In focus: external review of pandemic response begins

An in-depth review by external experts to assess the global response to the pandemic and identify lessons for the future is underway. The Review Committee will also examine the general functioning of the International Health Regulations.

Report of the review meetinf of the first comitee

Influenza pandemic alert raised to phase 6

 

11.June.2009

Dr Margaret Chan
Director-General of the World Health Organization

  

“Ladies and gentlemen,

A characteristic feature of pandemics is their rapid spread to all parts of the world. In the previous century, this spread has typically taken around 6 to 9 months, even during times when most international travel was by ship or rail.

Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection.

Guidance on specific protective and precautionary measures has been sent to ministries of health in all countries. Countries with no or only a few cases should remain vigilant.

Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities.

WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Pending the availability of vaccines, several non-pharmaceutical interventions can confer some protection.

WHO continues to recommend no restrictions on travel and no border closures.

Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection.

We are all in this together, and we will all get through this, together.

Thank you.”

 

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Washington Man Is Third U.S. H1N1 Death

(CBS/AP) Washington state health officials say a man in his 30s is the first person in the state - and the third in the U.S. - to die from what appears to be complications of the H1N1 virus, also known as swine flu.
The state Department of Health says in a news release that, like the first two U.S. H1N1 victims, the Snohomish County man had underlying heart conditions and also viral pneumonia at the time of his death May 6, but that he also had swine flu and it is considered a factor in the death.
"This death is tragic. Our thoughts are with all those affected by this man's passing," said Governor Chris Gregoire. "It's a sobering reminder that influenza is serious, and can be fatal."
The man was not further identified.
He reportedly began showing symptoms on April 30, and was treated with medications.
Health officials cautioned that the number of cases of swine flu in Washington are expected to continue rising for some time to come, and urged people to continue to practice preventive measures, such as frequent hand washing.
"We're working with local and federal partners to track this outbreak," said Secretary of Health Mary Selecky, "and while most illnesses from this new flu strain have been fairly mild, we must remember that influenza claims about 36,000 lives every year nationwide. That's why we urge people to take this outbreak, and the seasonal flu we see every year, very seriously."
Health officials said earlier Saturday that an additional 18 cases of swine flu have been confirmed in Washington, bringing the state's total to 101.

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Important Update: About antiviral drugs against influenza A(H1N1)

 

For what purposes can antiviral drugs be used against influenza A(H1N1)?

So far most people who have contracted the new A (H1N1) virus have experienced influenza-like symptoms (such as sore throat, cough, runny nose, fever, malaise, headache, joint/muscle pain) and recovered without antiviral treatment.

Antiviral drugs may reduce the symptoms and duration of illness, just as they do for seasonal influenza. They also may contribute to preventing severe disease and death. Influenza A (H1N1) is a new virus and only a small number of people with the infection have been treated for it with antiviral drugs. WHO is in touch with public health authorities and clinicians in affected countries and is gathering information about how effective the drugs are.

To which antiviral drugs does this influenza virus respond?

There are two classes of antiviral drugs for influenza: inhibitors of neuraminidase such as oseltamivir and zanamivir; and adamantanes, such as amantadine and rimantadine. Tests on viruses obtained from patients in Mexico and the United States have indicated that current new H1N1 viruses are sensitive to neuraminidase inhibitors, but that the viruses are resistant to the other class, the adamantanes.

Could the virus become resistant to oseltamivir and zanamivir?

Resistance can develop to antiviral drugs used for influenza. Therefore, WHO and its partners are monitoring antiviral drug resistance.

Under what circumstances should antiviral drugs be administered?

Antiviral drugs are to be used according to national pandemic influenza preparedness plans. Public health authorities in some countries have decided to treat patients likely to have this disease as a part of public health measures.

Where antiviral drugs are available for treatment, clinicians should make decisions based on assessment of the individual patient's risk. Risks versus benefits should also be evaluated on a case by case basis.

What is WHO doing about getting antiviral drugs to countries as preparation for a pandemic?

WHO’s first priority is to provide an emergency stock of antiviral drugs to countries that have no or insufficient stock of the drugs and lack the capacity to procure these drugs themselves.

WHO is also working with Member States, donors and other groups that have stockpiles and are willing to share these with WHO for distribution to countries in need.

Which drug will be provided, and how much of it does WHO have available?

WHO had a global stockpile of approximately 5 million adult treatment courses of oseltamivir. Part of this stockpile has already been distributed through the WHO Regional Offices, which are handling allocation and distribution. WHO is currently distributing the remaining 3 million adult treatment courses of this stockpile to developing countries in need.

WHO continues to assess needs and to work with manufacturers to secure more donations of antivirals. More antiviral drugs will be distributed once these donations are received.

Which countries will receive the drug, and how will they be selected?

WHO has arranged the first deployment of antiviral drugs from the WHO stockpile to 72 countries. Priority was given to vulnerable countries, taking into consideration national manufacturing and procurement capacity. As necessary, other countries will be supported through regional office stockpiles.

What if the initial emergency deployment turns out to be inadequate?

WHO is in discussion with manufacturers regarding the potential need for scaling up production. It is WHO’s understanding that manufacturers have plans for producing large numbers of treatments quickly.

WHO will work on behalf of its Member States to secure further antivirals as needed, either through donations or purchase at the lowest possible price.

 

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Last update - 3 May

3 May 2009 -- As of 1600 GMT, 3 May 2009, 18 countries have officially reported 898 cases of influenza A(H1N1) infection.

Mexico has reported 506 confirmed human cases of infection, including 19 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens. The United States Government has reported 226 laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (8), Ireland (1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15).

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

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

Canada on 2 May reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time.

There is no risk of infection from this virus from consumption of well-cooked pork and pork products.

Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

 

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Swine Influenza Update - 1 May 2009

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

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

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

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

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

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Current phase of pandemic alert

 

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

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

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

 

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Swine Influenza - update 28 April

The human swine flu outbreak continues to grow in the United States and internationally. Today, CDC reports additional cases of confirmed swine influenza and a number of hospitalizations of swine flu patients. Internationally, the situation is more serious too, with additional countries reporting confirmed cases of swine flu. In response to the intensifying outbreak, the World Health Organization raised the worldwide pandemic alert level to Phase 4. A Phase 4 alert is characterized by confirmed person-to-person spread of a new influenza virus able to cause “community-level” outbreaks.” The increase in the pandemic alert phase indicates that the likelihood of a pandemic has increased.

CDC has activated its emergency operations center to coordinate the agency’s emergency response. CDC ’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by this swine influenza virus. Yesterday, CDC issued a travel warning recommending that people avoid non-essential travel to Mexico. CDC continues to issue interim guidance daily on the website and through health alert network notices. CDC’s Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

 

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