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Pandemic (H1N1) 2009 - update 91

Weekly update

12 March 2010 -- As of 7 March 2010, worldwide more
than 213 countries and overseas territories or communities have
reported laboratory confirmed cases of pandemic influenza H1N1 2009,
including at least 16713 deaths.

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
information.

Situation update:

The most active areas of pandemic influenza transmission
are currently in Southeast Asia, however, lower levels of pandemic
virus circulation persist in other parts of Asia and in Eastern and
South-eastern Europe. In West Africa, limited data suggests that
pandemic influenza virus transmission may be increasing in region.
Of note, seasonal influenza B viruses have been increasingly
detected in Asia and appear to be spreading westward.

In Sub-Saharan Africa, limited data suggests that on-going
community transmission of pandemic influenza virus continues to
increase in parts of West Africa, without clear evidence of a peak
in activity. Increased detections of pandemic influenza virus have
been observed among sentinel surveillance sites in several
countries, including Senegal and Cote D'Ivoire, however, to date,
data is limited regarding the spectrum of clinical severity of
cases. Recent increases in influenza activity have also been
reported in Rwanda. Much of eastern and southern Africa likely
experienced an earlier peak in pandemic influenza activity during
November 2009 and late summer 2009, respectively.

In South and Southeast Asia, pandemic influenza virus
circulation persist in most countries, however, overall transmission
remains most active in Thailand, especially since mid January 2010.
Approximately half of all provinces in Thailand reported that
greater than 10% of all outpatients sought care for ILI, and
approximately 25% of all patients with ILI at sentinel sites tested
positive for influenza. The current increase in the number of cases
in Thailand remains well below an earlier period of peak
transmission during June through September 2009. In Bangladesh, an
increasing trend in respiratory disease was reported, however,
overall influenza activity remains low. In India, influenza virus
transmission persist at lower levels in the western region of India,
while activity in other regions has largely subsided.

In East Asia, pandemic influenza activity continues to
decrease or remain low as levels of ILI return to seasonal baselines
in Japan and in the Republic of Korea. In Mongolia, a recent sharp
increase in ILI activity was associated predominantly with a
resurgence of circulation of seasonal influenza B viruses. In China,
pandemic influenza activity has declined since peaking during
November 2009, however, overall influenza activity remains elevated,
largely due to an increase in the circulation of seasonal influenza
B viruses.

In North Africa and Western Asia, overall pandemic
influenza activity remains low in most places, with the exception of
Iraq and Afghanistan, both of which reported regional spread of
influenza with an increasing trend in respiratory diseases activity.
In Afghanistan, a moderate impact on the healthcare system was
reported in association with increased respiratory diseases
activity. Although overall influenza activity remains low in Iran,
all recent influenza virus detection have been due to seasonal
influenza B viruses.

In Europe, overall pandemic influenza transmission
continued to decline as low levels of pandemic virus continue to
circulate in parts of eastern and south-eastern Europe. The overall
percentage of sentinel respiratory specimens testing positive for
influenza remained low (6.8%) but slightly increased compared to the
previous week. Pandemic H1N1 2009 virus continues to be the
predominant circulating influenza virus in the European region with
the exception of the Russian Federation and Sweden where influenza B
was reported as co-dominant or dominant.

In the northern and the southern temperate zones of the
Americas, overall pandemic influenza transmission remained low as
influenza virus continued to circulate at low levels. In Central
America, Nicaragua and Honduras, reported slight increases in
respiratory diseases activity, possibly due to an increase in school
outbreaks; however, it is unclear to what extent the increases are
associated with circulation of pandemic influenza virus. In Brazil,
an increasing trend of respiratory diseases with low overall
intensity was reported in association with regional spread of
influenza virus.

In the temperate zone of the southern
hemisphere, overall influenza activity remained low, with sporadic
detections of pandemic and seasonal influenza viruses.

Although pandemic influenza virus continues to be the
predominant circulating influenza virus worldwide, circulation of
seasonal influenza B viruses continue to increase and spread across
Asia, parts of Eastern Europe, and Eastern Africa, but most notably
in China, Mongolia, Iran and the Russian Federation.

The Global Influenza Surveillance Network (GISN) continues
monitoring the global circulation of influenza viruses, including
pandemic, seasonal and other influenza viruses infecting, or with
the potential to infect, humans including seasonal influenza. For
more information on virological surveillance and antiviral
resistance please see the weekly virology update (Virological
surveillance data, below).
Weekly
update (Virological surveillance data)

(NEW)
Weekly update on oseltamivir resistance to pandemic influenza A
(H1N1) 2009 viruses [pdf 18kb]

*Countries in temperate regions are defined as those north
of the Tropic of Cancer or south of the Tropic of Capricorn, while
countries in tropical regions are defined as those between these two
latitudes.

**Abbreviations: influenza-like-illness (ILI),
acute respiratory infection (ARI), and severe acute respiratory
infection (SARI)
WHO
Clinical Management Guidelines for Human infection with Pandemic
(H1N1), 2009:

WHO
Guidelines for Pharmacological Management of Pandemic (H1N1) 2009
Influenza and other Influenza Viruses:

(NEW) Map of influenza activity and virus
subtypes (Week 8: 21 February -27 February 2010)
Map
of influenza activity and virus subtypes [png
267kb]
Description: Displayed data reflect the most recent
data reported to Flunet (www.who.int/FluNet), WHO regional offices
or on Ministry of health websites in the last 2 weeks. The percent
of specimens tested positive for influenza includes all specimens
tested positive for seasonal or pandemic influenza. The pie charts
show the distribution of virus subtypes among all specimens that
were tested positive for influenza. The available country data were
joined in larger geographical areas with similar influenza
transmission patterns to be able to give an overview
(http://www.who.int/csr/disease/swineflu/transmission_zones/en)

Qualitative indicators (Week 29 to Week 8: 13
July 2009 - 27 February 2010)

The qualitative indicators monitor: the global geographic
spread of influenza, trends in acute respiratory diseases, the
intensity of respiratory disease activity, and the impact of the
pandemic on health-care services.
Human
infection with pandemic (H1N1) 2009 virus: updated interim WHO
guidance on global surveillance

The maps below display information on the qualitative
indicators reported. Information is available for approximately 60
countries each week. Implementation of this monitoring system is
ongoing and completeness of reporting is expected to increase over
time.
List
of definitions of qualitative indicators

Geographic spread of influenza
activity
Map timeline

Trend of respiratory diseases activity
compared to the previous week
Map timeline

Intensity of acute respiratory diseases in
the population
Map timeline

Impact on health care services
Map timeline

Laboratory-confirmed cases of pandemic (H1N1)
2009 as officially reported to WHO by States Parties to the IHR
(2005) as of 7 March 2010
Map of affected countries and deaths

The countries and overseas territories/communities that
have newly reported their first pandemic (H1N1) 2009 confirmed cases
since the last web update (No. 90): None.

The countries and overseas territories/communities that
have newly reported their first deaths among pandemic (H1N1) 2009
confirmed cases since the last web update (No. 90): None.

Region

Deaths*

WHO
Regional Office for Africa
(AFRO)

167

WHO
Regional Office for the Americas (AMRO)

At
least 7576

WHO
Regional Office for the Eastern
Mediterranean (EMRO)

1019

WHO
Regional Office for Europe
(EURO)

At
least 4571

WHO
Regional Office for South-East
Asia (SEARO)

1664

WHO
Regional Office for the Western Pacific (WPRO)

1716

Total*

At
least 16713

* The reported number of fatal cases is an under
representation of the actual numbers as many deaths are never tested
or recognized as influenza related.

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