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.

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.

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.

Here is the weekend summary of swine flu / novel H1N1 cases around the globe. Because of various reporting deadlines the numbers may not appear the same on all reports. In addition, many of the states and Federal agencies in the United States have reduced or eliminated regular reporting.

WHO for May 23, 2009: 12,022 cases and 86 deaths in 43 countries.

Nicaragua, Venezuela and Bolivia have not reported any cases of swine flu. Is it true, or are their politics keeping them from reporting?

Canada as of May 22, 2009: 805 cases in 9 provinces and 1 territory, with 1 death. The median age of the cases is 21, meaning that half of the cases are age 21 or younger.

Department of Defense as of May 20, 2009: Reporting once a week now. 294 total cases. All cases are included in the counts by state health agencies and the CDC. Largest new outbreak is at Fort Riley, Kansas with 13 cases since the last DoD report.

CDC Report as of May 22, 2009: 6,552 cases and 9 deaths. CDC numbers continue to vary from state website numbers in some cases. It is not just reporting times differ. It appears that CDC is not pursuing updates from states as there have been occasions that CDC number has remained the same for several days despite state site changes.

Swine flu cases by city/metro area: Milwaukee=706, Chicago=668, Seattle=499, Phoenix=261, NYC and nearby counties=323.

Swine flu cases in Update NY counties: Erie=17 Buffalo area, Onondaga=11 Syracuse area.

Texas exploding with swine flu cases. Only rpting twice a week. 1,359 cases as of today. Rio Grande counties Cameron + Hildalgo=381 cases Milwaukee +194 cases in 4 days, Chicago +155, Seattle +132.

Florida is no longer reporting swine flu numbers on their site. Louisiana’s numbers make little sense. CO and SC counts difficult to locate on website.

The World Health Organization is the primary source for case information for nations outside of North America. It issues its report daily at 6 am GMT, which a couple of hours after midnight on the East Coast of the U.S.

Its case numbers for the United States, Canada and Mexico are “yesterday’s” numbers. The lag will continue as long as WHO stays on its current reporting schedule.

There are 9,830 cases of novel H1N1, or swine flu, that have been diagnosed worldwide. 79 deaths are due to this illness.

Several things leap out from the report. Nicaragua and Belize have not reported any cases, even though other nations in Central America have. Neither have Bolivia or Venezuela.

They may not have any cases. A more concerning scenario is that they do not have the capability to detect or diagnose the illness. A truly concerning scenario for Nicaragua, Bolivia or Venezuela would be that their political issues with the United States are preventing testing and diagnosis.

The nightmare for public health officials is the populous country that does not cooperate with international bodies when it comes to epidemics. It may be politics, or, in the cases of a nation like Somalia, they may not have the capacity to work with WHO or the CDC. This creates a “black hole” in the web of detection, prevention and treatment that public health authorities are weaving.

What can be done about a country that clearly could be a threat to the health of its neighbors and the world? Today it is the relatively benign swine flu, but tomorrow it could be something far worse.

The situation continues to evolve rapidly. As of 06:00 GMT, 1 May 2009, 11 countries have officially reported 331 cases of influenza A(H1N1) infection.

The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 156 confirmed human cases of infection, including nine deaths.

The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (34), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).

Further information on the situation will be available on the WHO website on a regular basis. WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

WHO

Cannot reach CDC or WHO sites at this moment. Media is reporting that WHO has raised the pandemic alert level to 5.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

So far, all this means is that human to human [h2h] transmission has been seen in two or more parts of the globe.

I will update this article as more information becomes available.

World Health Organization Influenza Pandemic Alert Phases

WHO

The Emergency Committee, established in compliance with the International Health Regulations (2005), held its second meeting on 27 April 2009.

The Committee considered available data on confirmed outbreaks of A/H1N1 swine influenza in the United States of America, Mexico, and Canada. The Committee also considered reports of possible spread to additional countries.

On the advice of the Committee, the WHO Director-General decided on the following.

The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.

The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.

As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.

This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.

Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.

The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.

The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus.

The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.

WHO

The current situation regarding the outbreak of swine influenza A(H1N1) is evolving rapidly. As of 27 April 2009, the United States Government has reported 40 laboratory confirmed human cases of swine influenza A(H1N1), with no deaths. Mexico has reported 26 confirmed human cases of infection with the same virus, including seven deaths. Canada has reported six cases, with no deaths, while Spain has reported one case, with no deaths.

Further information on the situation will be available on the WHO website on a regular basis.

WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

The United States Government has reported seven [now 8] confirmed human cases of Swine Influenza A/H1N1 in the USA (five [now six] in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.

The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from 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, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.

The World Health Organization has been in constant contact with the health authorities in the United States, Mexico and Canada in order to better understand the risk which these ILI events pose. WHO (and PAHO) is sending missions of experts to Mexico to work with health authorities there. It is helping its Member States to increase field epidemiology activities, laboratory diagnosis and clinical management. Moreover, WHO’s partners in the Global Alert and Response Network have been alerted and are ready to assist as requested by the Member States.

WHO acknowledges the United States and Mexico for their proactive reporting and their collaboration with WHO and will continue to work with Member States to further characterize the outbreak.

World Health Organization