Pandemic (H1N1) 2009 - update 105
18 June 2010 - As of 13 June, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18172 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.
The situation remains largely unchanged since the last update. Overall pandemic influenza activity remains low worldwide with geographically limited circulation of pandemic influenza virus in parts of the tropics, particularly in parts of Central America and the Caribbean and in parts of South and Southeast Asia. Seasonal influenza type B viruses continue to circulate at low levels across Asia and to a lesser extent across parts of Africa and South America. Recently re-emerged seasonal influenza H3N2 viruses continue to circulate in East Africa. As countries of the temperate southern hemisphere enter winter, overall only sporadic influenza activity has been detected so far.
In tropical region of the Americas, low or waning circulation of pandemic virus has been primarily reported in Costa Rica (since early 2010) and in Cuba (last reported at the end of May 2010), respectively. In Cuba and to a lesser extent in Costa Rica, recent pandemic influenza activity has been associated with small numbers of fatal cases. In Colombia, during the first week of June 2010, an increasing trend of respiratory diseases was associated with regional spread of pandemic influenza activity and a small number of new fatal cases, likely reflecting increasing but low level circulation of pandemic influenza virus. Throughout the rest of the region, there have been only sporadic detections of pandemic influenza virus during the past month. In several countries of the region, there has been recent circulation of seasonal influenza viruses including type A (Venezuela since May 2010) and B (Bolivia since March 2010). Throughout the region there has been variable ongoing co-circulation of other respiratory viruses, particularly RSV.
In Asia, pandemic influenza virus continues to actively circulate in Malaysia, Singapore, and to a much lesser extent in parts of India, Bangladesh, and Bhutan. In Malaysia, limited data suggest that virus transmission persists but continues to decline; the number of new cases reported per week plateaued during mid-April 2010 and began to decline at the end of May 2010. In Singapore, during the second week of June 2010, the levels of ARI remained near the warning level but below the epidemic threshold; approximately 28% of respiratory samples from patients with ILI tested positive for pandemic influenza virus. In South Asia, low level circulation of pandemic influenza virus has persisted in western India (since early 2010) and Bangladesh (since late February 2010); in India but not Bangladesh, regional, low intensity transmission during 2010 has been associated with small numbers of fatal cases over time. Seasonal influenza type B viruses continue to co-circulate with pandemic influenza virus in Bangladesh and have only recently emerged and become predominant in India, although at low levels. Of note, there have been recent media reports of increasing pandemic influenza activity in the southern Indian state of Kerala and more information is expected to become available soon. In Bhutan, there have recent reports of school outbreaks of pandemic influenza virus infection in three separate areas of the country, however, the overall intensity of respiratory diseases in the population was reported to be low.
In Sub-Saharan Africa, pandemic influenza virus continued to circulate at low levels in limited areas of East and West Africa. During the first week of June 2010, 10% and 16% of all respiratory samples tested positive for pandemic influenza virus in Tanzania and Ghana, respectively. Small but significant numbers of seasonal H3N2 viruses continue to be been detected in Kenya and Tanzania since late May 2010.
Overall, in the temperate regions of the northern hemisphere, pandemic influenza viruses have been detected only sporadically during the past month. In the temperate southern hemisphere, only two countries, Chile and Uruguay, have recently reported small numbers of pandemic influenza virus detections. Other respiratory viruses, most notably RSV, are known to be circulating in Chile and Argentina. During first two weeks of June 2010, small numbers of seasonal influenza H3N2 and type B viruses have been detected in South Africa. In New Zealand and Australia, overall levels of ILI remain low; only sporadic detections of seasonal and pandemic influenza viruses have been recently reported in Australia.
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)
- 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 22: 30 MAY - 5 JUNE 2010)
Qualitative indicators (Week 29 to Week 22: 13 July 2009 - 5 June 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.
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 June 2010
The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 104): 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. 104): none.
*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
***No update since 23 May 2010