What was the Swine Flu outbreak of 2009?

Answer 1

Where did it start?

Update:

Very recent studies during Spring of 2011, have indicated that the start of this new flu may have actually been in China and not Mexico. That finding is being investigated at present. Prior to this, it was believed that the first cases were in Mexico. More studies are underway in China.

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Location of origin (initially reported):

Spring 2009:

There was speculation that it may have started at an American-owned pig farm in Veracruz, Mexico, a Smithfield Foods facility. However, the following article states that Mexico's Agriculture Department has proven it was not the original location: Press Release from the National Pork Producers Council:

"Washington, May 14, 2009 -

Mexico's agriculture department today said the influenza strain that now has infected almost 4,300 people in 33 countries did not originate from hogs at a Smithfield Foods operation that had been singled out by some, including critics of modern pork production, as the source of the A-H1N1 flu virus.

Test results released today by the Mexican Ministry of Agriculture, Ranching, Rural Development, Fisheries and Food (SAGARPA) confirmed that the novel A-H1N1 virus was not in pigs at the Granjas Carroll de México farm in Veracruz. The pigs also tested negative for other viruses. "

From The Humane Society of US:

"...the progenitor of the Swine Flu virus currently threatening to trigger a human pandemic has now been identified..." (A-H1N1/09 "Novel H1N1")

"Scientists postulate that a human flu virus may have starting (sic) circulating in U.S. pig farms as early as 1995, but 'by mutation or simply by obtaining a critical density', caused disease in pigs and began to spread rapidly through swine herds in North America." (the version of H1N1 that was mostly found only in pigs, aka "Regular Swine flu")

This H1N1 (Regular Swine Flu) then mutated from just a pig flu to the H1N1, that is causing the 2009 pandemic, by adding genetic material from human viruses and Avian (bird flu) Influenza viruses to the genetic material already in the regular swine flu from strains of pig flu in Asia, Europe, and North America.

These (Avian and Human) "...two gene segments of the H1N1 swine flu virus now spreading in human populations around the world appear to come from a swine flu viral lineage circulating in Eurasia..." (Novel H1N1)

A form of human to human swine flu virus (H1N1) is not new. Swine flu caused a brief panic in 1976 when it appeared in the U.S. at an army base, and sickened several of the soldiers stationed there. Ironically the biggest fallout from that incident of swine flu came from the vaccine that President Gerald Ford urged citizens to get: only one person died from the actual flu while twenty-five died and five-hundred took sick from the vaccine or from problems loosely linked to the vaccines.

To further complicate our understanding of where this virus came from, researchers are now saying that "swine" flu isn't even the correct description of what this current one is, since this virus is made up from a mix of porcine (pig), avian (bird), andhuman flu strains. [This is why the CDC started calling it Novel (new)].

Swine flu, in its purely "piggy" form, is actually found in pigs worldwide, literally in every country. The World Animal Health organization was recommending the pandemic flu virus be renamed to "North-American influenza" to reflect its presumed origins. The World Health Organization and Centers for Disease Control and Prevention (CDC) have now started to call it more consistently Type A H1N1/09. See the related question below about the scientific name and other names for this pandemic flu.

For more details of how the virus mutated from the pig-to-pig-transmitted flu to become the Novel H1N1 flu, that can be spread human-to-human, see the related question below: "What caused the 2009 Swine Flu? "

Here are some additional facts about the swine flu/H1N1-09:

(1) "Regular Swine Flu" (a different strain of H1N1) is a respiratory disease normally found in pigs. The novel (new) A- H1N1/09 is a mutation of this original swine flu virus and is passed human to human, with rare reported cases of human to hog infection.

(2) It is caused by a type A influenza virus with RNA genetic material.

(3) Humans with direct sustained close contact with pigs, such as in big pig farms, are those who can occasionally be infected with regular swine flu. (A-H1N1/09 is spread human to human most often.)

(4) Adults shed influenza virus from the day before symptoms begin through 5-10 days after illness onset.

(5) Uncomplicated influenza illnesses typically last for 3 to 7 days for most people with some cough and malaise for around 2 weeks or more.

(6) Young children also might be contagious several days before they have obvious symptoms, and children can be infectious for 10 or more days after the first signs of illness.

(7) You cannot catch swine flu from eating pork. The virus is killed by exposure to heat at normal cooking temperatures -- 167-212°F (75-100°C).

(8) Symptoms of swine flu are similar to those of most influenza illnesses: fever and chills, sore throat, cough, headache, body aches, and fatigue.

(9) For treatment, there are two antiviral drugs that a doctor may prescribe, which work best if started soon after getting sick (within two days of the appearance of symptoms). The two drugs are oseltamivir (Tamiflu) and zanamivir (Relenza). Tamiflu is for treatment in adults and children aged 1 year and older, and must be taken within 48 hours of the first symptom for best results but can still be helpful in some cases after then.

(10) The best current advice for individuals is to practice good hand washing hygiene to help prevent coming in contact with the disease.

See the related questions below for more information on prevention.

Vaccines

Update 2010:

Beginning in the 2010-2011 flu season, the new vaccine developed for this influenza virus in 2009 is now included in the seasonal flu vaccine along with two other vaccines for the anticipated viruses that were to be included in the vaccine for this season. This will allow vaccination for the A-H1N1/09 virus and the "regular" flu viruses during this flu season without having to have two vaccinations as was the case in 2009 when the vaccine was first made available. It will not hurt to take this season's "regular" flu vaccination containing "swine flu" even if you had the vaccination for Novel Swine Flu and/or the flu itself in 2009-2010.

Fall 2009:

The Food and Drug Administration in the US has approved four vaccines for use and these have been being distributed by the CDC to the state health departments for further distribution to local providers and programs for vaccination. These were released in late October and are being given to the highest risk population on a priority basis until vaccine production is at full speed and able to keep up with demand. This is expected to be by January 2010. See related question below about the vaccines.

World Health Organization (WHO) Phase of Pandemic:

Update: The pandemic is now in the "Post Pandemic Phase." This means that the pandemic is over but there will still be sporadic and isolated outbreaks, but the peak of infections is now over.

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June 11, 2009 World Health Organization (WHO) raises Pandemic Level to Level 6 (Pandemic Phase).

From WHO news conference 11 June 2009:

"On the basis of available evidence and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met. I have therefore decided to raise the level of influenza pandemic alert from Phase 5 to Phase 6.

The world is now at the start of the 2009 influenza pandemic."

The transcripts of the Press Conference can be read or videos watched at the WHO site. A link is provided in the related links section below this answer. It is important to note that a declaration of Pandemic by WHO does not indicate an increase in the severity, just that the criteria for Phase 6 regarding the spread of the Novel H1N1 Influenza have been met. This puts into place additional steps by WHO and World Nations' plans for control and prevention in such a widespread situation of pandemic.

It continues to spread to new countries as expected.

For the most recently updated details of the progression of the spread of the pandemic, see the related question below: "Which cities states or countries have deaths or cases of swine flu? "

Answer 2

Outside the body, influenza virus can be destroyed by heat of 167-212°F (75-100°C), the range of normal cooking temperatures. In addition, to clean surfaces, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses, if used in proper concentration for a sufficient length of time (follow label directions on the products).

To deactivate the virus on your body and hands, use soap, warm water, and plenty of friction. In the absence of soap and water, alcohol based hand sanitizers that contain a minimum of 60% alcohol are effective when used properly. The gels should be rubbed into the hands and between the fingers until they are dry. Friction is an essential part of the physical process of removing the viruses to wash down the drain when using soap and water and to be effective with use of a sanitizer.

Once you are already infected with the virus, there are no medications that will kill the viruses in your body (like antibiotics that are used to kill bacteria, but are not effective on viruses). The flu must run its course until your body can rid it. There are anti-viral medications (like Tamiflu) that can help lessen the symptoms and shorten the recovery time, if given within two days of the first signs of infection. But they are interrupting the reproduction of new viruses, not actually killing the ones already in your cells. During the course of the flu, your immune system prepares and distributes the antibodies needed to disable the virus particles and end your symptoms in 8 to 10 days.

See more related information in the related questions area.

Answer 3

There usually are no long term adverse effects at all from the A-H1N1/09 pandemic swine flu when there are no complications in the course of the infection in otherwise healthy adults.

A positive long term effect would be the immunity gained by having had this flu that enabled your immune system to produce antibodies to the virus which will protect you from getting it again in the future and possibly also provide "cross-over" protection to similar influenza viruses.

Answer 4

Update June 20, 2013:

The CDC has issued the following media advisory:

The Advisory Committee on Immunization Practices (ACIP) voted today, 13 to 0, in favor of recommending FluBlokduring the 2013-2014 influenza seasons for vaccination of persons 18 through 49 years of age with egg allergy of any severity. FluBlok was licensed by the Food and Drug Administration (FDA) in January 2013. Unlike current production methods for other available seasonal influenza vaccines, FluBlok does not use the influenza virus or chicken eggs in its manufacturing process.

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Flu vaccines for the 2012-2013 flu season in the US:

Flu vaccines have been around for decades, successfully preventing the flu, with very few untoward side effects.

This year's trivalent seasonal flu vaccines will protect against the following three strains of influenza:

• Type A/California/7/2009 (H1N1) ~ the "swine flu vaccine",

• Type A/Victoria/361/2011 (H3N2), and

• Type B/Wisconsin/1/2010.

There is also a new vaccine in the 2012-2013 flu season that is FluMist Quadrivalent. This new vaccine includes two Type B strains of flu instead of one. It contains B strains from both the B/Yamagata/16/88 and the B/Victoria/2/87 lineages in addition to the same strains of the Type A viruses (H1N1 and H3N2) that are included in the trivalent vaccines for this season. See the related questions below for more info.

For the 2012-2013 Flu season in the US, the following vaccines for influenza are approved for use:

• AFLURIA Trivalent made by CSL/Merck
• AGRIFLU made by Novartis
• FLUARIX Trivalent made by GlaxoSmithKline Biologicals
• FLUMIST made by MedImmune Vaccines, Inc.
• FLUMIST QUADRAVALENT made by MedImmune Vaccines, Inc.
• FLULAVAL Trivalent made by ID Biomedical Corporation of Quebec

• FLUVIRIN Trivalent made by Novartis
• FLUZONE made by Sanofi Pasteur, Inc.
• FLUZONE - High Dose made by Sanofi Pasteur, Inc.
• FLUZONE-Intradermal made by Sanofi Pasteur, Inc.

_____________________________________________________________________________For the 2011-2012 flu season in the US, the Food and Drug Administration (FDA) announced the approval of six vaccines on July 18, 2011. These approved trivalent vaccines will all contain vaccine for the H1N1/09 "Swine Flu" and two other viruses suggested by CDC for this season (see more below). These approved vaccines are:

1. Afluria (CSL Limited)
2. Fluarix (Glaxo Smith Kline Biologicals)
3. FluLaval (ID Biomedical Corporation)
4. FluMist (MedImmune Vaccines, Inc.)
5. Fluvirin (Novartis Vaccines and Diagnostics Limited)
6. Fluzone, Fluzone High-Dose, Fluzone Intradermal (Sanofi Pasteur, Inc.)

The Fluzone Intradermal is a new formulation for administration in the layers of the skin (intradermal injection) instead of the intramuscular (IM) injection. Fluzone Intradermal administration uses a microinjection system with a very fine needle. Approved for those aged 18 through 64.

The CDC-approved trivalent vaccines for this flu season will protect against the following three virus strains:

1. A/California/7/09 (H1N1)-like virus (Pandemic (H1N1) 2009 influenza virus)
2. A/Perth/16/2009/ (H3N2)-like virus
3. B/Brisbane/60/2008-like virus

The H1N1/09 Swine Flu Pandemic is over, the world now has entered the post pandemic phase per the World Health Organization (WHO).

World Health Organization's Director-General, Margaret Chan, announced on August 10, 2010 that the Pandemic Phase is over and we have entered the Post Pandemic Phase.

The virus has killed more than 18,000 since April 2009, this figure is approximately 4% of the 250,000 to 500,000 annual influenza deaths.

There may be some ongoing cases in limited locations around the world, however, the specifics and counts of cases are no longer being tracked by CDC, WHO, the US states, and most other countries, now that the pandemic has been declared over. Influenza cases are monitored, but specific H1N1/09 counts (and the lab tests needed to isolate the specific virus to be able to count them correctly) aren't routinely being done.

The CDC publishes a weekly influenza surveillance report for the US called FluView that gives influenza-like illness statistics with some information from the US laboratories about results of testing they have done that gives a rough idea of the numbers of H1N1/09 still being found in positive lab tests. See the related question below or the related links section below for links to the weekly report. CDC also has an International Flu Report that you can access from the related question or link sections below.

UPDATE March 26, 2011 International Flu Report from CDC:The CDC report indicates that the presence of H1N1/09 is still seen, but in fewer locations and smaller numbers. Those places that are still finding infections of this influenza virus are (see also the related links below for the full report):

Europe

According to WHO's EuroFlu, all reporting countries reported either low or medium influenza activity in Week 10. In 37 out of 47 reporting countries, influenza-like illness (ILI) activity peaked in recent weeks and is now declining. During Week 10, 42% of sentinel specimens (specimens routinely collected from designated health care facilities for surveillance purposes) tested positive for the influenza virus. Forty-six percent of those positive samples were influenza A (mainly 2009 H1N1) and 54% were influenza B.

Asia

According to WHO's Influenza Collaborating Center in China, influenza activity in China decreased sharply from peaks in Week 5 (northern China) and Week 4 (southern China). In Week 9, 17% of specimens tested in both regions were influenza-positive. The most common influenza subtypes in China were 2009 H1N1 and influenza B. In Mongolia, Japan and the Republic of Korea, influenza-like illness activity decreased.

UPDATE on the week ending November 6, 2010 from WHO:2010-2011 Influenza Season Week 44 ending November 6, 2010

All data are preliminary and may change as more reports are received.

Synopsis:

During week 44 (October 31-November 6, 2010), influenza activity remained low in the United States.

* Of 2,704 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 185 (6.8%) were positive for influenza.

* Two human infections with novel influenza A viruses were reported.

* The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.

* One influenza-associated pediatric death was reported and was associated with an influenza A virus for which the subtype was undetermined.

* The proportion of outpatient visits for influenza-like illness (ILI), 1.3%, was below the national baseline, 2.5%. All 10 regions reported ILI below region-specific baseline levels; one state experienced low ILI activity, 49 states experienced minimal ILI activity.

* Geographic spread of influenza in three states was reported as local; the District of Columbia, Puerto Rico, and 34 states reported sporadic activity; Guam and 13 states reported no influenza activity, and the U.S. Virgin Islands did not report.

From the CDC November 2010

Influenza-Associated Pediatric Mortality in the US 2009 - Oct. 2010

One influenza-associated pediatric death was reported to CDC during week 44 (Texas). This death was associated with an influenza A virus for which the subtype was not determined. The death reported during week 44 occurred between October 24 and October 30, 2010.

In the US in the 2009 - 2010 Pandemic and flu season there have been a total of 282 deaths of children. In the 2010-2011 flu season in the US there has been only one pediatric death from influenza through October 2010.

July_2010">July_2010">July_2010">July 2010Estimation of unreported cases based upon reported cases:

Updated Estimates from April 2009 - January 16, 2010:

On February 12, 2010, CDC updated the estimates to include the time period from April 2009 through January 16, 2010.

CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths."

7/15/2010 Situation UpdateAccording to the final FluView for the 2009-2010 influenza season (May 16-22, 2010), flu activity in the United States declined again from the previous week and is about the same as what is normally seen during the summer in the United States. Only a small number of influenza viruses are being reported, most of which are 2009 H1N1. Flu is unpredictable, but sporadic cases of flu, caused by either 2009 H1N1 or seasonal flu viruses, will likely continue to occur throughout the summer in the United States.

Internationally, 2009 H1N1 viruses are still circulating, including in the Southern Hemisphere, which is entering its flu season

7/9/2010 Situation Update from WHO2009 H1N1 continues to actively circulate in certain areas of the tropics, including the Caribbean, West Africa, and South and Southeast Asia. In the Southern Hemisphere, influenza A (H3N2) viruses are currently co-circulating with 2009 H1N1. In the Northern Hemisphere, the number of influenza B viruses detected has exceeded reports of influenza A.

Influenza type B and A (H3N2) viruses have been detected in South Africa at an increasing rate. Low levels of influenza-like illness (ILI) have been reported from several Southern Hemisphere countries, including Australia, New Zealand, Chile and Argentina. 2009 H1N1 and A (H3N2) viruses are currently co-circulating in certain Caribbean, Central America, and Southeast Asia countries. 2009 H1N1 is actively circulating in Southern and Western regions of India and Western regions of Africa. In Bangladesh, the seasonal influenza activity is shifting from 2009 H1N1 to influenza type B. Influenza type B continues to actively circulate in central and southern regions of Africa.

2/12/10 Estimated number of cases and deaths in the US from CDC:Cases: 57 million Deaths: 11,690

*Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for *Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for estimation of unreported/untested cases based on reported cases.

June 17, 2010

Online Pharmacy Fraud, mislabeled drug TM-FLU sold as generic Tamiflu.

FDA Announces Internet Scam

A drug called TM-FLU from the online pharmacy called TRYDRUGS PHARMACEUTICALS PVT. LTD., at M.G. Road, Ahmedabad, Gujarat, does not contain Oseltamivir, which is the active ingredient of the well known brand of antiviral medicines, Tamiflu. This drug contains a different prescription medicine and should not be used as an OTC (Over the Counter) drug, it requires physician monitoring during its use.

On June 17, 2010 the US FDA (Food and Drug Administration) declared that this "generic Tamiflu" called TM-FLU is fraudulent and does not contain Oseltamivir. It will not be effective for influenza. There is no FDA approved generic Tamiflu product. Worse, it does contain Cloxacillin (one of the antibiotics of the penicillin group). This can cause deadly allergic reactions in some people, and antibiotics are not effective against the viruses that cause influenza.

The following advice is given in the FDA announcement (see link):

Health care professionals and consumers are encouraged to report adverse events that may be related to the use of these fraudulent products to the FDA's MedWatch Program by phone at 800-FDA-1088, by fax at 800-FDA-0178, or by mail at: MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787.

You should not use this drug from this online pharmacy. You should discard any remaining quantity in the proper way for your location. This pharmaceutical company is fake and they are doing fraudulent business.

See the links below for more information.

June 3, 2010

Although the H1N1/09 Swine Flu Pandemic is still in effect, it is believed to have now passed the peak.

There are still enough cases of the pandemic virus widespread across the world, that it is still considered a pandemic, but the peak seems to have passed and it is anticipated that the gradual shift to fewer and fewer cases will continue.

From the CDC April 23, 2010

During the week of April 11 - 17, 2010, according to the CDC, most key indicators declined from the prior week.

• Visits to doctors for influenza-like illness (ILI) declined from last week and are low nationally, with all 10 U.S. regions reporting ILI below region-specific baseline levels.

• Laboratory-confirmed hospitalizations rates have leveled off and very few hospitalizations were reported by states during the week ending April 17.

• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report increased over last week, but in general, are not higher than expected. Also, this indicator can lag behind the others. No pediatric deaths were reported this week. Since April 2009, CDC has received reports of 337 laboratory-confirmed pediatric deaths: 281 due to 2009 H1N1, 53 pediatric deaths that were laboratory confirmed as influenza A, but the flu virus subtype was not determined, and three pediatric deaths that were associated with seasonal influenza viruses. (Laboratory-confirmed deaths are thought to represent an undercount of the actual number. CDC has provided estimates about the number of 2009 H1N1 cases and related hospitalizations and deaths).

• No states reported widespread or regional influenza activity. This is the first week since the week ending December 13, 2008 that no states are reporting widespread or regional flu activity.

• The majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

3/5/10 From the World Health Organization (WHO):

5 March 2010 -- As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16455 deaths.

Summary: In the temperate zone of the northern hemisphere, transmission of virus persists in some areas of Europe and Asia but influenza activity is declining and at low level in the most areas. The most active areas of transmission are currently observed in parts of Southeast Asia and East and South-eastern Europe. Recently, influenza type B is increasingly reported in Asia.

2/12/10 Estimated number of cases and deaths in the US*:

Cases: 57 million Deaths: 11,690

*Cumulative from April 2009 to January 16, 2010, plus CDC estimates of unreported cases based upon a calculated formula for estimation of unreported/untested cases based on reported cases.

Updated Estimates from April 2009 - January 16, 2010

On February 12, 2010, CDC updated the estimates to include the time period from April 2009 through January 16, 2010.

• "CDC estimates that between 41 million and 84 million cases of 2009 H1N1 occurred between April 2009 and January 16, 2010. The mid-level in this range is about 57 million people infected with 2009 H1N1.
• CDC estimates that between about 183,000 and 378,000 H1N1-related hospitalizations occurred between April 2009 and January 16, 2010. The mid-level in this range is about 257,000 2009 H1N1-related hospitalizations.
• CDC estimates that between about 8,330 and 17,160 2009 H1N1-related deaths occurred between April 2009 and January 16, 2010. The mid-level in this range is about 11,690 2009 H1N1-related deaths."

Mortality Rates:UPDATE 03/07/10

The US Centers for Disease Control and Prevention (CDC) has estimated that, as of 2/12/10, since the beginning of the pandemic, the US has had approximately 57 million cases of A-H1N1/09 Pandemic Swine Flu and approximately 11,690 resulting deaths. Based upon this, an estimate of the mortality rate in the US from the pandemic is 0.02%.

In comparison, the CDC and World Health Organization (WHO) have estimated that with seasonal flu, "we see over 30 million cases in the United States. We see 200,000 hospitalizations and, on average, 36,000 deaths." (During the entire fall and winter flu season.) Based upon this, the average mortality rate of seasonal flu in the US would be 0.12 %.

The statistics of this mortality rate variation and other information gathered during the pandemic are under study by epidemiologists. It may be attributable to the fact that the especially vulnerable demographic group of the elderly (age 65 and older) suffers the majority of the cases and deaths from seasonal flu (because their weakened immune systems are unable to fight it off before their frail bodies must attempt to deal with the symptoms caused by another new strain of virus). In contrast, the majority of cases of the pandemic swine flu are among the younger and healthier demographic groups, so that, except for the very young and those with underlying medical conditions, most are able to survive the disease. It is not fully understood yet why the elderly do not contract this virus subtype as easily as the typical seasonal viruses, but speculation is that they may have acquired immunity through prior exposure to a similar virus strain.

*All data are preliminary and may change as more reports are received.

WORLD UPDATE

Total................................Cases.......1562049.........Deaths......16665As of 1/05/10*

*Cumulative

FROM THE WORLD HEALTH ORGANIZATION (WHO)

MUTATED VIRUSES NOVEMBER 20, 2009

The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness. So far on additional testing, no further cases with this mutation have been found. WHO believes this suggests that the mutation is not widespread in Norway.

All of the mutated H1N1 viruses still respond to Tamiflu and Relenza (oseltamivir and zanamivir, respectively), and the pandemic swine flu (A-H1N1/09) vaccines are still effectively providing immunization against these virus mutations as well.

Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases.

Laboratories in the WHO Global Influenza Surveillance Network closely monitor influenza viruses worldwide and will remain vigilant for any further changes in the virus that may have public health significance."

IN THE UKNOVEMBER 20, 2009

FROM BBC, RESISTANT MUTANT STRAIN OF A-H1N1/09 IN FIVE PEOPLE IN WALES

Five patients on the same unit of a University Hospital in Wales appear to have contracted the A-H1N1/09 "Swine Flu" infection when it spread among the patients on their unit. The unit they shared treats those with underlying severe health conditions, which would have made them at higher risk of getting the disease. The hospital is keeping them isolated, and health officials say there is no risk to others.

The strain has been found to be resistant to Tamiflu, one of the anti-viral medicines used to treat the swine flu. Although mutations that are resistant to Tamiflu have been found in a small number of cases (several dozen) around the globe during the pandemic, until now, those strains were evaluated and had not been able to spread from person to person.

See BBC report [see link below]

PETS AND SWINE FLU

UPDATE 12/31/09

The first dog to be found to have Swine Flu (which was caught from the owner) was diagnosed in New York on 12/21/09 by veterinarians. The dog had shown signs of coughing, not eating, and lethargy accompanied with a fever when the owners took it to the vet. The elderly (13 year old dog) was given two days of IVs and antibiotics before being allowed to go home and is now recovering.

There is currently no vaccine for pets for H1N1/09 influenza, just for seasonal flu, but the safeguards of proper cough and sneeze etiquette and hand washing that you would take with a human child should also be taken to prevent the spread to your pets, according to the American Veterinary Medical Association (AVMA). So far, there have been very few cases among pet animals, but in all cases, the animal had been in close proximity to a person in the household with the H1N1/09 virus.

The American Veterinary Medical Association (AVMA) has said if you are sick or a pet is sick with flu symptoms:

"...isolate yourselves from each other, which we realize is only possible to some degree," said AVMA spokesman Michael San Filippo.

An Animal Medical Center in New York representative recommends, "Don't play kissyface with your dog or your cat or your ferret. You wouldn't with your kids if you were sick, so don't do it with your pet."

Unconfirmed cases of swine flu in a few dogs in China were reported on December 1, 2009, but the diagnosis had not yet been verified by lab results.

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The first dog to be found to have Swine Flu (which was caught from the owner) was diagnosed in New York on 12/21/09 by veterinarians. The dog had shown signs of coughing, not eating, and lethargy accompanied with a fever when the owners took it to the vet. The elderly (13 year old dog) was given two days of IVs and antibiotics before being allowed to go home and is now recovering.

There have been several reported and confirmed cases of pet ferrets having contracted H1N1/09 pandemic swine flu from their owners. There is no evidence that the reverse has occurred (that a person got it from a ferret or any other pet).

Also, there is now a case of a domestic house cat also with confirmed H1N1/09. It was in very close contact with the owner while the owner had the pandemic swine flu. It is suggested by the American Veterinary Medical Association that caution be taken with pets when anyone in the household has the flu. (The cat recovered fully from the flu).

So far, no pot bellied pigs have been shown to have contracted the virus. Dogs do have their own strain of flu virus that is currently circulating and only a veterinarian can determine which type of flu they have, so watch your dog carefully for any signs of respiratory disease or distress.

Keep your pets safe from the flu if a member of the household has the virus the same way you would protect other people by isolating the sick person as much as possible, avoid close contact with family and pets, and use good cough and sneeze etiquette and thorough frequent handwashing.

If any pets show signs of the flu (respiratory cold-like symptoms), check with your veterinarian for advice. See more below at the related link for the American Veterinary Medical Association.

VACCINE ADVERSE EFFECTS REPORT FROM CDC/FDA:

As of a December 30, 2009 report of the Vaccine Adverse Event Reporting System (VAERS), 32 cases have been reported of serious adverse effects of the A-H1N1/09 vaccine resulting in, or related to, deaths of those 32 people.

See the related links section for a link to that full report.

12/23/09

A SECOND H1N1/09 VACCINE RECALL

A second round of recall of H1N1/09 Swine Flu vaccine occurred 12/23/09 when MedImmune, the maker of the US approved live vaccine for intra-nasal administration, recalled just under 5 million doses of the vaccine. The recall was like the first vaccine recall earlier in the month, it was not a safety recall, it is because the vaccine had been tested to have a slight decrease in the potency. (See Vaccine section below for more details on the first recall.)

The US Federal Drug Administration (FDA) stated that it was not unusual for vaccines to lose strength over time. This type of vaccine usually has a shelf-life of around 4 months. The FDA also does not recommend re-vaccination of those who had a vaccination using the recalled lots since the vaccines were potent enough when given in the prior months. The maker of the vaccine, a subsidiary of AstraZeneca, has also said that the potency of vaccines already given would be well above the necessary strength to provide protection without any need to revaccinate.

The loss of strength was measured during routine quality testing which is ongoing.

12/30/09

The CDC and FDA have issued a summary of the Adverse Events that have been reported through the Vaccine Adverse Event Reporting System about the H1N1/09 vaccine. See also above at the first of this answer and the related link section below for more information.

The summary was developed based upon the information gathered by the FDA and CDC through the Vaccine Adverse Event Reporting System. This summary from the CDC is as of Dec 30, 2009, shows a possible link between 32 people's deaths and the vaccine. Almost 100 million doses have been distributed for use in the US alone.

VAERS Summary:

As of December 30, 2009, 99.3 million doses of 2009 H1N1 vaccine had been shipped to vaccination providers in the United States, although the precise number of vaccines administered is unknown.

• As of December 30, 2009, VAERS had received 7326 adverse event reports following 2009 monovalent H1N1 vaccination.

• The vast majority (94%) of adverse events reported to VAERS after receiving the 2009 monovalent H1N1 vaccine are classified as "non-serious" (e.g., soreness at the vaccine injection site).

• Of the 7326 reports, 440 (6%) were reports that were classified as "serious" health events (defined as life threatening or resulting in death, major disability, abnormal conditions at birth, hospitalization, or extension of an existing hospitalization)*.

• The percentage of reports involving what would be considered serious health events is not different between 2009 H1N1 and seasonal influenza vaccines. Additionally, no new or unusual events or pattern of adverse events have emerged.

• VAERS reports continue to be monitored as more vaccine is administered.

• Among the 440 reports of serious health events, there were 32 reports of death.

• As with all reports of serious adverse events and deaths, the 32 VAERS reports that involve deaths are under review by CDC, FDA and the states where the reported deaths occurred. Preliminary findings do not indicate a common cause or pattern (such as similarities in age, gender, geographic location, illness surrounding death, or underlying medical conditions) to suggest that these deaths were associated with the vaccine. These cases are under further review pending additional medical records (e.g., autopsy reports, medical files).

12/23/09

A Centers for Disease Control and Prevention (CDC) official, Dr. Anne Schuchat, estimated that 60 million Americans have now taken the vaccines with at least one dose. and said intense monitoring for side effects has not turned up any safety concerns

As of today over 111 million doses of the four vaccines approved for distribution in the U.S. have been released for use.

SECOND VACCINE RECALL 12/23/09 (also a non-safety recall)

A second round of recall of H1N1/09 Swine Flu vaccine occurred 12/23/09 when MedImmune, the maker of the US approved live vaccine for intra-nasal administration, recalled just under 5 million doses of the vaccine. The recall was like the first vaccine recall earlier in the month, it was not a safety recall, it is because the vaccine had been tested to have a slight decrease in the potency. (See Vaccine section below for more details on the first recall.)

VACCINE RECALL 12/15/09

The US Food and Drug Administration (FDA) announced the non-safety recall of certain lots of the H1N1/09 vaccine, totaling 1.2 million doses, on December 15, 2009. They determined that the vaccine in a particular lot of pre-filled syringes did not meet the range of potency (strength) that was specified by the FDA and the division of Merck and Company, Inc. for use in the US.

Merck, whose division, Sanofi Pasteur, produced the vaccine, has confirmed that the recall affects 1.2 million doses.

According to the Centers for Disease Control and Prevention (CDC) this non-safety issue has prompted the recall of swine flu vaccine that was prepared in single dose syringes for children under age three. These reports indicate that there is no safety issue and those who have already had the vaccination using these particular lots of vaccine do not need to have additional vaccine administered since the strength level is only slightly below what was required in the original approval by FDA.

Only certain lots of the vaccine are included in the recall of December 15, 2009. In the manufacture of most medicines and vaccines, the recommended dose is based on a specified strength range that will be effective for the general population. Because a larger person may need slightly more and a smaller person slightly less, the exact measure of the recommended dose is adjusted based on clinical trials. These trials are used to determine the parameters of the dosage that can be effective for larger sized people, but still safe and not too much for the smaller sized people. In some types of medicines this dose must be more exact and then it is often based on the size of person, such as doses specified as so many milligrams or units per kg of weight.

The doses of vaccines do not need to be as specific. But when the FDA has approved and expected delivery of a specific dose that will be safe and effective for the general population, instead of one which needs to be more finely adjusted by individual measurements, they will require the recall and expect the company to provide the drug exactly as stated in the approval documents.

This is an indication that the ongoing monitoring of the H1N1/09 vaccine by the FDA is being carried out well and the watch is especially close. The recall is a reassuring indicator to medical professionals.

The following statements were made by CDC:

Should infants and children who received vaccines from these lots be re-vaccinated?

No. The vaccine potency is only slightly below the "specified" range. The vaccine in these lots is still expected to be effective in stimulating a protective response despite this slight reduction in the concentration of antigen. There is no need to re-administer a dose to those who received vaccine from these lots. However, as is recommended for all 2009 H1N1 vaccines, all children less than 10 years old should get the recommended two doses of H1N1 vaccine approximately a month apart for the optimal immune response. Therefore, children less than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine.

What action(s) should parents of children who have received vaccine from the recalled lots take?

Parents of children who received vaccine from the recalled lots do not need to take any action, other than to complete the two-dose immunization series if not already completed.

CDC has indicated that the following lots are included in the recall:

0.25 ml pre-filled syringes, 10-packs (NDC # 49281-650-25, sometimes coded as 49281-0650-25):

UT023DA

UT028DA

UT028CB

0.25 ml pre-filled syringes, 25-packs (NDC # 49281-650-70, sometimes coded as 49281-0650-70):

UT030CA

VACCINE DISTRIBUTION

Some states (such as Texas) are now allowing access to the A-H1N1/09 vaccine by the general public. The prioritization for high risk persons is no longer employed to determine eligibility for immunizations since production has caught up with the demand in those states.

About 45 million doses have been released in the first round of vaccine distribution in the US according to the CDC and now the vaccine will be produced at a rate of approximately 20 million doses per week.

The vaccines approved so far by the FDA for use in the US are those produced by Novartis, Sanofi, and CSL (who have produced the inactivated vaccines for injection), and MedImmune who has produced an attenuated (weakened) vaccine for administration in nasal spray for ages 2-49.

The vaccines for Europe approved by EMEA, are two vaccines that are inactivated ("dead") and adjuvanted ("strengthened" so smaller doses can produce the same immunization to enable more doses). They are Focetria by Novartis and Pandemrix by GlaxoSmithKline and both are for administration by injection. Approval awaits for a third vaccine.

(SEE ALSO VACCINE SECTION BELOW FOR MORE)

HOW LONG ARE YOU CONTAGIOUS?

New studies, on how long a person remains contagious, back up the previously reported CDC guidelines that one should be suspected to be capable of still spreading the Novel Swine Flu for one full week after the symptoms start, or until 24 hours after the fever subsides [while taking no fever reducers] which ever is longer, rather than the most recent CDC guidelines that waiting for 24 hours after fever subsides without taking fever reducers is long enough.

The studies show that in some cases the virus remains in the nasal passages of patients for up to 16 days after symptoms begin. Below are some excerpts from the report:

Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said.

When the coughing stops is probably a better sign of when a swine flu patient is no longer contagious, experts said after seeing new research that suggests the virus can still spread many days after a fever goes away.

Using a very sensitive test to detect virus in the nose or throat, [the study] found that 80 percent had it five days after symptoms began, and 40 percent seven days after. Some still harbored virus as long as 16 days later. How soon they started on antiviral medicines such as Tamiflu made a difference in how much virus was found, but not whether virus was present at all. . .

Doctors know that people can spread ordinary seasonal flu for a couple of days before and after symptoms start by studying virus that patients shed in mucus. The first such studies of swine flu are just coming out now, and they imply a longer contagious period for the novel bug.

A-H1N1/09 Has 0.01% Mortality Rate According to recent studiesUntil now, it has been difficult to come up with an estimate of the mortality rates of Swine Flu (novel H1N1/09), since the case numbers were being drawn from known cases from hospitalized patients or other laboratory confirmed cases, which were known to be just a fraction of the total number of infections (because those figures excluded the unknown number of mild cases treated at home, untested, and unreported.)

Very rough estimates of the mortality rate of the pandemic A-H1N1/09 influenza have now been calculated from statistics gathered by a French study in late August 2009 and reported in the Public Library of Science (PLOS). Based on their findings, it is estimated that Novel Swine Flu is 100 times more virulent than seasonal flu.

The main cause of death with A-H1N1/09 is viral pneumonia with resulting ARDS (Adult Respiratory Distress Syndrome). Even though treated in a hospital ICU, approximately 50% of ARDS cases result in death. In the French study, the number of ARDS cases was found to be one in every 5000 cases, giving the estimate of ARDS deaths as 1 in 10,000 cases of infection.

The number of deaths from ARDS in seasonal flu cases, based on empirical evidence in France, is calculated to be between 5 and 10 each year out of an average annual number of seasonal flu cases of 6 million infections. Until better counts of cases are available, that gives a rough estimate of the deaths due to ARDS resulting from seasonal influenza of one out of a million infected patients.

The 1 death in 10,000 cases from A-H1N1/09 compared to 1 in 1,000,000 from seasonal flu strains gives the prior mentioned indications of A-H1N1/09 being 100 times more virulent than seasonal flu.

(For the full article about the study, see the related links section below.)

US Officials predicted in August 2009that there is a potential for 40% to 50 % of the US population to have had the A-H1N1/09 Virus over the course of the next two years.

December 12, 2009 CDC UPDATE:

Ongoing monitoring has continued to lead the CDC to conclusions that this virus is much different than the seasonal flu in the age of those affected. Those age 65 and older are much less at risk from 2009 H1N1 than with seasonal flu:

"... this disease primarily affects people younger than 65 year old, with the number of cases, hospitalizations and deaths overwhelmingly occurring in people 64 years and younger. The risk of illness, hospitalization and death related to 2009 H1N1 is very age specific and very different from seasonal influenza. With seasonal influenza, about 60 percent of seasonal flu-related hospitalizations and 90 percent of flu-related deaths occur in people 65 years and older. The proportion of younger people being impacted by 2009 H1N1 is much greater than what occurs during seasonal flu and their risk of serious illness, including hospitalization and death from 2009 H1N1 is much greater than that for seasonal flu. People 65 and older are much less affected by this virus than what routinely occurs with seasonal influenza and therefore the risk of serious illness, hospitalization and death from 2009 H1N1 in people in this age group is much less than that posed by seasonal flu."

See case and fatality numbers by US state below.

WORLD UPDATE

Totals: more than..........Cases......1562049.........Deaths......16665As of 1/05/10*

*Cumulative. (Given that countries are no longer required to test and report individual cases, the number of cases reported actually understates the real number of cases, according to WHO).

SOUTHERN HEMISPHERE

From WHO 11/13/09 ""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: Pandemic Phase (6) is still in effect.

It is important to note that this does not indicate an increase in the severity, just that the criteria for Phase 6 regarding the spread of the Novel H1N1 Influenza have been met.

10/25/09The President Barack Obama has declared a US National Emergency due to the increase in cases of H1N1/09 and concern about a potential over-burdening of the national health care infrastructure in the US. Update 12/13/09The CDC is allocating doses of the vaccine to each state as the vaccine is produced and released by the drug companies. The allocation process is explained by them as:

"The number of doses "allocated" for ordering is the amount that is at the distribution depots and ready for states to order. The quantity of vaccine allocated is based on the project area's population size. As an example, if 6 million doses total (3 million doses of nasal spray vaccine AND 3 million doses of injectable vaccine) are ready for ordering nationally and a state has 10% of the US population, then their allocation for today is 600,000 doses total (300,000 doses of the nasal spray vaccine and 300,000 doses of injectable vaccine)."

Distribution at the point of service in some locations is still being made on a priority basis to those at highest risk first: pregnant women; individuals who live with or care for children under 6 months old; healthcare and emergency service workers; individuals between 6 months to 24 years old; and then adults 25 to 64 with chronic health conditions.

There is a single injection for adults and children over 9 years old. Children under 10 will need two vaccinations, a second one approximately a month after the first one will provide the needed protection for these with immature immune systems. In adults fully immunity is usually developed within 8 to 10 days of the vaccination. In children who require two doses of vaccine, full immunity takes slightly longer after the second vaccination, approximately two weeks.

The CDC and WHO recommend that people also get the seasonal flu shot as usual. It will have no protection against A-H1N1/09, and the swine flu shot will have no protection against the seasonal flu strains that are expected to be in the Northern Hemisphere this fall and winter as usual. The seasonal and H1N1 vaccines could be given on the same date, however, you should not wait to get the seasonal flu shot until the swine flu shot is available to your risk group. As soon as you have an opportunity to get the seasonal flu shot you should go ahead and get that done as soon as possible.

The H1N1/09 vaccine is made from the pandemic strain of swine flu, but otherwise it is being made the same wayand with the same preservatives, and medium for injection as has been used for decades now for seasonal flu shots. So there is no expectation of problems with getting the vaccination than that which would be normal for the seasonal flu injections. Over the decades of use of this type of vaccine, problems have been very low.

There have been very few reactions or problems with this method of vaccine development and delivery and there is no scientific data to support the concerns that some have voiced about the preservative thimerosal. There is no cause and effect data linking autism to the thimerosal in scientific studies, or other problems. The minuscule amount of mercury in the preservative's compound ingredients is no more than would be obtained through a meal of fish.

Some manufacturers have been developing single doses of vaccine that will not contain the thimerosal which may be available to those who have this concern. The larger 10cc vials will have to have the preservative added, but single dose vials and single dose pre-loaded syringes may be an option for some. Discuss this with your health care professional in advance of presenting for the vaccination if you have concerns.

Vaccinations Are Voluntary In the US*

August 21, 2009 excerpts from the press briefing by CDC:

"The whole vaccination program is voluntary, whether or not a person receives vaccine and at the national level, there are no mandates for vaccination." *

*Exception: In some states, such as NY, health care workers are required by law to get the vaccination if they work in a clinical practice with patients in their care.

". . . the protective effects of influenza vaccine or for the most part, almost any vaccine, are not immediate. The body has to take its time to generate some antibody, that usually occurs over a couple week period. So even with a very effective vaccine and even where only one dose is required, people should not presume that the minute they're immunized they're protected. Also, again, in the viewpoint of being very clear about influenza vaccines they are generally not like the other vaccines, polio or measles vaccine, many which are 95% plus effective in preventing disease if you're exposed to it, and influenza vaccines in healthy, young adults are not quite that protective. There's various estimates of protection, depending on the match of the strain, but, for example, with a well-matched strain in healthy, young adults, protection level is in the area of 70%, 80%, might be typical. . . "

"That has important implications, even if you're vaccinated, wash those hands, cover those coughs, stay home if you're sick."

August 21, 2009 excerpts from the press briefing about vaccine production by the Food and Drug Administration (FDA):

". . . with respect to safety, these are the studies of licensed vaccines from licensed manufacturers, where what's been changed is just the use of this particular H1 strain as opposed to other H1 strains we use in seasonal vaccines so there is a long, accumulated safety database about these products. . . "

ManufacturersThe manufacturers who were contracted and licensed by the US Health and Human Services to produce the H1N1/09 Vaccine are the same ones used by the US for seasonal flu since 2004: Novartis, GlaxoSmithKline, Sanofi Pasteur, CSL Biotherapies, and MedImmune. Taking precautions is a responsibility we all share.

Protect yourself and others by getting a vaccination and by using proper hygiene.

Visit Flu.gov to learn how you can help promote public awareness.

Antiviral MedicationsVIRUSES RESISTANT TO OSELTAMIVIR (TAMIFLU)

IDENTIFIED 11/20/09

Cluster of Tamiflu Resistant A-H1N1/09 virus reported 11/20/09 found in the US in a North Carolina hospital:

Duke University Medical Center of Durham, NC has reported Tamiflu-resistant strains of A-H1N1/09 Swine Flu now found to have infected a few patients in the hospital. It is thought that the infections originated at the University hospital. Hospital officials say that they do not believe this indicates increased risks for the general population, since all four patients were extremely ill cancer patients, and on the same unit in the hospital. The reports of the Tamiflu resistant strains in the US came on the same day as similar reports from Norway and Wales, on Friday, 11/20/09 [for more information on the UK and Norway, see below and related links at the bottom of the page].

About 15 other situations with resistant mutated strains have been reported around the world since April, including four in the United States. Some cases proved fatal, but others caused only mild illnesses according to the CDC.

According to the CDC 12/13/09:

"To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza, even while taking antiviral medications."

Drug Resistant Strains of H1N1/09

Close to 1000 pandemic H1N1 viruses have been evaluated by the laboratories in the Global Influenza Surveillance Network for antiviral drug resistance. All other viruses have been shown sensitive to both oseltamivir and zanamivir. WHO and its partners will continue to conduct ongoing monitoring of influenza viruses for antiviral drug resistance.

Therefore, based on current information, these instances of drug resistance appear to represent sporadic cases of resistance. At this time, there is no evidence to indicate the development of widespread antiviral resistance among pandemic H1N1 viruses. Based on this risk assessment, there are no changes in WHO's clinical treatment guidance. Antiviral drugs remain a key component of the public health response when used as recommended.

Tamiflu Side Effects in Children 7/31/09According to research from the European Programme for Intervention Epidemiology Training and colleagues from the Health Protection Agency (HPA) in London, which was published in Eurosurveillance, the peer-reviewed journal of the European Centre for Disease Prevention and Control, children are having neuropsychiatric side effects from Tamiflu such as nightmares, inability to concentrate, insomnia, and slight confusion.

The article at the NHS web site (link is provided to the full article in the related links section below), states:

". . . more than half of children taking Tamiflu to combat swine flu suffer side effects such as nausea, insomnia and nightmares," said The Daily Telegraph. It also said the study suggests that one in five children who took part reported having a neuropsychiatric side effect."

These were almost all in Japan and none so far have been reported in the US.

% of High Risk Cases

About 70% of individuals that are hospitalized with complications from A-H1N1/09 influenza have some kind of underlying disease. The most predominant of that is asthma. The second is diabetes. Other common underlying conditions believed to have contributed to the complications requiring hospitalization include Immunocompromised status, either through cancer chemotherapy or other compromising conditions (about 13%) and chronic underlying heart disease.

Guidance Documents from the US Centers for Disease Control and Prevention (CDC)

See related links section for links to the full CDC guidance documentation.

US GUIDANCE FOR INSTITUTES OF HIGHER LEARNING FROM CDC 8/20/09

See the links below in the related links section for links to the following Guidance Papers:

Guidance for Responses to Influenza for Institutions of Higher Education During the 2009 - 2010 Academic Year.This covers recommendations divided into two groups:

Recommendations to use now, during this academic year, assuming a similar severity to the spring/summer H1N1 flu outbreak, and recommendations to consider adding if the flu begins to cause more severe disease.

Preparing for the Flu: A communication Toolkit for Institutions of Higher Education.

Includes Posters, Fact Sheets, Q&A Information, Templates for letters and announcements, and other communication resources.

Technical Report on CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009 - 2010 Academic Year.

Includes detailed explanations of the strategies presented in the CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009- 2010 Academic Year and suggestions on how to use them. The guidance is designed

to decrease exposure to regular seasonal flu and 2009 H1N1 flu while limiting the

disruption of day-to-day activities and the vital academic activities that go on in Institutions of Higher Education.

Portions of this guidance pertaining to dormitories and residence halls may be useful for residential (boarding) schools providing primary and secondary education, with adaptations as needed for their younger population.

US SCHOOL GUIDANCE FOR FALL TERM FROM CDC 8/7/09:

(See related links section for a link to this information at the CDC web site.)

GUIDANCE FOR BUSINESSES AND EMPLOYERS FROM CDC 8/19/09Arrange for close regular monitoring of media health information and state and local updates to stay alert to changes in the community.

CDC also provides Preparing for the Flu a Communication Toolkit for Businesses and Employers , see link to this information in related links section below.

OTHER GUIDANCE DOCUMENTS

Guidance Documents on other topics from the US Centers for Disease Control and Prevention (CDC) and WHO are available at their web sites, see links below.

For an alphabetical listing of the WHO Guidance Document topics see the link below.

Changes in A-H1N1/09 Activity Reports from CDC and WHO

CDC follows suit with WHO, stops reports of numbers of cases of Novel H1N1, continues hospitalization and death counts and monitoring. They are now using a new methodology for estimating quantitative figures. See link below for methods.

The statistics in the answer to this WikiAnswers question will have to be modified as availability of reliable data changes. Updates based on available data will continue.

World Case Counts and Fatality Numbers By CountryThis section is no longer being updated~Last updates 1/5/10

Total...............................Cases.......1562049.........Deaths......16665

Cumulative totals (lab verified cases only*)

*This will make totals vary from the estimated totals reported elsewhere in this Q&A

-As of 1/05/10

World Case Counts and Fatality Numbers By Country

Country Cases Deaths Afghanistan 853 17 Akrotiri & Dhekelia 88 0 Albania 350 6 Algeria 633 39 Andorra 1 0 Angola 37 0 Anguilla 14 0 Antigua and Barbuda 4 0 Argentina 142,592 617 Armenia 101 2 Aruba 13 0 Australia 37,642 191 Austria 964 5 Azerbaijan 14 2 Bahamas 29 4 Bahrain 1,346 7 Bangladesh 802 6 Barbados 154 3 Belarus 102 20 Belgium 76,973 17 Belize 42 0 Bermuda, UKOT 10 0 Bhutan 6 0 Bolivia 2,310 58 Bosnia & Herzegovina 558 7 Botswana 31 0 Brazil 58,178 2,105 Brit.Virgin Islands, UKOT 19 0 Brunei 971 1 Bulgaria 766 35 Cambodia 531 6 Cameroon 4 0 Canada 25,828 401 Cape Verde 62 0 Cayman Islands, UKOT 112 1 Chile 12,258 150 China* (Hong Kong) 33,109 50 China* (Mainland) 115,208 501 Colombia 3,288 193 Cook Islands 106 1 Costa Rica 1,596 47 Cote d'Ivoire 3 0 Croatia 526 22 Cuba 794 41 Cyprus 297 3 Czech Republic 1,207 48 Democratic Republic of Congo 78 0 Denmark 651 21 Djibouti 9 0 Dominica 36 0 Dominican Republic 491 23 Ecuador 2,251 96 Egypt 10,056 120 El Salvador 834 31 Estonia 628 7 Ethiopia 6 0 Falkland Islands 7 1 Faroe Islands 44 0 Fiji 234 0 Finland 6,122 36 France 5,000 221 France, New Caledonia, FOC 27 6 French Polynesia, FOC 4 0 French Guiana 126 2 Gabon 1 0 Georgia 759 6 Germany 209,885 132 Ghana 54 1 Gibraltar 35 0 Greece 8,768 60 Greenland 1 0 Grenada 20 0 Guadaloupe, FOC 2 0 Guam 269 2 Guatemala 1,170 18 Guernsey 17 0 Guyana 73 0 Haiti 91 0 Honduras 560 18 Hungary 283 37 Iceland 8,650 2 India 25,572 898 Indonesia 1,097 10 Iran, Islamic Republic 3,672 147 Iraq 2,868 40 Ireland 3,189 22 Isle Of Man 75 0 Israel 4,330 75 Italy 3,593 188 Jamaica 149 6 Japan 11,636 108 Jersey 234 0 Jordan 3,033 16 Kazakhstan 17 0 Kenya 417 0 Kiribati 4 0 Korea, North 50 47 Republic of Korea (South) 108,234 170 Kosovo 98 10 Kuwait 8622 27 Kyrgyzstan 61 1 Laos 242 2 Latvia 57 24 Lebanon 1838 5 Lesotho 65 0 Libya 223 1 Liechtenstein 13 0 Lithuania 68 14 Luxembourg 333 2 Macau 2,625 2 Macedonia 2600 14 Madagascar 877 3 Malawi 4 0 Malaysia 12,210 77 Maldives 25 1 Malta 718 5 Marshall Islands 115 1 Martinique, FOC 3 0 Mauritius 69 8 Mexico 67,982 823 Micronesia 79 0 Moldova 1,024 17 Monaco 36 0 Mongolia 1,073 26 Montenegro 119 2 Montserrat 21 0 Morocco 2,775 38 Mozambique 101 2 Myanmar 68 0 N. Mariana Islands 6 0 Namibia 72 1 Nauru 8 0 Nepal 112 1 Netherlands 1,473 51 Neth. Antilles, Curacao** 8 0 Neth. Antilles, Sint Maarten 2 0 New Caledonia, FOC 12 0 New Zealand 3,198 22 Nicaragua 2,172 11 Nigeria 2 0 Norway*** 12,654 29 Oman 6,029 30 Pakistan 121 10 Palau 46 0 Palestinian Territories 1,582 22 Panama 787 11 Papua New Guinea 12 0 Paraguay 855 52 Peru 9,003 205 Philippines 5,212 30 Poland 2,024 116 Portugal 166,922 58 Puerto Rico 908 49 Qatar 550 8 Republic of the Congo 21 0 Romania 5,421 42 Russia 24,299 580 Rwanda 331 0 Saint Kitts 6 2 Saint Lucia 55 1 Saint Maarten 2 0 Saint Vincent 17 0 Samoa 138 2 San Marino 5 0 Sao Tome & Principe 41 2 Saudi Arabia 14,532 97 Serbia 520 47 Seychelles 33 0 Singapore 1,217 19 Slovakia 955 25 Slovenia 990 13 Solomon Islands 4 1 Somalia 2 0 South Africa 12,642 93 Spain 22,379 256 Sri Lanka 422 23 Sudan 24 1 Suriname 138 2 Swaziland 5 0 Sweden 2,130 20 Switzerland 11,210 9 Syria 432 127 Taiwan 5,474 35 Tajikistan 16 0 Tanzania 677 1 Thailand 29,886 191 Timor-Leste 6 0 Tonga 20 1 Trinidad & Tobago 211 5 Tunisia 1200 15 Turkey 12,316 507 Turks & Caicos 44 0 Tuvalu 23 0 Uganda 251 0 Ukraine 57,862 213 United Arab Emirates 125 6 United Kingdom 27,826 303 United States of America 111,324 4,869 Uruguay 550 33 Vanuatu 3 0 Venezuela 1,973 121 Viet Nam 11,083 52 Virgin Islands (US) 80 1 West Bank & Gaza Strip ? ? Yemen 5,038 25 Zambia 726 0 Zimbabwe 1,318 0 Total 1,562,049 16,665 -As of 1/05/10

Cumulative figures are subject to revision

Abbreviations:

UKOT: United Kingdom Overseas Territory

FOC: French Overseas Collectivity

OT: Overseas Territory

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 cruise ship crew and passengers. None left the ship during the illness nor 24 hours before the onset of symptoms.

CHANGES IN THE CDC REPORTING OF NOVEL H1N1 (A-H1N1/09) CASES 7/24/09From CDC: "Because only a small proportion of persons with respiratory illness are tested for novel H1N1, at this time, confirmed and probable case counts represent a significant underestimation of the true number of novel H1N1 flu cases in the U.S., so the true benefit of reporting these numbers to track the course of the epidemic is questionable. In addition, because of the extensive spread of novel H1N1 flu within the United States, it has become extremely resource-intensive for states to count individual cases.

Instead of reporting confirmed and probable novel H1N1 flu cases, CDC has transitioned to using its traditional flu surveillance systems to track the progress of both the novel H1N1 flu pandemic and seasonal influenza. These systems work to determine when and where flu activity is occurring, track flu-related illness, determine what flu viruses are circulating, detect changes in flu viruses and measure the impact of flu on hospitalizations and deaths in the U.S.""

US Case Counts and fatality numbers by stateThis is being reported from various available sources, since the CDC is no longer publishing cases and deaths by state on a weekly basis. The timing of information about one state may be off slightly from that of another, the date at the top of the list will be applicable to most entries but beside each state there may be a different date, in which case, it will be the date of that particular state's information that is provided. 1/14/10 Estimated number of cases and deaths in the US*:Cases: 115431 Deaths:10837

*Cumulative, plus CDC estimates of unreported cases

This section is no longer being updated~Last updates 1/14/10

US Case Counts and fatality numbers by state - State Cases Deaths Alabama 2,453 39 Alaska 460 12 Arizona 8,545 140 Arkansas 154 20 California 10,031 470 Colorado 1,550 59 Connecticut 5,194 30 Delaware 381 6 District of Columbia 54 1 Florida 3,636 187 Georgia 886 41 Guam 338 2 Hawaii 2,221 11 Idaho 1,165 22 Illinois 4,416 86 Indiana 317 37 Iowa 739 40 Kansas 1,201 26 Kentucky 2,042 37 Louisiana 1,876 41 Maine 2,220 18 Maryland 1,284 41 Massachusetts 1,912 29 Michigan 3,166 76 Minnesota 2,174 60 Mississippi 1,279 14 Missouri 1515 11 Montana 949 19 Nebraska 430 14 Nevada 2,437 36 New Hampshire 722 9 New Jersey 1,414 40 New Mexico 308 50 New York 2,738 157 North Carolina 638 81 North Dakota 650 3 Ohio 227 33 Oklahoma 237 40 Oregon 1,105 75 Pennsylvania 10,934 75 Puerto Rico 908 49 Rhode Island 203 13 Samoa, American 85 1 South Carolina 1,634 41 South Dakota 2,081 23 Tennessee 1,163 50 Texas 11,403 203 Utah 988 44 Vermont 404 3 Virgin Islands 80 1 Virginia 327 35 Washington 658 91 West Virginia 1,214 20 Wisconsin 9,555 50 Wyoming 725 10 Total 115,431 10,837 -As of 1/14/10

*Numbers are likely under reported, see information above about CDC's new estimates.

Travel Advice The CDC has recommended that anyone with flu like symptoms should not travel for 7 days following the beginning of the first symptoms or until there have been no symptoms for at least 24 hours [including no fever, without fever reducing drugs], whichever is longer.

Some countries are screening incoming flights for people with symptoms of the flu (and especially those coming from the US) and putting those with possible H1N1 in quarantine or requiring other precautionary steps to be taken. See the related question link below for the following question for additional details of travel information and advice from the US Department of State and the CDC:

See additional information in the related questions below for virus prevention techniques. See the CDC link below for state by state information from each state's health department.

For a weekly report from the CDC with charts and graphs and lots of interesting data, see the related link below in related link section.A link to the CDC Novel H1N1 Influenza Information in Spanish is provided in links below as well as a link to a full listing of the other languages in which the CDC information is available.

Answer 5

In the spring of 2009 a new virus that causes a new influenza illness -- A-H1N1/09 (swine flu) -- was discovered in Mexico. It started as a local outbreak and quickly spread into an epidemic throughout Mexico, then the US and eventually all of North America. By the time of the fall 2009-2010 flu season, it had spread far and wide around the world and qualified as a true pandemic affecting people in every country of the world. We are currently (2011) in the post pandemic phase with fewer and fewer isolated outbreaks. See the questions below for more information.