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

The CDC continues to release data on Fridays for the previous week. The data in this report is for the week ending November 7 and was released November 13, 2009.

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1. Visits to doctors for influenza like illness: second week that rates have declined. Now 6.7% and the seasonal baseline is 2.3%. Note, however, that many doctors are telling patients who call with ILI symptoms not to come in to the office unless it is serious.
2. Hospitalizations for lab confirmed influenza: still climbing.
3. Deaths from pneumonia and influenza: still increasing.
4. 46 states report widespread flu activity. That is down two states since the last weekly report.
5. Virus typing continues to find nearly all specimens are pandemic H1N1, swine flu.

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Don’t miss my television interview on the Time Warner local new channel, YNN. I was asked to counterpoint the county medical society president.

Is the Vaccine Production Process Broken?

Here are case counts for the pandemic swine flu, or pandemic novel H1N1 from the top five cities in the United States.

1. Milwaukee: 3,085 cases
2. Chicago and Cook county: 2,203 cases
3. New York City with Nassau, Suffolk, Rockland and Westchester counties: 1,449 cases
4. New York City alone: 1,149 cases
5. Hildalgo County, Texas: 600 cases

Here is the latest pandemic flu case count for selected cities and metro areas. Those cities in gray have ceased posting their counts, or are no longer counting.

Here are the latest available case counts for pandemic swine flu or pandemic novel H1N1 for select cities and urban area.

The World Health Organization reports that as of June 17 there are 39,520 cases reported of pandemic swine flu or pandemic novel H1N1. 167 deaths due to the pandemic are reported. Of course, the country with the greatest number of cases, the U.S, only reports on Friday so the total is very understated. We are reporting 20,630 cases in the United States as of June 17.

Latin American nations marked with this color.

Here is a list of every nation reporting over 100 cases of pandemic swine flu.

Here are some select cities and metro areas and the numbers of swine flu or novel H1N1 cases reported for them on their respective state sites. Chicago and Cook County, Illinois, stands out as does Hildalgo County, Texas, the county along the Rio Grande just upstream from Brownsville.

The WHO is set to announce officially that novel H1N1 or swine flu has reached official pandemic status. That is a phase six. This is the first influenza pandemic since the Hong Kong flu of 1968.

A pandemic declaration is based on the spread of the illness and not necessarily upon how deadly it is. Of the four influenza pandemics in modern times, 1918 Spanish Flu, the 1957 Asian Flu and the 1968 Hong Kong Flu, this outbreak appears to be the mildest. That could change but for now we have an influenza pandemic from a mild strain.

This declaration puts national governments on the spot. Most have prepared a pandemic flu plan with the steps that they would take when a pandemic is declared. For many nations, this means expenditure of money and resources they do not have. As with many international agreements, the wealthier countries are far readier and able to comply.

The United States plan can be found at PandemicFlu.gov. The plan provides for eventualities such as a very deadly illness that might require internal travel restrictions and quarantines.

The Centers for Disease Control (CDC) are your best source for authoritative information about influenza, swine flu, and the steps you should be taking.

WHO has gone to reporting cases counts on Monday, Wednesday and Friday. That is probably because the U.S. is doing so and half the cases of swine flu or novel H1N1 are in the U.S.

As of this morning, WHO reports that 69 nations have reported cases, for a total of 21,940. 125 deaths have been reported.

The way this will work is that the CDC will make its report after 11 am today, and the next WHO report will be in three days, on Monday. Current public data is not important to the various public health agencies, based on their inability to synchronize their reports.

Australia, Canada, Mexico and the United States have the most new cases. The outbreak is not finished in Mexico despite their lifting of the various restrictions on public activity. Central and South American countries are at the very beginning of their outbreaks, with small total numbers but significant new cases.

There are no reports of cases in Africa except the lone individual in Egypt.

Here is a selection of cities and counties reporting cases of novel H1N1 or swine flu. The blanks indicate an addition, or in a few cases, the lack of new data. Some states are electing to not publicly report their cases, or to only report hospitalizations for the illness.

The World Health Organization reports 19,273 cases of novel H1N1 or swine flu as of this morning. There have been 117 related deaths.

WHO map of nations reporting cases of novel H1N1 or swine flu as of June 3, 2009. Click on image for a larger map.

The table below shows the top ten countries reporting outbreaks.

Map of New York State showing counties and their swine flu or novel H1N1 case totals. As of June 1, 2009.

645 cases of novel H1N1 or swine flu in New York State as of this afternoon. 415 cases are in New York City, and adding in the adjacent counties, the NY metro total is 544 cases. Buffalo and Erie County have 41 cases. Onondaga County and Syracuse have 29 cases.

Map of New York State swine flu or novel H1N1 cases by county. May 29 2009. Click on map for larger image.

Here is the list of New York City school closings.

Erie County and Buffalo info

Erie County map of case locations by zip code

Onondaga County and Syracuse info

Here are some swine flu or novel H1N1 case counts for select United States cities or metro areas. Missing reports are due to the state health authorities no longer posting counts on their websites.

It is worrisome that both Washington state and Wisconsin have ceased public reporting. Seattle, Milwaukee and Madison have large outbreaks of swine flu and that data would be useful.

Map of New York State counties with novel H1N1 or swine flu cases as of May 27. Click image for larger map.

New York City school closings can be found at this link.

Erie County Health Commissioner suggests students with influenza like illness be banned from school. Williamsville schools are the center of a cluster of swine flu cases.

And, a new case in Monroe County. Elementary school student in Churchville-Chili School District.