Nether­lands, Italy, much of North­ern Europe, Belarus, Bul­garia, and in the Russ­ian Fed­er­a­tion (par­tic­u­larly in the Urals). Dis­ease activ­ity may be peak­ing in a few coun­tries, notably Ice­land, Ire­land, and parts of the UK (North­ern Ire­land) that expe­ri­enced intense trans­mis­sion dur­ing early autumn. Because of a sharp rise in pan­demic influenza cases one week ago in Ukraine, the Min­istry of Health requested assis­tance from WHO Euro­pean Regional Office to eval­u­ate and respond. The ini­tial analy­sis of infor­ma­tion indi­cates that the num­bers of severe cases do not appear to be exces­sive when com­pared to the expe­ri­ence of other coun­tries and do not rep­re­sent any change in the trans­mis­sion or vir­u­lence of the virus.

Over 99% of sub­typed influenza A viruses in the Europe were pan­demic H1N1 2009 with the excep­tion of the Russ­ian Fed­er­a­tion where <10% of viruses subtyped were seasonal influenza subtypes, H3N2 and seasonal H1N1.

In West­ern Asia, increas­ing activ­ity has been observed in sev­eral coun­tries. In Israel, sharp increases in rates of ILI and pan­demic virus detec­tions have been observed over the past 3 weeks. In Afghanistan, the pro­por­tion of sen­tinel vis­its for acute res­pi­ra­tory infec­tions (ARI) has increased over the past 3–4 weeks, but more dra­mat­i­cally in the last 1–2 weeks.

In East Asia, very intense and increas­ing influenza activ­ity con­tin­ues to be reported in Mon­go­lia with a severe impact on the health­care sys­tem. In China, the pro­por­tion of sen­tinel hos­pi­tal vis­its for ILI and the pro­por­tions of res­pi­ra­tory sam­ples test­ing pos­i­tive for influenza, con­tin­ued to increase over the past 3–4 weeks. More than 80% of influenza viruses iso­lated in China were pan­demic H1N1 2009. In Hong Kong SAR, rates of ILI have returned base­line after a recent wave of pre­dom­i­nantly pan­demic H1N1 influenza in Sep­tem­ber and Octo­ber. In Japan, sharp increases in influenza activ­ity con­tinue to be reported nation­ally. On north­ern island of Hokkaido, which to date has been the most heav­ily affected, dis­ease activ­ity may have recently peaked.

Although active, pre­dom­i­nantly pan­demic influenza trans­mis­sion per­sists in the Caribbean region, dis­ease activ­ity may have recently peaked in some places as evi­denced by recently declin­ing rates of ARI and severe acute res­pi­ra­tory infec­tions (SARI) in the Caribbean Epi­demi­ol­ogy Cen­tre (CAREC) coun­tries. Most other coun­tries in the trop­i­cal region of Cen­tral and South Amer­ica con­tinue to report declin­ing influenza activity.

With the excep­tion of Nepal and Sri Lanka, over­all trans­mis­sion con­tin­ues to decline in most parts of South and South­east Asia.

In the tem­per­ate region of the south­ern hemi­sphere, lit­tle pan­demic influenza activ­ity has been reported in recent weeks. Of note, a clus­ter of pan­demic influenza cases been reported in Argentina in the cap­i­tal area.

WHO

Europe:

Sev­en­teen coun­tries have reported increases in influenza-like ill­ness (ILI) and/or ARI con­sul­ta­tions (defined as coun­tries with increases in the pre­vi­ous three weeks). These increases are par­tic­u­larly notable in the group aged 5–14 years. In eight of these coun­tries (Ger­many, the Nether­lands, Nor­way, Repub­lic of Moldova, Roma­nia, Slo­va­kia, Spain and Swe­den), the pos­i­tiv­ity rate of sen­tinel swab spec­i­mens exceeded 20% (min­i­mum num­ber of tested sen­tinel spec­i­mens: 20).

The inten­sity of clin­i­cal activ­ity was described as very high in Nor­way, Swe­den, Bul­garia and the Repub­lic of Moldova for the first time. Other coun­tries report­ing con­tin­ued very high inten­sity this week were Ice­land, Ire­land and the Russ­ian Fed­er­a­tion (Urals region and far east­ern region). Eight countries/regions described high clin­i­cal activ­ity: Belarus, Fin­land, Kaza­khstan, Poland, Russ­ian Fed­er­a­tion (cen­tral, north-western, Siber­ian and Volga region), Turkey, Ukraine and North­ern Ire­land. The clin­i­cal inci­dence of ILI and/or ARI was reported as wide­spread in 19 coun­tries. The Repub­lic of Moldova reported very high inten­sity, wide­spread clin­i­cal inci­dence and severe impact of influenza on health ser­vices. Impact was reported as mod­er­ate in nine coun­tries, includ­ing Ukraine, and low in 17 others.

EuroFlu