2010년 4월 30일 발표 WHO 통계

2010년 4월 25일까지 Pandemic (H1N1) 2009 사망자 17919명(214국 이상에서 실험실 확정진단 환자 발생)

Pandemic (H1N1) 2009 – update 98

Weekly update

30 April 2010 — As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17919 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 current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

In Sub-Saharan Africa, data from a limited number of countries suggests that active transmission of pandemic influenza H1N1 virus is declining across West and West-central Africa. Ghana is reporting moderate amounts of pandemic virus (16 % of all clinical specimens tested were positive for pandemic influenza) but smaller numbers of cases continue to be detected in Senegal, Niger and Cameroon. In East Africa, influenza activity has returned to low levels. Only Rwanda has detected small numbers of pandemic virus in the past week. In addition, a few seasonal influenza H3N2 viruses are seen in Ghana. Influenza type B has been increasingly detected in the area, notably in Ghana and Cameroon.

In East Asia, pandemic influenza H1N1 virus circulation is now sporadic. In China, Mongolia, and Republic of Korea most influenza like illness cases continued to be primarily due to seasonal influenza type B viruses. In China and Mongolia influenza detections have continued to decline compared to previous recent weeks. The Republic of Korea reported increasing levels of respiratory disease activity associated with increasing detections of seasonal influenza type B in respiratory specimens over five consecutive weeks. Of note, small numbers of pandemic influenza H1N1, seasonal H3N2 and H1N1 viruses continued to be sporadically detected in some countries of the region.

In Southeast Asia, overall levels of influenza activity were low. Although the predominant influenza virus circulating was still pandemic influenza H1N1, there was co-circulation of seasonal influenza type B and, to a lesser extent, H3N2 viruses in several countries including Singapore, Cambodia, Indonesia and Thailand. Malaysia has reported increasing levels of respiratory diseases activity associated with pandemic influenza H1N1 laboratory confirmed cases. Media sources have also reported school closures in the country. In Singapore, influenza-like-illness levels are still below the seasonal epidemic threshold but have increased compared to previous week.

In South Asia, Bangladesh reported an increase in respiratory diseases activity associated with increasing numbers of pandemic influenza H1N1 laboratory confirmed cases since beginning of April. India reported pandemic influenza activity in the states of Maharashtra and recently Karnataka. Levels of respiratory diseases activity in both of these countries appear much less intense than in the initial wave of transmission which occurred late 2009. Although pandemic influenza is the predominant virus circulating in the region, seasonal influenza type B viruses continued to be detected in Iran and Bangladesh.

In the tropical zone of the Americas, limited data suggested that pandemic influenza H1N1 activity remains low but with a few localized areas of transmission. Jamaica, Panama and Guatemala, reported increasing trends in respiratory disease activity. In Cuba, all provinces reported an increase in numbers of acute respiratory diseases cases in the last two weeks, mainly from the city of Havana. In Peru, the number of pneumonia cases in children under 5 years of age in Lima has been increasing since six consecutive weeks and remained above the epidemic threshold. However, the extent to which these pneumonia cases have been due to pandemic influenza H1N1 virus is not known. Notably, respiratory syncitial virus (RSV) has been reported to be circulating in the area.

In the temperate zone of the Northern Hemisphere, overall pandemic influenza H1N1 activity remained low. In United States, the proportion of outpatient visits for influenza-like illness was below the national baseline. No influenza B is reported by countries of North America. In Europe, pandemic influenza activity is at very low intensity in all countries. The overall proportion of sentinel respiratory samples testing positive for influenza remained stable at about 4.5%. For the current week, the total number of sentinel influenza B detections continued to exceed that of influenza A, mainly due to viral detections from Eastern Europe: Central, Siberian, Far Eastern regions of the Russian Federation and Kazakhstan.

In the temperate countries of the Southern Hemisphere, influenza-like illness activity remained low and at the levels experienced at the same time in previous years. Australia has continued to report sporadic detections of pandemic influenza H1N1, seasonal influenza B and H3N2 viruses in low numbers in recent weeks.

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)
The cumulative total for reports of antiviral resistant isolates of pandemic (H1N1) 2009 virus remains at 285. There have been no new cases reported since the situation update on 16 April 2010.

28 April 2010 — For this reporting week (15-28 April 2010), no additional cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. The cumulative total remains at 285 so far. All but one of these have the H275Y substitution and are assumed to remain sensitive to zanamivir.

*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:

MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 15: 11 APRIL – 17 APRIL 2010)

Map of influenza activity and virus subtypes [png 230kb]
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 15: 13 July 2009 – 17 April 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 25th of April 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. 97): 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. 97): none.

Region	Deaths*
WHO Regional Office for Africa (AFRO)	168
WHO Regional Office for the Americas (AMRO)	At least 8316
WHO Regional Office for the Eastern Mediterranean (EMRO) **	1019
WHO Regional Office for Europe (EURO)	At least 4835
WHO Regional Office for South-East Asia (SEARO)	1773
WHO Regional Office for the Western Pacific (WPRO)	1808
Total*	At least 17919

*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.
**No update since 7 March 2010

Pandemic (H1N1) 2009 – update 80

Weekly update

23 December 2009 — As of 20 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 11516 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 data.

Situation update:

In the temperate zone* of the northern hemisphere, transmission of pandemic influenza virus remains active and geographically widespread, however overall disease activity has recently peaked in much of the hemisphere. There continues to be increases in influenza activity in later affected areas of central and eastern Europe, and in parts of west, central, and south Asia.

In United States and Canada, influenza activity continues to be geographically widespread but overall levels of ILI** have declined substantially to near the national baseline level in the US and below the seasonal baseline in Canada. Although numbers of hospitalizations and death in US have declined steadily since their peak over 6 weeks ago, the proportional mortality due to pneumonia and influenza (P&I mortality) remains elevated above the epidemic threshold for the 11th consecutive week. In Canada, rates of ILI, numbers of outbreaks, and proportions of samples testing positive for influenza have declined substantially since peaking six weeks ago. Approximately 53% of hospitalized cases in Canada had an underlying medical condition; cases with underlying medical conditions tended to be older (compared to those without), and were at increased risk of hospitalization and death. Also from Canada, a smaller proportion of hospitalized cases during the winter transmission season compared with those hospitalized cases during the summer transmission season, were persons of aboriginal origin (3.9% vs. 20.3%).

In Europe, geographically widespread and active transmission of pandemic influenza virus continued to be observed throughout the continent, however, overall pandemic influenza activity appears to have recently peaked across a majority of countries. At least ten countries reported that 30% or more of their sentinel respiratory specimens had tested positive for influenza. Greater than 98% of subtyped influenza A viruses detected in Europe were pandemic H1N1 2009, however, seasonal influenza viruses (H1N1, H3N2, and type B) continue to be detected at low levels. Of note, a few countries are experiencing increasing disease activity and have yet to peak (Hungary and Montenegro ), while several others are experiencing a resurgence in activity (Serbia, Ukraine, Georgia, and Turkey). Rates of ILI have returned to near seasonal baselines in the earlier affected areas of western Europe (Belgium, the Netherlands, Ireland, and Iceland) and a substantial decline in activity has been observed in much of northern Europe over the past month. In central and southern Europe, where influenza virus transmission has been most active recently, disease activity in most places has either plateaued (Albania, Czech Republic, Estonia) or begun to decline (Austria, Germany, Poland, Latvia, Croatia, Slovakia, and Greece). Further east, influenza activity appears to be variable, with the Russian Federation reporting a steady decline in rates of ARI after a recent peak three weeks ago; while several other countries are reporting increases in rates of ILI/ARI (Ukraine and Georgia). In Europe, the highest rates of ILI have been recorded among children 0-4 years of age (in 15 countries) and among older children 5-14 years of age (in 18 countries). Detections of RSV in Europe continued to increase over the past six weeks, partially accounting for elevated ILI activity among young children in some countries.

In Western and Central Asia, limited data suggest that influenza virus circulation remains active throughout the region, however disease trends remain variable. Increasing respiratory diseases activity continued to be reported in Kazakhstan and in Egypt; while several others countries, Israel and Oman, have been reporting declining trends of respiratory diseases activity after recording a peak of activity approximately one month ago.

In East Asia, the situation remains similar to last week; influenza transmission remains active but appears to be declining overall. Influenza/ILI activity has recently peaked and continues to decline in Japan, in northern and southern China, Chinese Taipei and in Mongolia. In southern Asia, influenza activity continues to increase in the northern India, Nepal, and, Sri Lanka.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for in Barbados and Ecuador, were recent increases in respiratory diseases activity have been reported.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza continued to be reported without evidence of sustained community transmission.

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).

*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)

Qualitative indicators (Week 29 to Week 50: 13 July – 13 December 2009)

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.

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.

Geographic spread of influenza activity

Trend of respiratory diseases activity compared to the previous week

Intensity of acute respiratory diseases in the population

Impact on health care services

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 20 December 2009

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.79): 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 79): Georgia and Albania.

Region	Deaths*
WHO Regional Office for Africa (AFRO)	109
WHO Regional Office for the Americas (AMRO)	At least 6670
WHO Regional Office for the Eastern Mediterranean (EMRO)	663
WHO Regional Office for Europe (EURO)	At least 2045
WHO Regional Office for South-East Asia (SEARO)	990
WHO Regional Office for the Western Pacific (WPRO)	1039
Total*	At least 11516

* 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.

Pandemic (H1N1) 2009 – update 79

출처 : http://www.who.int/csr/don/2009_12_18a/en/index.html

Weekly update

18 December 2009 — As of 13 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 10582 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 data.

Situation update:

In the temperate zone* of the northern hemisphere, transmission of pandemic influenza virus remains active and geographically widespread, however disease activity has peaked or passed its peak in many places, particularly North America. Influenza activity continues to increase in later affected areas of south-eastern and central Europe, and in central and south Asia.

In United States and Canada, active influenza transmission persists but overall levels of ILI** have declined substantially to near seasonal baselines. In the US, proportional mortality due to pneumonia and influenza (P&I mortality) has remained consistently elevated above the epidemic threshold for the past 10 weeks; however, weekly numbers of lab-confirmed hospitalizations and deaths continue to decline over the past month.

The preliminary analysis of data from Northern Hemisphere countries that have now passed through an entire season of winter transmission indicate that the mortality rate, as expressed in fatal cases per million people, is in the same range as that which was observed in the Southern Hemisphere winter. This would indicate that the overall severity of the pandemic has not changed although the proportion of the population infected has been much higher in the temperate countries of the Northern Hemisphere during their winter season compared to the circulation observed in their summer season.

In Europe, geographically widespread and active transmission of pandemic influenza virus continued to be observed across the continent. At least 10 countries, mostly in western and northern Europe, reported declining respiratory disease activity. During the last reporting period, ILI/ARI activity continued to increase or reach a plateau in a limited number of countries: the Czech Republic, Estonia,, Hungary, Montenegro and Switzerland (a range of 28-71% of sentinel respiratory samples were positive for influenza in these countries). A high intensity of respiratory disease activity was reported in parts of northern and south-eastern Europe and in parts of the Russian Federation. 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009. Detections of RSV in Europe continued to increase over the past five weeks, partially accounting for elevated ILI activity among young children in some countries.

In Western and Central Asia, influenza transmission remains active. ILI/ARI activity continues to increase in Kazakhstan and Kyrgyzstan, and has peaked in some countries including in Afghanistan, Oman, and Israel. Influenza virus continues to circulate in Iran, Iraq, Jordan, Egypt and in much of the surrounding region but may have recently peaked in some parts.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza activity has recently peaked and begun to decline in Japan. ILI activity continued to decline but remained elevated in northern and southern China, Chinese Taipei and in Mongolia. In southern Asia, influenza activity continues to increase in the northern parts of India, Nepal, Sri Lanka, and the Maldives.

In the tropical region of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining.

Pandemic H1N1 2009 virus appears to be the predominant influenza virus circulating in northern and eastern Africa. In West Africa, a mixture of pandemic and seasonal influenza viruses have been detected. Seasonal viruses have included both seasonal H1N1 and H3N2, with the later predominating.

In the temperate region of the southern hemisphere, sporadic cases of pandemic influenza are being reported without evidence of sustained community transmission.

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).

*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)

Qualitative indicators (Week 29 to Week 49: 13 July – 6 December 2009)

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.

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.

Geographic spread of influenza activity

Trend of respiratory diseases activity compared to the previous week

Intensity of acute respiratory diseases in the population

Impact on health care services

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 13 December 2009

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No.78): 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 78): Bahamas, Bosnia & Herzegovina, Estonia, Montenegro, Libyan Arab Jamahiriya.

Region	Deaths**
WHO Regional Office for Africa (AFRO)*	109
WHO Regional Office for the Americas (AMRO)	At least 6335
WHO Regional Office for the Eastern Mediterranean (EMRO)	572
WHO Regional Office for Europe (EURO)	At least 1654
WHO Regional Office for South-East Asia (SEARO)	892
WHO Regional Office for the Western Pacific (WPRO)	1020
Total**	At least 10582

* No update since web update no. 78

** 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.

Pandemic (H1N1) 2009

출처 : The Medical Journal of Australia, 30 November 2009
http://www.mja.com.au/public/issues/192_02_180110/cha10960_fm.html

eMJA Rapid Online Publication – 30 November 2009

In early April 2009, a novel influenza A virus was identified in Mexico and Southern California.1 The subsequent rapid international spread and sustained community transmission in the Americas, Europe, New Zealand and Australia resulted in the World Health Organization escalating the pandemic influenza response to Phase 6 on 11 June 2009.2

The Australian Health Management Plan for Pandemic Influenza, which includes the ALERT, DELAY, CONTAIN, SUSTAIN, CONTROL and RECOVER phases of response,3 was predicated on pandemic influenza causing high morbidity and mortality. However, pandemic (H1N1) 2009 influenza appeared to be causing milder disease. Cases of severe disease and deaths have been reported,4 in particular, pregnant women could have severe disease.5,6 A modified strategy, the “PROTECT” phase, was thus enacted on 17 June 2009.7 It focused on identifying and treating infection in people with moderate to severe disease and those with certain risk factors (pregnancy and underlying chronic diseases), controlling outbreaks in institutions, and monitoring hospitalisation.8

The PROTECT phase coincided with the start of the influenza season in Sydney, and the surge in hospital admissions of patients with pandemic (H1N1) 2009 influenza coincided with the expected surge in seasonal influenza. This situation allowed us to compare patient characteristics, clinical features and outcomes of infection with pandemic (H1N1) 2009 influenza and seasonal influenza. Part of this work was presented at the 14th Congress of the Asian Pacific Society of Respirology in Seoul, Korea, 14–18 November 2009 (Poster no. APSR 2009-594).

Methods

We reviewed the medical records of all adult patients (aged 18 years and over) with a laboratory-confirmed diagnosis of influenza who were admitted to Liverpool Hospital, Sydney, from 17 June (the beginning of the PROTECT Phase) to 31 July 2009.

During this period, nose and/or throat swabs were collected from all patients admitted with an influenza-like illness. Following total nucleic acid extraction using the MagNA Pure System (Roche Diagnostics Australia, Sydney, NSW) influenza was confirmed by polymerase chain reaction using the Influenza 4 Easy-Plex assay kit (AusDiagnostics, Sydney, NSW). Subsequent typing was performed on all influenza A-positive isolates on the stored extract (− 80°C) using the Influenza 6 Easy-Plex assay kit (AusDiagnostics, Sydney, NSW).

Demographic and clinical details were extracted from the clinical notes and electronic information system. These details included age, sex, place of residence, and presence of comorbid conditions or risk factors for possible severe illness (eg, obesity, diabetes, pregnancy and immunosuppression). The date of onset of presenting influenza-like illness symptoms (coryza, fever, cough, breathlessness, chest pain, sore throat, lethargy, myalgia, vomiting, diarrhoea and abdominal pain), clinical signs and laboratory results (including haematological, biochemical, serological, microbiological and arterial blood gas results with patients breathing room air) were also extracted. The clinical course, management directed by the attending physicians, and outcomes at discharge were similarly recorded.

Chest x-rays were reviewed and classified according to the type, pattern and extent of any abnormalities. The principal respiratory diagnosis was made after review of the complete record, with pneumonia defined as the presence of consistent radiological abnormalities and clinical signs.

Health-care-associated influenza was defined as onset of symptoms more than 4 days after admission, to correspond with the upper limit of influenza virus incubation.9

Statistical analysis

Continuous and categorical data were analysed with Microsoft Office Excel 2007 (Microsoft Corporation, Redmond, Wash, USA) and SPSS student version 16.0 (SPSS Inc, Chicago, Ill, USA) using two-sample t tests, Fisher’s Exact test, or adjusted or unadjusted χ2 tests, as appropriate.

The study was approved by the Sydney South West Area Health Service, Human Research Ethics Committee (Project No. QA2009/047).

Results

Sixty-five patients were admitted to Liverpool Hospital with a laboratory-confirmed diagnosis of influenza between 17 June and 31 July 2009. One of these patients had been admitted for ischaemic gut, and was excluded from the analysis because the patient did not have a concurrent influenza-like illness. Of the remaining 64 patients, 48 tested positive for pandemic (H1N1) 2009 influenza and the remaining 16 tested positive for seasonal influenza A (11 for subtype H3 and five for untypeable non-pandemic [H1N1] 2009 influenza). The epidemic curve showed that the peak of the outbreak occurred around 8 July (Box 1). Five of the 64 cases of influenza (all pandemic [H1N1] 2009) were health-care associated.

Box 2 shows demographic characteristics and presenting features and outcomes for patients admitted with pandemic (H1N1) 2009 and seasonal influenza. Patients with pandemic (H1N1) 2009 influenza were significantly younger than those presenting with seasonal influenza (mean age, 45 years v 64 years; P < 0.01). Patients with seasonal influenza were more commonly immunosuppressed than patients with pandemic (H1N1) 2009 (P < 0.05). Although a relationship with pregnancy (patients in their postpartum period or pregnant) was more common in the pandemic (H1N1) 2009 group (eight patients v one patient with seasonal influenza), this difference did not reach statistical significance (Box 2).

Thirteen patients were admitted to the intensive care unit (ICU) — three with seasonal and 10 with pandemic (H1N1) 2009 influenza. The clinical course and hospitalisation of these patients is illustrated in Box 3. Of the three patients remaining in ICU, two died (patient 13 and patient 6 in Box 3 on 8 August and 12 August, respectively), with the remaining patient discharged alive from hospital on 23 September 2009.

Box 2 shows that the mean duration of symptoms before presentation was 4 days, with fever, cough and dyspnoea being the most common symptoms in both groups. Similarly, there was no difference in the clinical signs between the two groups, with a diagnosis of pneumonia occurring in similar proportions of patients with seasonal and pandemic (H1N1) 2009 influenza.

Laboratory results showed no difference between the two groups in mean total white blood cell count, nadir lymphocyte count, C-reactive protein concentration, and mean partial pressure of arterial oxygen (patients breathing room air) at presentation. Forty-six patients had blood cultures and 12 had sputum cultures performed. Three patients had bacterial co-infections with Streptococcus pneumoniae and Haemophilus influenzae confirmed by blood culture, and methicillin-sensitive Staphylococcus aureus was isolated from one sputum culture.

Chest x-rays were taken of 59 of the 64 patients, and abnormalities were detected in 31 patients. Abnormal radiological features ranged from localised infiltrates to bilateral airspace consolidation (Box 4). Four patients had radiological abnormalities attributable to chronic lung conditions without evidence of concurrent pneumonia.

Fifty-three hospitalised patients were treated with a neuraminidase inhibitor and antibiotics. Corticosteroids were significantly more likely to be prescribed in the seasonal influenza group compared with the pandemic (H1N1) 2009 group (P < 0.05; Box 2). However, all corticosteroid use was deemed to be for treatment of an underlying respiratory illness rather than influenza. Treatment response did not differ significantly between the two groups, and the overall mean time to defervescence was 2.6 days (range, 0–10 days) and mean number of days in hospital was 8 days (range, 0–61 days). Overall, there were five deaths (four in the pandemic (H1N1) 2009 group and one in the seasonal influenza group). Two deaths occurred in the ICU (see above).

Discussion

A major strength of our study was that the epidemics of seasonal and pandemic (H1N1) 2009 influenza occurred concurrently, which allowed us to make a direct comparison. Our data show that there was no difference between the two groups except that patients admitted with pandemic (H1N1) 2009 influenza tended to be younger and less immunocompromised. The clinical, radiological and laboratory features at presentation were similar in both patient groups, as were the clinical course, management and outcomes. Our findings show that, for hospitalised patients, the clinical manifestations and severity of pandemic (H1N1) 2009 and seasonal influenza were similar. This suggests that the number of admissions to our hospital and ICU reflected the higher burden of disease in the community rather than a greater virulence of the novel pandemic influenza virus.

Significant morbidity and mortality from influenza in pregnant women during previous pandemics has been reported.10,11 For seasonal influenza, the highest morbidity for pregnant women occurred in the third trimester.12 There have been several reports that pregnant women are at increased risk of severe complications from pandemic (H1N1) 2009 influenza.5,6 However, we were unable to demonstrate a difference in clinical severity between the seasonal and the pandemic viruses. The reliability of our estimate is limited by the small sample size, and a definitive answer to this question requires a multicentre study.

The clinical and epidemiological characteristics of 18 people hospitalised with pneumonia caused by pandemic (H1N1) 2009 influenza in Mexico City have been reported.13 The age, presence of comorbid conditions, presenting symptoms, laboratory findings and clinical features were similar to those in our group. However, in the Mexican series the higher proportion of abnormalities on chest x-ray (all patients), the number of patients with severe disease requiring invasive ventilation (12), and the mortality rate (39%) differ from our series (mortality rate, 8%). This could reflect differing admission criteria and smaller numbers.

In conclusion, our study shows that the clinical disease caused by the novel pandemic (H1N1) 2009 influenza virus in humans is comparable to that caused by the current circulating seasonal influenza strains in Sydney. The number of patients with severe disease reflects the disease burden in the community resulting from the pandemic. Pregnant women are at risk of severe infection from influenza, but whether pandemic (H1N1) 2009 influenza is particularly virulent in pregnant women and those in their postpartum period requires further study. It remains unclear whether antiviral drugs alter the clinical course of severe influenza infection.

1 Admissions to Liverpool Hospital of 64 adults with confirmed seasonal and pandemic (H1N1) 2009 influenza during the “PROTECT” phase of the epidemic*

* The peak of both epidemics occurred around 8 July 2009.

2 Demographic, clinical and laboratory features of the 64 patients admitted to Liverpool hospital with seasonal and pandemic (H1N1) 2009 influenza, 17 June to 31 July 2009

Patient features	Seasonal influenza	H1N1 2009 influenza
No. of patients	16	48
Mean age (years)	64	45*
No. female	13	30
Comorbid conditions
None	6	21
Chronic obstructive pulmonary disease	4	9
Obesity	2	9
Diabetes	1	15
Immunocompromised	7	8*
Pregnancy related	1†	8‡
Community acquired	16	43
Health-care associated	0	5
Symptoms
Fever	15	46
Cough	15	34
Dyspnoea	8	33
Lethargy	7	21
Myalgia	4	10
Sore throat	2	11
Vomiting and/or diarrhoea	5	23
Mean days from symptom onset to presentation (range)	4 (0–10)	4 (0–15)
Observations at presentation
Febrile (temperature > 37.5°C)	10	38
Tachycardia (> 100 beats per min)	8	29
Hypotensive (blood pressure < 90 mmHg systolic or < 60 mmHg diastolic)	5	7
Tachypnoea (> 16 breaths per min)	15	44
Hypoxia (peripheral blood oxygen saturation < 95%)	9	29
Laboratory results
Mean white blood cell count (cells × 109/L[range])	8.86 (0.1–20.7)	8.87 (1.1–27.6)
Nadir lymphocyte count (cells × 109/L[range])	0.68 (0–1.5)	0.66 (0.1–1.9)
Mean C-reactive protein concentration (mg/L[range])	134 (9–580)	104 (6–630)
Mean Pao2 with patient breathing room air (mmHg [kPa])	61 (8.1)	72 (9.6)
Chest x-ray findings
Normal	9	19
Abnormal	6	25
No chest x-ray	1	4
Diagnosis of pneumonia	6	21
Pneumonia severity index (range)	135 (100–158)	92 (30–160)
Non-pneumonic diagnosis	10	27
Treatment
Oseltamivir or zanamivir	13	40
Antibiotics	15	43
Corticosteroids	10	13
Intensive care unit admission	3	10
Non-invasive or invasive ventilation	2	10
Extracorporeal membrane oxygenation	0	2
Mean days to defervescence (range)	2.6 (0–10)	3.2 (0–14)
Mean days in hospital (range)	7 (1–18)	8 (0–61)
Overall deaths	1	4§
Pao2 = partial pressure of oxygen in arterial blood. * P < 0.05. † Patient in the second trimester of pregnancy. ‡ Of the eight patients, three were in the postpartum period, with two in the first, two in the second and one in the third trimester of pregnancy. § Of the five deaths, three occurred during the study period; the remaining two occurred on 8 and 12 August 2009.

3 Clinical courses of 13 patients admitted to Liverpool Intensive Care Unit (ICU) with pandemic (H1N1) 2009 influenza and seasonal influenza, 17 June to 31 July 2009*

* As of 31 July 2009, three patients remained in the ICU, with two of these being treated with extracorporeal membrane oxygenation.

4 Chest x-rays showing typical abnormalities found in patients hospitalised with influenza, 17 June to 31 July 2009

Patient with pandemic (H1N1) 2009 influenza showing airspace opacity in the left upper and left lower lobes and medial right upper zone.

Patient with pandemic (H1N1) 2009 influenza showing bilateral interstitial and airspace opacity.

Patient with seasonal influenza showing bilateral airspace opacity.

Acknowledgements

We thank the medical and nursing staff of Liverpool Hospital, who assisted with the clinical care of patients affected by influenza, and the scientific staff of Sydney South West Pathology Service — Liverpool, who performed the diagnostic testing on the patients. We also thank Professor Guy Marks for his comments on our manuscript.

Competing interests

None identified.

Author detailsYa-Shu Chang, MB ChB, Respiratory Registrar1Sebastiaan J van Hal, MB ChB, FRACP, FRCPA, Infectious Diseases Physician2Peter M Spencer, MB BS, Respiratory Registrar1Iain B Gosbell, MD, FRACP, FRCPA, Foundation Professor of Microbiology and Infectious Diseases,3 and Infectious Diseases Physician2Peter W Collett, MB BS, PhD, FRACP, Respiratory Physician1

1 Department of Respiratory Medicine, Liverpool Hospital, Sydney, NSW.

2 Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Sydney, NSW.

3 Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney, NSW.

Correspondence: i.gosbellATuws.edu.au

References

1. Ginsberg M, Hopkins J, Maroufi A, et al. Swine influenza A (H1N1) infection in two children — southern California, March–April 2009. MMWR Morb Mortal Wkly Rep 2009; 58: 400-402.
   
2. World Health Organization. Pandemic (H1N1) 2009. http://www.who.int/csr/disease/swineflu/en/index.html (accessed 6 Aug 2009).
   
3. Australian Government Department of Health and Ageing. Australian health management plan for pandemic influenza. 2008. http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/ahmppi-1 (accessed 6 Aug 2009).
   
4. Kaufman MA, Duke GJ, McGain F, et al. Life-threatening respiratory failure from H1N1 influenza 09 (human swine influenza). Med J Aust 2009; 191: 154-156.
   
5. Fonseca V, Davis M, Wing R, et al. Novel influenza A (H1N1) virus infections in three pregnant women — United States, April–May 2009. MMWR Morb Mortal Wkly Rep 2009; 58: 497-500.
   
6. Jamieson DJ, Honein MA, Rasmussen SA, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009; 374: 451-458.
   
7. Australian Government Department of Health and Ageing. H1N1 Influenza 09 latest news. New pandemic phase PROTECT. 17 June 2009. http://www.health.gov.au/internet/healthemergency/publishing.nsf/Content/news-170609 (accessed Nov 2009).
   
8. New South Wales Department of Health. Emergency. Pandemic influenza A (H1N1) 2009. Questions and answers. Common questions and answers regarding H1N1 Influenza 09. http://www.emergency.health.nsw.gov.au/swineflu/consumers/qa.asp (accessed 6 Aug 2009).
   
9. Centers for Disease Control and Prevention. Influenza. In: Heymann DL, editor. Control of communicable diseases manual. Washington, DC: American Public Health Association, 2008: 315-331.
   
10. Harris JW. Influenza occurring in pregnant women. JAMA 1919; 72: 978-980.
    
11. Freeman DW, Barno A. Deaths from Asian influenza associated with pregnancy. Am J Obstet Gynecol 1959; 78: 1172-1175.
    
12. Neuzil KM, Reed GW, Mitchel EF, et al. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998; 148: 1094-1102.
    
13. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009; 361: 680-689. Epub 2009 Jun 29.

(Received 13 Aug 2009, accepted 9 Nov 2009)
=============================

Swine flu `is no worse than seasonal strains’

source : http://www.theaustralian.com.au/news/health-science/swine-flu-is-no-worse-than-seasonal-strains/story-e6frg8y6-1225805509987?from=public_rss

THE dominant expert view that swine flu is much more dangerous than seasonal strains is under attack from Australian research, which has found little to no difference in patients infected by the two types.

In results that could undermine uptake of the swine flu vaccine, researchers tracked the progress of all patients admitted to a major Sydney hospital during the recent epidemic, finding the course of the illness was “comparable to those of the current circulating seasonal influenza in Sydney”. The findings threaten to debunk the firming medical orthodoxy that swine flu hits patients much harder than the strains that circulate every winter, particularly children and pregnant women.

The results have already been criticised by some infectious diseases experts, who say the findings are based on very small numbers and do, in fact, point to a greater danger from swine flu.

The study’s authors, from Sydney’s Liverpool Hospital, the Sydney South West Pathology Service and the University of Western Sydney, said their results showed that high numbers of hospital admissions for swine flu reflected the rapid spread of the disease, not any increased virulence of the H1N1 virus.

“Our findings show that, for hospitalised patients, the clinical manifestations and severity of pandemic (H1N1) 2009 and seasonal influenza were similar,” they wrote in the study published online yesterday by the Medical Journal of Australia.

Even among pregnant women — a group that was said to have been particularly at risk of severe complications in the recent epidemic — the authors said they were “unable to demonstrate a difference in clinical severity” compared with pregnant women with annual flu strains. For the research, the authors tracked all 64 adults who were admitted to Liverpool Hospital with influenza from June 17 until July 31.

A

Back to top

B

Back to top

C

Back to top

G

Back to top

H

Back to top

I

Back to top

J

Back to top

L

Back to top

P

Back to top

R

Back to top

S

Back to top

U

Back to top

V

Back to top

W

미국의 돼지독감 사망자 수가 멕시코를 추월했습니다. 겨울철에 들어선 남반부 국가들의 사망자가 아주 많은 편은 아닌 것 같습니다. 미국, 멕시코, 캐나다, 칠레에서 많은 사망자가 발생한 원인을 분석하는 것이 아주 중요할 것 같습니다. 올 겨울을 넘겨봐야 확실히 알 수 있겠지만 WHO의 pandeimc(6단계) 경보격상은 ‘늑대소년’이라는 조롱을 받을 가능성이 아주 높아 보입니다.

1814명의 감염자가 발생한 중국과 1446명의 감염자가 발생한 일본의 경우 사망자가 1명도 없는 반면에 1587명의 감염자가 발생한 아르헨티나의 경우 사망자가 26명이나 발생한 이유가 무엇일까요? 그 밖에 뉴질랜드(912명), 싱가폴(878명),  이스라엘(577명), 독일(470명), 니카라과 )308명), 프랑스(300명),  엘살바도르(253명), 한국(202명)도 사망자가 전혀 발생하지 않았습니다.

확정 진단을 받은 감염자 대비 사망자 비율 : 382/89921=0.42%
전세계 인구(68억) 대비 감염자 비율 : 89921/60억=0.0015%
전세계 인구(68억) 대비 사망자 비율 : 382/60억=0.0000064%

[사망자 통계] 

미국      170명
멕시코    119명
아르헨티나 26명
캐나다     25명
칠레       14명
호주        9명
영국        3명
태국        3명
콜럼비아    2명
코스타리카  2명
도미니크    2명
과테말라    2명
온두라스    1명
우루과이    1명
브라질      1명
필리핀      1명
스페인      1명

===================

Pandemic (H1N1) 2009 – update 57

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the International Health Regulations (2005)

3 July 2009 09:00 GMT

The breakdown of the number of laboratory-confirmed cases is given in the following table and map.

Map of the spread of pandemic (H1N1) 2009: number of laboratory confirmed cases and deaths [png 190kb]

Country, territory and area	Cumulative total		Newly confirmed since the last reporting period
	Cases	Deaths	Cases	Deaths
Algeria	5	0	3	0
Antigua and Barbuda	2	0	0	0
Argentina	1587	26	0	0
Australia	4568	9	478	2
Austria	15	0	0	0
Bahamas	6	0	0	0
Bahrain	15	0	0	0
Bangladesh	12	0	11	0
Barbados	12	0	2	0
Belgium	49	0	2	0
Bermuda, UKOT	1	0	0	0
Bolivia	283	0	78	0
Bosnia and Hezegovina	1	0	1	0
Brazil	737	1	57	0
British Virgin Islands, UKOT	2	0	1	0
Brunei Darussalam	85	0	56	0
Bulgaria	10	0	0	0
Cambodia	7	0	1	0
Canada	7983	25	0	0
Cap Verde	3	0	0	0
Cayman Islands, UKOT	14	0	1	0
Chile	7376	14	1165	2
China	1814	0	296	0
Colombia	101	2	8	0
Costa Rica*	227	2	-52	0
Cote d’Ivoire	2	0	0	0
Cuba	73	0	27	0
Cyprus	70	0	22	0
Czech Republic	15	0	6	0
Denmark	63	0	8	0
Dominica	1	0	0	0
Dominican Republic	108	2	0	0
Ecuador	163	0	0	0
Egypt	67	0	0	0
El Salvador	253	0	27	0
Estonia	13	0	0	0
Ethiopia	3	0	1	0
Fiji	2	0	0	0
Finland	43	0	17	0
France	300	0	23	0
French Polynesia, FOC	2	0	0	0
Martinique, FOC	2	0	0	0
France, New Caledonia, FOC	6	0	0	0
Germany	470	0	53	0
Greece	109	0	17	0
Guatemala	254	2	0	0
Honduras	123	1	5	0
Hungary	11	0	1	0
Iceland	4	0	0	0
India	104	0	0	0
Indonesia	8	0	0	0
Iran	1	0	0	0
Iraq	11	0	0	0
Ireland	51	0	10	0
Israel	577	0	71	0
Italy	130	0	7	0
Jamaica	32	0	0	0
Japan	1446	0	180	0
Jordan	22	0	2	0
Kenya	12	0	11	0
Korea, Republic of	202	0	0	0
Kuwait	35	0	1	0
Laos	3	0	0	0
Latvia	1	0	0	0
Lebanon	47	0	8	0
Lithuania	3	0	2	0
Luxembourg	4	0	0	0
Malaysia	112	0	0	0
Malta	2	0	2	0
Mauritius*	1	0	-6	0
Mexico	10262	119	1582	3
Montenegro	9	0	5	0
Morocco	17	0	0	0
Myanmar	1	0	0	0
Nepal	5	0	2	0
Netherlands	134	0	6	0
Netherlands, Aruba	5	0	5	0
Netherlands Antilles, Curaçao	8	0	1	0
Netherlands Antilles, Sint Maarten	7	0	0	0
New Zealand	912	0	201	0
Nicaragua	308	0	15	0
Norway	41	0	9	0
Oman	3	0	0	0
Palau	1	0	1	0
Panama	417	0	0	0
Papua New Guinea	1	0	0	0
Paraguay	103	0	7	0
Peru	538	0	0	0
Philippines	1709	1	848	0
Poland	19	0	4	0
Portugal	27	0	10	0
Qatar	10	0	0	0
Romania	36	0	8	0
Russia	3	0	0	0
Saint Lucia	1	0	0	0
Samoa	1	0	0	0
Saudi Arabia	89	0	8	0
Serbia	15	0	3	0
Singapore	878	0	177	0
Slovakia	18	0	5	0
Slovenia	5	0	1	0
South Africa	12	0	11	0
Spain	760	1	43	0
Sri Lanka	17	0	2	0
Suriname	11	0	0	0
Sweden	74	0	5	0
Switzerland	72	0	16	0
Thailand	1414	3	0	0
Trinidad and Tobago	53	0	0	0
Tunisia	3	0	0	0
Turkey	40	0	8	0
Uganda	1	0	1	0
Ukraine	1	0	0	0
United Arab Emirates	8	0	0	0
United Kingdom	7447	3	909	0
Guernsey, Crown Dependency	5	0	0	0
Isle of Man, Crown Dependency	1	0	0	0
Jersey, Crown Dependency	11	0	3	0
United States of America	33902	170	6185	43
Uruguay	195	1	0	0
Vanuatu	2	0	0	0
Venezuela	204	0	11	0
Viet Nam	131	0	8	0
West Bank and Gaza Strip	30	0	17	0
Yemen	7	0	0	0
Grand Total	89921	382	12720	50

Chinese Taipei has reported 61 confirmed cases of pandemic (H1N1) 2009 with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.

Cumulative and new figures are subject to revision

Abbreviations

UKOT: United Kingdom Overseas Territory
FOC: French Overseas Collectivity

Netherlands Antilles, Curaçao : 3 confirmed cases: The three confirmed cases are crew members of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.

Norway: 7 confirmed cases are crew members and passengers of a cruise ship. They did not leave the boat during their illness nor during the 24 hours preceding the onset of symptoms.

*: The data has been revised on the basis of further laboratory confirmation