Thursday, December 31, 2009

Egypt: Deaths #130 - #133

My edits are in (blue)

4 new deaths of swine influenza virus
Thursday, December 31st, 2009 - 20:15

The swine flu deaths continue to rise started Amira Abdel-Salam

The Ministry of Health said in a statement today, Thursday, and the death of 4 new cases of swine flu virus, bringing the total deaths to 133 cases.

The statement said that the situation of (case number) 130 Egyptian woman, aged (37 years), from Kafr El-Sheikh,

and the situation of (case number) 131 Egyptian woman, aged (48 years) from the Cairo governorate,

and the situation of (case number) 132 Egyptian woman, aged (40 years), from Alexandria,

and the situation (case number) 133 of the Egyptian man old (65 years) from Monofia. (Menoufia)

Hat tip: Twall
Comment: [Will add the information for case number 127,128 129,130,131 and 132 when i locate it.
This is sixteen deaths reported in a single twenty four hour period based on the moh information.]

Study: H1N1 not highly contagious in households

Dec 30, 2009 (CIDRAP News) – People living in the same household were less likely to catch H1N1 influenza from a sick family member than they would have been in past pandemics or during a normal flu season, a team from University College London and the Centers for Disease Control and Prevention report today in the New England Journal of Medicine.

Drawing on a database of information gathered about patients with lab-confirmed H1N1 during the pandemic’s early stages, the researchers found the new flu was not very contagious. There were secondary infections in 27% of 216 households and 13% of 600 household residents, compared to secondary attack rates that rose to 20% in the 1957 and 1968 pandemics and up to 40% in some flu seasons. Children and teenagers were twice as susceptible as adults.

The database was assembled from reports filed by state health departments in April and May 2009, while the CDC was still requesting case counts. The reports were written up for any patients whose flu infections were lab-confirmed either as H1N1 flu, or as neither of the H1 and H3 strains that circulated in the 2008-09 flu season.

The reports, filled out during telephone interviews, included information about household size and any other cases in the household. Influenza in the secondary cases was not confirmed by lab tests, however; it was merely described on the basis of symptoms as either “acute respiratory illness” (fever, cough, sore throat and/or runny nose) or “influenza-like illness” (fever and cough or sore throat).

In 72% of the 216 households, no one caught flu from a family member. In 21%, one person did, and in 6%, two or more did. The median age of all 600 household members was 26, but the median age of those who contracted flu from someone was 14.5 to 16.5, depending on how their symptoms were recorded.

The age of the person who brought flu into the household, however, had no effect on their contagiousness; toddlers, teenagers and adults all transmitted flu to others.

The time that it took for flu to pass to a family member—technically, the mean serial interval, between the start of symptoms in the index case and in the first secondary case—was 2.6 days. No one symptom could be linked to H1N1’s being more or less infectious, except that almost all of the patients reported coughing.

For reasons the authors could not explain, the probability of household transmission decreased as the number of household members increased. Among two-person households, 28% of contacts developed flu within 7 days of the first patient’s symptoms starting, but in households with six or more members, only 9% did. “These differences … highlight the fact that the sociologic, environmental, and biologic mechanisms available to explain the relationship between secondary attack rates and household size are still limited,” they said.

The study is significant, the authors said, because so little work has been done on risk factors for flu transmission at home, despite public health recommendations that people who contract flu stay home until 24 hours after their fever subsides. In addition, they said, the findings confirm the observation that children and teenagers are more vulnerable to H1N1 flu than adults.

Cauchemez S, Donnelly CA., Reed C, et al. Household transmission of 2009 pandemic influenza A (H1N1) virus in the United State. N Engl J Med 2009;361(27):2619-27 [Full text]

Indonesia reports 20 H5N1 cases -- 19 fatal -- since January

Robert Roos * News Editor

Dec 30, 2009 (CIDRAP News) – Indonesia's Ministry of Health, updating information on H5N1 avian influenza for the first time since January, quietly reported this week that the country has had 20 human cases so far this year, with 19 of them fatal—a 95% case-fatality rate (CFR).

A terse notice from the Ministry of Health on Dec 28 listed the figures and said the latest reported case was identified in South Jakarta on Sep 23. Indonesia's cumulative H5N1 toll since 2005 is now 161 cases with 134 deaths, for a CFR of 83%.

The World Health Organization (WHO) updated its chart of H5N1 cases and deaths today to include the new numbers from Indonesia, but it posted no report on the cases. The global H5N1 total is 467 cases with 282 deaths, a CFR of 60%. Indonesia is the hardest-hit country overall, though Egypt has had more cases this year—39, with just 4 deaths.

Indonesia's then–health minister, Siti Supari, announced in June 2008 that the government would stop issuing prompt reports of new H5N1 cases and instead offer only periodic updates. The announcement raised concern about the world's ability to track the virus's evolution and impact.

Supari also stirred controversy in 2007 by clamping down on sending samples from H5N1 patients to the WHO, saying viruses from the samples are used to make vaccines that enrich pharmaceutical companies but are too expensive for Indonesia and other developing countries.

Since the June 2008 announcement, Indonesia has issued few official reports of H5N1 cases. The WHO posts H5N1 situation updates based on reports from governments; the last time the agency gave an update on Indonesia was Jan 22, reporting two cases. A press report quoting an Indonesian official in early March noted four more cases, all fatal, but they were not registered by the WHO at the time.

The health ministry's notice this week gave no details on any of the recent cases.

The WHO's H5N1 tally for this year to date includes 72 cases with 32 deaths, compared with 44 cases with 33 deaths in 2008. Besides Egypt and Indonesia, countries that have reported cases and deaths this year are China (7 and 4), Vietnam (5 and 5), and Cambodia (1 and 0).

The often deadly H5N1 virus has not yet gained the ability to spread easily from person to person, though it has circulated widely in birds for the past 6 years. Disease experts still fear that it could gain transmissibility through mutation or by reassorting with another flu virus.

See also:

WHO chart of H5N1 cases and deaths

Dec 30 Bird Flu Information Corner blog entry on the Ministry of Health statement

Jun 5, 2008, CIDRAP News story "Indonesia quits offering prompt notice of H5N1 cases"

Wednesday, December 30, 2009

Egypt: Death #118 - #122

[Edits by Twall]

World Health Organization announced that the mutation of a pandemic virus question difficult to predict and no follow-up and the vigilance of the Organization after skipping the swine flu epidemic of all standards in terms of casualties and the number of deaths.
Dr.. Hussein Algerian director of the Regional Office of the World Health Organization Eastern Mediterranean that the production of vaccines against swine flu has increased, and manufacturers can produce the quantities that are sufficient to meet the needs of the epidemic .. He pointed out that the optimism on the Elimination of the epidemic is unlikely during this period and must be wary of the disease.
On the other hand the Ministry of Health for the death of 5 new cases of swine flu, bringing the number of deaths in Egypt so far to 212 cases.
Five cases, starting from the 118 case of a woman at the age of 61 years of Giza 119 and the situation of a woman at the age of 48 years of the Governorate of Alexandria and the situation of 120 women, aged 35, from Kafr El-Shaikh.
121 case of a woman, aged 34, from Damietta, 122 case of a woman at the age of 23 years of appreciation (Qalyoubia = )
hat-tip Twall|en&u=

WHO: Pandemic (H1N1) 2009 - update 81 - Weekly update

30 December 2009

As of 27 December 2009, worldwide more than 208 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 12220 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Situation update:

The most active areas of pandemic influenza transmission currently are in central and eastern Europe. Focal increases in rates of ILI/ARI during recent weeks were reported in at least three eastern European countries, Georgia, Montenegro, and Ukraine.

A high intensity of respiratory diseases activity with concurrent circulation of pandemic influenza persists in parts of southern and eastern Europe, particularly in Greece, Poland, Bulgaria, Serbia, Ukraine, and the Urals Region of the Russian Federation.

In Western Europe, influenza transmission remains active and widespread, but overall disease activity has peaked. At least 13 of 21 countries (testing more than 20 sentinel samples) reported that 30% or more of sentinel specimens were positive for influenza, down from a peak of over 70%. All were influenza viruses detected in Western Europe were pandemic H1N1 2009, however, very small numbers of seasonal influenza viruses, making up less than 1% of all influenza viruses detected, were reported in Russia.

In addition, limited available data indicates that active, high intensity transmission is occurring in Northern African countries along the Mediterranean coast (Algeria, Tunisia, and Egypt).

In Central Asia, limited data suggest that influenza virus circulation remains active, but transmission may have recently peaked in some places.

In West Asia, Israel, Iran, Iraq, Oman, and Afghanistan also appear to have passed their peak period of transmission within the past month, though both areas continue to have some active transmission and levels of respiratory disease activity have not yet returned to baseline levels.

In East Asia, influenza transmission remains active but appears to be declining overall. Influenza/ILI activity continued to decline in Japan, in northern and southern China, Chinese Taipei, and Hong Kong SAR (China). Slight increases in ILI were reported in Mongolia after weeks of declining activity following a large peak of activity over one month ago.

In southern Asia, influenza activity continues to be intense, particularly in northern India, Nepal, and, Sri Lanka. Seasonal influenza A (H3N2) viruses are still being detected in very small numbers in China making up about 2.5% of the influenza A viruses detected there.

In North America, influenza transmission remains widespread but has declined substantially in all countries. In the US, sentinel outpatient ILI activity has returned to the seasonal baseline, and indicators of severity, including hospitalizations, paediatric mortality, and P&I mortality have declined substantially since peaking during late October. Rates of hospitalization among cases aged 5-17 years and 18-49 year far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower than those observed during recent influenza seasons.

In the tropical regions of Central and South America and the Caribbean, influenza transmission remains geographically widespread but overall disease activity has been declining or remains unchanged in most parts, except for focal increases in respiratory disease activity in a few countries.

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

The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza.

For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).
hat-tip Ironorehopper

May take a year to conquer H1N1 flu pandemic: WHO

GENEVA (Reuters) - The H1N1 flu pandemic may not be conquered until 2011 and continued vigilance is required against the virus which can still mutate, the head of the World Health Organization said on Tuesday.

WHO Director-General Margaret Chan also warned that although countries have shored up their defenses against the first influenza pandemic in more than 40 years, they remain ill-prepared for mass outbreaks of the deadlier bird flu virus.

"It is still premature and too early for us to say we have come to an end of the pandemic influenza worldwide. It would be prudent and appropriate ... to continue to monitor the evolution of this pandemic for the next six to 12 months," Chan told a year-end news conference.

"The one thing we need to guard against is a sense of complacency," she added.

Countries including Britain, Canada and the United States have passed peaks of a second wave of H1N1, but outbreaks are intensifying in India, Egypt and elsewhere, according to Chan.

H1N1 has now spread to more than 200 countries, with nearly 12,000 deaths confirmed in laboratory, but it will probably take two years to establish the true death toll, she said.

Millions of people have been infected with the virus which emerged in April, most recovering without special treatment.

But young people, pregnant women and people with underlying health conditions such as heart or lung disease are more vulnerable and often require intensive care in hospital.

Influenza viruses are notoriously unpredictable and can mutate into more severe forms, according to the WHO chief.
Chan, who admitted she had not received her own H1N1 flu shot yet but would have it soon, said: "I am a bit more relaxed, but I will never let down my guard."


Rich countries and drug companies have pledged to donate 190 million doses of H1N1 vaccine for use in some 90 developing countries, she said.

Her United Nations agency plans to start distributing the first doses in Azerbaijan and Mongolia in early January, to be followed by Afghanistan, she added.

On recalls of some H1N1 vaccine -- by AstraZeneca's MedImmune unit and Sanofi-Aventis SA -- she said they were because they were not as potent as they should be but posed no risk.

"The recalls are not related to safety of vaccines," she said, saying the issue had been dealt with in an "ethical way."

Chan, noting the world's financial crisis and weak health systems in some countries, said: "The fact that the long overdue influenza pandemic is so moderate in its impact is probably the best health news of the decade."

But Chan, who fought avian flu and SARS while serving as
health director in her native Hong Kong, said the world was still not ready to combat a pandemic of the H5N1 bird flu virus, noting it was "more toxic and deadly."

"No, the world is not ready for a pandemic to be caused by H5N1," she said.
hat-tip Pathfinder

Egypt: Allocate 5% of the beds in the lake for patients with influenza

December 30th, 2009

Decided to Major General Mohamed Shaarawy, the allocation of 5% of the family all hospital centers and cities of the lake for the reception and treatment of patients with avian flu and swine, with the emphasis on health directorate managers aware of maintaining hospitals and doctors, and so regularly, how to handle suspected cases in the reception the disease and how to deal with patients and to provide the medications used to treat these cases, and compliance with the Minister of Health on the disposition of the drug, according to the needs of the pathological condition, and coordination with the education and education in dealing with suspected cases of schoolchildren.

Sharawi stressed during the meeting of the Executive Council of the province on the need to intensify campaigns to market existing cities to prevent the sale of live poultry and poultry farms to close within the residential blocks and the need for health systems and hospitals, the analysis of regular citizens who stayed in the district maintaining foci of infection and visitors to hospitals, suffering from high temperature and suspected of contracting avian and swine influenza.

Sharawi also decided to cut off utilities (water and electricity) from the shops that still sell live poultry, until the activity and make it easier for these stores to change this activity to another activity.

Indonesia: Health Minister Reports 20 Confirmed H5N1, 19 deaths, for 2009

Avian Flu Situation In 2009
28 Dec 2009

From January 1 to December 28, 2009, there were 20 cases of H5N1 in Indonesia, 19 people died. The first H5N1 case occurred on January 9, in Bogor, while the last case was found on September 23, 2009 in South Jakarta.

Thus, cumulatively, the total number of H5N1 cases [in Indonesia] since the year 2005 to 2009 amounted to 161 cases of 134 people died.

This information is published by the Center for Public Communication, Secretariat General of the Ministry of Health. For further information please contact via telephone numbers: 021-52907416-9, fax: 52921669, Call Center: 021-30413700, or e-mail address puskom.publik @, info@puskom.depkes.go. id,
hat-tip dbg

New Brunswick: Tamiflu Resistant Case

N.B. records 8th H1N1 death
Young Quispamsis man fought flu for a month

Tuesday, December 29, 2009 | 8:52 PM AT
CBC News

New Brunswick public health officials are reporting the province's first death related to a drug-resistant H1N1 strain.

A 27-year-old Quispamsis man died in hospital on Monday after nearly a month in intensive care, public health officials said. Doctors tried treating him with the anti-viral drug Tamiflu but those efforts failed.

The man was the eighth person in New Brunswick to die with the H1N1 virus.

“He was suffering from a number of underlying conditions that predisposed him to having a very severe case of the disease,”
said Dr. Paul Van Buynder, the province's deputy chief medical health officer.

According to Van Buynder, the H1N1 strain the man contracted was resistant to drugs such as Tamiflu that are used to fight the virus.

Vaccine available

Van Buynder said it's unlikely the victim had received an H1N1 shot. Had he been vaccinated, the man would have been safe from the virus — even the drug-resistant strain, Van Buynder said.

Health officials said they have not found a second case linked to the most recent H1N1 flu victim.

About two-thirds of New Brunswick residents have received the H1N1 shot.

Van Buynder encouraged those who haven't been vaccinated to get a shot as possible.

Although mass vaccinations have ended, shots are still available in VON (Victorian Order of Nurses) clinics, public health clinics and from certain family doctors.
hat-tip Shiloh

India: Bird flu scare returns in Bengal village [poultry]

Wednesday, Dec 30, 2009

West Bengal is in again in the grip of bird flu or avian influenza scare. More than 2,000 birds, including domestic poultry, were found dead in the remote village of Durmoth at Mongolkot in Burdwan district, prompting the state animal resources development department to send a team to collect samples. The result will be announced within the next few days.

The district administration has started an awareness campaign in the village, which was one of the areas hit when bird flu broke out in January 2008. At that time the state had incurred a loss of Rs 500 crore and 4 million birds had to be culled. Thirteen districts were hit by the bird flu menace at that time.

“There is no need to panic. The samples have been sent for testing. Birds have died, but there can be a number of reasons behind it. We are prepared to tackle any outbreak,” said Narayan Biswas, state Animal Resource Development Minister.

“Our team visited the area on Tuesday and collected samples of dead birds from the village and its periphery. We have sent the samples to the testing laboratory in Belgachhia. We have started an awareness campaign in the area and have asked the villagers to dispose of the carcasses of the birds in a pit,” said Udaybhanu Gangopadhyay, Deputy Director of district ARD.
hat-tip Pathfinder

Tuesday, December 29, 2009

Egypt: 3 More Deaths - Total 120

Tuesday, December 29th, 2009 - 20:23

Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health
Abdul Salam wrote Princess

The Ministry of Health said in a statement today, the death of three new cases of swine influenza virus, raising the total deaths to 120 HIV cases.

The ministry said in a statement that the situation of (case number) 118 Egyptian woman, aged 61, from Giza Governorate, the situation of (case number) 119 Egyptian woman, aged (48 years), from Alexandria, and the situation of (case number) 120 Egyptian woman, aged (35 years), from Kafr El-Sheikh.
hat-tip Twall

Egypt: Two deaths raise influenza Total of 117

December 29th, 2009
The Ministry of Health on Monday, the death of two new cases of HIV, "eh HP 1 The 1" is known as "swine flu" in order to increase the number of deaths in Egypt since the emergence of the disease and so far 117 cases.

The Health Ministry said in a statement issued late yesterday that the two deaths to the new man and a woman of the governorates of Cairo and Sohag.

The ministry pointed out that the case of death of 116 men from Cairo Governorate at the age of 28 years, and No. 117, death of a woman from Sohag Governorate, at the age of 36 years.

hat-tip Twall

Vietnam: Patient mortality after 13 days treatment Tamiflu

December 29, 2009
(AFP) - A male patients (aged 64) in the Mexican Department, Van Giang, Hung Yen [Mễ Sở, Văn Giang, Hưng Yên] died after 13 days continuous treatment Tamiflu and antibiotics. This is the first 53 deaths across the country related to influenza A/H1N1.

Am December 29, Nguyen Huy Nga, Director of Department of Preventive Health and Environment (Ministry of Health) said, patients onset disease with symptoms of fever on June 12, 2009 [12/6] hot, thorny malaria, cough white sputum. Patient self-treatment at 3 days but does not help, then visit and enter the hospital with 108 TU army [TƯ Quân đội 108] diagnosed severe pneumonia.
Here, patients are antibiotic treatment and PCR test results positive for influenza A/H1N1 virus. Patients treated antiviral drug (Tamiflu) 6 on the condition should not support as of December 18, 2009, the patient be forwarded to the tropical disease hospital TU [Bệnh viện Bệnh nhiệt đới TƯ]
Here, patients continued treatment Tamiflu and antibiotics immediately after admission. However, severe disease continued progress, the situation did not improve and pneumonia patients die today December 25, 2009, after 13 consecutive days were treated with Tamiflu. Patients also have a history of high blood pressure 8 years now.

Monday, December 28, 2009

Lessons learned from a decade of epidemics

December 28, 2009

When the last millennium came to an end, the Y2K bug was grabbing attention. As the first decade of this one neared an end, a pandemic bug was in the spotlight.

In the past 10 years, fear has accompanied new viruses, including bird flu, or H5N1, severe acute respiratory syndrome, or SARS, and most recently, the virus formally known as 2009 pandemic influenza A, or H1N1.

But much can be learned from the decade's experience with these viruses, experts say.

For public health officials, the challenge in a pandemic is to inform people about how they can protect themselves without causing panic.

Worldwide, governments set up their pandemic plans based on bird flu, a highly pathogenic virus that infected a relatively small number of people, mainly in China and Southeast Asia, where it has had a case-fatality rate of about 60 per cent. Evan Frustaglio, a 13-year-old hockey player from Toronto, died on the eve of the H1N1 vaccine becoming available. Demand for the vaccine jumped overnight.Evan Frustaglio, a 13-year-old hockey player from Toronto, died on the eve of the H1N1 vaccine becoming available. Demand for the vaccine jumped overnight. (Facebook)

The worst-case scenario is a virus that is both highly pathogenic and highly transmissible, meaning it causes serious disease and spreads easily from person to person.

While both bird flu and SARS were highly pathogenic, neither was particularly transmissible. The opposite is the case with H1N1, which is very transmissible but is not very pathogenic, said Sir Roy Anderson, a professor of infectious disease epidemiology at Imperial College in London.

When H1N1 first emerged in Mexico in April 2009, the fatality rate seemed about one in 100, but this turned out to be too high, since only the serious cases came to the attention of health authorities. The death rate is now estimated to be about one in many tens of thousands or perhaps one in a 100,000 — in the same ballpark as typical seasonal flu.

"At the start, the media messages were on average balanced but a little bit alarmist because everybody thought this was the big one, with a totally novel strain of the virus with a high case fatality," Anderson said.

By early fall, the news media started reporting on a much smaller fraction of people sickened with serious illness from H1N1.

Another reason the case fatality rates were overestimated for H1N1, Anderson said, is that it is a difficult disease to diagnose. Influenza causes similar symptoms to cold virus, including chest secretions and a rapid rise in temperature.

Problems in diagnosing H1N1 show the need for more sophisticated ways of telling if someone has been exposed, he said.

The H1N1 flu pandemic also taught the importance of monitoring flu viruses for mutations that occur when someone is infected with two viruses at the same time and the viral genetic codes get jumbled.

Panic from pandemic alert?

That's how bird flu could become more transmissible or swine flu could become more pathogenic — changes scientists worldwide are watching for closely. They are also looking for any evidence that flu viruses are becoming resistant to antiviral medications such as Tamiflu and Relenza.

When the World Health Organization raised its alert level for H1N1 from three to four, then to five and finally six — a full-blown pandemic that is widespread geographically — the changes were meant to signal to governments to put their pandemic plans into place, not to cause panic in the public.

When the public is told to "be vigilant" during an alert for example, governments need to put out accurate, balanced views of what's happened and be frank if there's uncertainty, Anderson said. The design of protective masks to protect health-care workers improved after the SARS outbreak in 2003 that killed 800 people around the world, including 44 in Toronto.The design of protective masks to protect health-care workers improved after the SARS outbreak in 2003 that killed 800 people around the world, including 44 in Toronto. (Kevin Frayer, Canadian Press Picture Archive)

"Sometimes [alerts] help, sometimes they induce panic," said Clive Seale, a professor of medical sociology at Queen Mary, University of London, who edited a book titled Health and the Media.

Those now-familiar steps — washing your hands, avoiding touching your face, coughing and sneezing into your sleeve, reducing mixing, staying home when sick, early treatment with antivirals, and getting vaccinated — probably did make a difference in stemming the spread of H1N1.

But researchers won't be able to tell until next year, when they're able to analyze the pattern of the pandemic, as they do with seasonal flu outbreaks.

Attention to details

Health Minister Leona Aglukkaq made the same point during her year-end news conference on H1N1. She said it was important to deal with facts of confirmed cases when the virus emerged during the spring of 2009. Doing otherwise could have diverted resources to where they weren't needed, she said.

Canada's pandemic plan clearly outlined the roles and responsibilities for each jurisdiction, applying one of the lessons learned from SARS, Aglukkaq said.More outbreaks of infectious diseases such as H5N1 bird flu may occur as livestock continue to be brought into densely populated cities.More outbreaks of infectious diseases such as H5N1 bird flu may occur as livestock continue to be brought into densely populated cities. (AP Photo)

But after governments started drafting pandemic plans in response to bird flu, in Anderson's view, they focused on generalities without paying enough attention to logistics and details.

Details such as how to get antiviral drugs to people within 48 hours of infection, deciding on who should be in priority groups for the vaccine, and how to get the vaccine into arms are all important steps that governments should work out in advance, rather than during a pandemic, Anderson said.

SARS also highlighted to hospitals why it's so important to focus on infection-control procedures, since the infection persisted for a long period and caused serious illness for nurses and doctors working in the institutions. The outbreak also led to the development of new facemasks that were more effective and easier to breathe in, Anderson said.

More outbreaks are "somewhat inevitable," he said, given that the world's population continues to grow and live in densely populated cities. To serve these urban residents, livestock are brought into cities, where infections are likely to spread from animals to humans in the future.

The reality of today's world means that when new viruses emerge, air travel largely dictates its spread early on in the outbreak. In the cases of both severe acute respiratory syndrome in 2003 and H1N1 in 2009, air travellers spread the infection from its origin to major cities around the world.

Egypt: 3 More Deaths - Total 115

The death of 3 influenza and high total to 115 cases

Monday, December 28, 2009
Ministry of Health announced the death of three new cases of disease, swine flu h1n1, bringing the number of deaths to 115 cases since the disease from entering Egypt.

The Health Ministry said in a statement today, the situation No. 113 for the old man 55 years of Suez Governorate, in the case of 114 female, 37 years old, from Fayoum.

The statement pointed out that the situation of the 115 old woman 41 years of Red Sea Governorate.

Vietnam: H1N1 Deaths


19 yo From: Ben Tre Onset: 9/3 Adm: 9/5 DOD: 9/12

46 yo From: Dak Lak [u/c] Adm: 9/16 DOD: 9/17

42 yo From: Binh Phuoc [u/c] Onset: 9/15 Adm: 9/18 DOD: 9/19

59 yo From: Ben Tre [u/c] Onset: 9/16 Adm: 9/16 DOD: 9/24

23 yo [36 wk pregnant] From: Dak Lak Onset: 9/20 DOD: 9/25

30 yo From: Ho Chi Minh City [u/c] Adm: 9/21 DOD: 9/24

13 yo From: Mekong Delta, Long An [late treatment] DOD: 9/25

49 yo From: Australia Ho Chi Minh City Adm: 9/13 DOD: 9/25

21 yo [28 wk pregnant] From: Can Gio Dist., HCMC. Adm: 9/22 DOD: 9/27

15 yo [39 wk pregnant, baby lived] From: Dong Nai. Adm: 9/25. DOD: 9/29.

25 yo [24 wk pregnant] From: Khanh An, U Minh, Ca Mau Onset: 9/22 Adm: 9/22 DOD: 9/27.

47 yo From: Phu Tan Dist., Cau Mau Onset: 9/24 Adm: 9/27

DOD: 9/30

29 yo From: District 12, HCMC [u/c] Adm: 9/29 DOD: 10/2.

63 yo From Phu Son, Thanh Hoa [u/c] Onset: 9/10 Adm: 9/20 DOD: 9/21.

51 yo From: Ca Mau Adm: 9/29 DOD: 10/3 (?) Tests Pending.

#21: 14 yo From: Bla Village, Dak Song, Kong Chro district, Gia Lai Province. Adm: 10/5 DOD: 10/8

#22: 36 yo From: Binh Phu, Ho, Ben Tre, Ben Tre Province. Onset: 10/2. Adm: 10/4 DOD: 10/5

#23: 19 yo From: Ngo Quyen Bac Giang City, Bac Giang Province. Onset: 10/4 Adm: 10/5 DOD: 10/7

#24 29 yo [39 wk pregnant] From: An Huu Hoai An dist., Binh Dinh Province. Adm: 10/10 for caesarean section. 10/14: respiratory distress, high fever, severe pneumonia. DOD: 10/15.

#25 60 yo From: Son Dong, Bac Giang [u/c] DOD: Approx. 10/14 (art. Dated 10/21).

#26 20 mo old From: Hai Chau district, Da Nang. Onset: 10/12. Adm: 10/14 DOD: 10/20.

#27 27 mo old From Nam Mo Cay, Ben Tre. Onset: 9/26. Adm: 9/30 DOD: 10/16

#28 25 yo [9 mos pregnant] From: Nien Phong Vill., Hoa Thang com. Phu Hoa, Phu Yen Prov. Adm: 10/19 DOD: 10/20

#29 48 yo From: Ha Thai vill., Chu Pong, Chu Se dist., Gia Lai Prov. [u/c] Adm: 10/12 DOD: 10/20

#30 24 yo [7 mos pregnant] from Me Xuan Vill., Ia Me Comm., Chu Prong Dist., Gia Lai Prov. Onset: 10/10. Adm: 10/18 DOD: 10/21.

#31 2 yo From: Tan Ha, Lam Ha, Lam Dong Prov. [u/c] Onset: 10/14 Adm: 10/16 DOD: 10/22.

#32 21 yo [6 mos pregnant] From: Son Tay, Thach, Hanoi. Onset: 10/15. Adm: 10/17. DOD: 10/21

#33 10 mo old From: Social Housing Bong, Ea Kar, Dak Lak Adm: Trans. 10/21 DOD: 10/26

#34 41 yo [civil engineer at hydro power plant] From: Thanh Thuy, Thanh Binh Ward, Hai Chau district, Da Nang Province. Onset: 10/17 10/18: back in Da Nang. Adm: 10/21 DOD: 10/24

#35 27 yo From: Cu Kuin district, Dak Lak province. [u/c]

Adm: 10/9 DOD: 10/15

#36 31 yo [37 wk pregnant] From: Krong Pac district, Dak Lak. Onset: 10/11 Adm: 10/14 DOD: 10/17.

#37 17 yo From: An Giang Onset: 5 days @ home. DOD: 10/29.

Red eye (note in article dengue stat, hemorrhagic fever-3 deaths).

#38 38 yo From: Yen Vien, Hanoi. [u/c] Onset: 10/2.

Adm: 10/5 Test Results: 10/6 pos. 10/10: Test Neg. DOD: 10/31. Resistant to all antibiotics.

#39 32 yo From: Hoa Binh province [worked in Tay Ninh province] Onset: ? Adm: 10/23 Adm: 10/24 HCMC 10/25: tested positive. 10/30: tested negative. DOD: 11/3 No underlying conditions.

#40 54 yo From: Mai Son district, Son La province. Onset: 10/20. Adm: 10/27. DOD: 11/2. Tested positive on 10/27. Tested negative after 5 days of treatment.

#41 17 yo From: Dong Anh, Hanoi. Adm: 11/5. DOD: 11/7.

#42 16 yo [6 months pregnant]From: Vinh Quang, Rach Gia, Ho Chi Minh City, Kien Giang, Mekong Delta. Onset: 11/3. Adm: 11/7. Transferred: 11/8. DOD: 11/9.

#43 23 yo From: Binh Tan, Phuoc Ninh, Phuoc Long, Binh Phuoc Province. Adm: 10/30 Tested positive. DOD: 11/12. 6 days of treatment. Tested Negative.

#44 20 yo [27 wk pregnant] From: Khanh Son, Khanh Hoa province. Onset: 11/12. Transferred 11/19. DOD: 11/24.

#45 59 yo From: Binh Lieu, Quang Ninh. Onset: 11/5. DOD: 11/26. Misdiagnosed for Malaria, and treated as such. No Tamiflu until 11/15.

#46 17 yo From: Thoai Son, An Giang province. Onset: 10/21. Went to clinic, no help. Adm: 10/25 An Giang Hosp. Deep coma, severe respiratory distress. DOD: 10/29.

#47 33 yo From: Long Xuyen, An Giang province. Onset: 11/15. Adm: 11/16 An Giang Military hospital. 11/19 trans. To General Hospital, An Giang. DOD: 11/20.

#48 57 yo From: Phuong Lien ward, Dong Da District, Hanoi. Onset: 11/22, fever headache. 11/14 returns, gets flu drug treatment. Fever first two days, then fever left. Periodic fever for the next 8 days, treated himself at home. Adm: 11/29. DOD: 11/30 or 12/1. Diag: malaria. 12/7: Blood tests reveal confirmed H1N1.

#49 23 yo [33 wks pregnant] From: Hai Duong, Hai Hau, Nam Dinh. Onset: 5 days at home, sym’s of high fever, sore throat, aggressive cough. 3 days blood & sputum, increasing difficulty breathing. Included in the TB & Lung Disease Hosp. Trans. To Hospital for Tropical Central on 12/7, diagnosed with pneumonia virus. 12/8: miscarriage & confirmed H1N1. DOD: 12/12:

#50 28 yo [6 months pregnant] From: Tan Dinh village, Vinh Linh district, Quang Tri Prov. DOD: 12/10-16/09

Onset: 11/28. Went to Station Family Health, outpatient treatment. 12/3 trans. To Vinh Linh Hospital, diagnosed w/pneumonia. Continue outpatient treatment. Adm: 12/4 Provincial Hospital [Quang Tri Gen.], then transferred to hospital from Hue. Conf: 12/4. DOD: 12/10.

#51: 3 yo From: Yen Dinh, Thanh Hoa. Onset: 11/22 [fever,vomiting, diarrhea]. 11/23 taken to Yen Dinh dist. Hospital. Transferred that day to Children’s Hospital of Thanh Hoa. 11/27: Transferred to Central Pediatrics Hospital in comatose condition. Test given, positive for H1N1. DOD: 12/3

#52: 34 mos From: Ba Dinh District, Hanoi. [u/c]. Onset: 12/1 [fever, runny nose, diarrhea, treated outpatient unit of Central Children’s Hosp.]. Adm: 12/5 Central Children’s Hospital [fatigue, shortness of breath, rapid breathing, heart shock, respiratory insufficiency] Treated active resuscitation, respiratory support/vent, cardiovascular support. 12/13: pneumonia, tested positive, started treatment on Tamiflu. DOD: 12/14.

Egypt: 3 Deaths - Total 112

Monday, December 28, 2009
The Ministry of Health on Sunday evening, the death of three new cases infected with A (H 1, that 1) the world-renowned swine flu, bringing the total number of deaths to 112 cases.

According to a statement issued by the ministry yesterday, the situation of the 110 men (61 years) from the Cairo governorate, and the situation of the 111 men (40 years), and the situation of 112 young (34 years) and two of the Giza Governorate.

The Ministry of Health that the total number of HIV cases in Egypt, has reached 10056 case so far. The ministry said in a statement issued today, the total number of confirmed cases of swine flu in schools from the academic year and until now, the 3990 case.

The statement pointed out that the total number of confirmed cases in universities from the academic year and so far amounted to 529 cases.

The statement added that the number of confirmed cases infected outside schools and universities was the case until today 5537.

He noted that the total number of cases of recovery from bird (er HP 1 that 1) The 9828 case .. He pointed out that there are currently 119 cases under hospital treatment.

Sunday, December 27, 2009

Egypt: 3 more deaths reported - total 109

Sunday, December 27th, 2009 - 21:13

Hatim the Minister of Health
The Ministry of Health for the death of three new cases of disease, swine flu, bringing the number of deaths to 109 cases since the disease from entering Egypt.

The Health Ministry said in a statement on Sunday that the situation (case) No. 107 Egyptian woman at the age of 55 years of Dakahlia Governorate.
Case No. 108 is of a woman at the age of 66 years from Qalyoubia province, as was the case (No.) 109 and according to the statement of a woman at the age of 35 years of Assiut Governorate

hat-tip Twall

Egypt: 22 deaths of swine flu in Cairo

Sunday, December 27th, 2009 - 12:04

Dr.. Abdel-Azim Wazir Governor of Cairo that deaths resulting from the swine flu case hit 103 nationwide, including 22 cases in Cairo, including 3 cases of school.

The Minister has been closed 153 schools in the school reopening 92 of them, and the closure of 336 chapters have been re-opened 219 chapters, and the rise in incidence, but less than the expected number before the start of the school year.

The Minister issued strict instructions to the Directorate of Education and not to slacken by the committee formed to follow up and ensure the cleanliness and maintenance of schools, both internally and externally and the presence of doctors and disinfectants, and the full implementation of preventive measures, and the emphasis on school managers, the immediate shutdown of schools upon the arrival of the decision of closing down and transmit the Director to investigate the case of failure or inaction in implementation, and in the case of the failure of managers of private schools are taking action and signing of financial and administrative supervision of the Directorate of Education.

Saturday, December 26, 2009

Egypt: Two flu deaths raise the total to 103

Thursday, December 24th, 2009 - 21:32

Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health
Cairo (a. U. A)

The Ministry of Health reported two new deaths HIV AH1N1, known internationally as the swine flu, bringing the number of deaths in Egypt since the emergence of the disease and so far 103 cases.
The ministry statement said on Thursday that the case number (102) for the old lady (47 years) from Qalyoubia province, case No. (103) of old lady (23 years), from Monofia.
hat-tip Twall

Health announces three new deaths from influenza- total deaths 106

Saturday, December 26th, 2009 - 00:51

Swine influenza continue to harvest the lives of the Egyptians
The Ministry of Health yesterday, Friday, three deaths were newly infected with (the virus H1N1) "er HP 1 The 1" strain of swine flu in order to increase the number of deaths in Egypt since the emergence of the disease so far to 106 cases, which are two women and a man from Cairo, Alexandria and Assiut.

The ministry pointed out - in a statement - that the death of 104 women from the Cairo governorate amount of (35 years), No. 105, death of a woman, aged (21 years), from Alexandria, No. 106, death of a man from Assiut-old (35 years).
hat-tip Twall

Thursday, December 24, 2009

WHO: Pandemic (H1N1) 2009 - update 80

Weekly update

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

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data.

Situation update:

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

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

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

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

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

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

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

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

Weekly update (Virological surveillance data)

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

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

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

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance on global surveillance
A description of WHO pandemic monitoring and surveillance objectives and methods can be found in the updated interim WHO guidance for the surveillance of human infection with pandemic (H1N1) virus.

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.


CDC: 2009-2010 Influenza Season Week 50 ending December 19, 2009

2009-2010 Influenza Season Week 50 ending December 19, 2009

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


During week 50 (December 13-19, 2009), influenza activity continued to decrease in the U.S.

  • 306 (6.9%) 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 were positive for influenza.
  • All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Nine influenza-associated pediatric deaths were reported. Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined.
  • The proportion of outpatient visits for influenza-like illness (ILI) was 2.3% which is at the national baseline of 2.3%. Seven of the 10 regions (1, 3, 5, 6, 7, 8 and 10) reported ILI below region-specific baseline levels.
  • Seven states reported geographically widespread influenza activity, 18 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 13 states reported local influenza activity, the U.S. Virgin Islands and 11 states reported sporadic influenza activity, Guam and one state reported no influenza activity.


Wednesday, December 23, 2009

Egypt: 5 New Deaths - Total 101

Wednesday, December 23rd, 2009 - 23:17

Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health

The Ministry of Health of 5 cases and new deaths from the (virus infection h1n1) HIV (er H. Wan and) the world-renowned swine flu, bringing the number of deaths to 101 cases. The new deaths are a woman and four men from the governorates of Giza and Qalyubia, Eastern and Kafr El-Sheikh and the lake.

A statement of the Ministry of Health, the case number (97) of a woman at the age of 38 years of Qalyoubia province, and case No. (98) of the old man 55 years of conservative Giza, and case No. (99) for a man aged 42, from the eastern province.

The statement said that the case No. (100) to a man aged 36, from Kafr El -
Sheikh, and case No. (101) for a man aged 35 years from the province of the lake.(Beheira)

hat-tip Twall

Egypt: 3 cases of swine flu death (96 total)

The Health Ministry announced the death of 3 new cases of swine flu, bringing the number of deaths in Egypt so far to 96.
Dr.. Abdulrahman Shaheen Media Advisor to the Minister of Health said the three cases involving girl, 16 years old from the lake where she had a sugar coma either case 95 for Egyptian woman aged 20 years of Dakahlia province and was suffering respiratory symptoms and health condition was critical, and died yesterday .
The situation of 96 Egyptian woman, aged 26, from Cairo, was admitted to intensive care and put on a respirator and died yesterday after serious complications result of infection with the virus.
hat-tip Twall

Tuesday, December 22, 2009

A stream is in Guangdong in children with symptoms of suspected new super-flu

By Reuters December 20 (Associated Press Shi Lei roundup) China A stream epidemic scope expanded A stream of severe, deaths continues to increase. A stream in Guangdong, the rare emergence of new children with severe symptoms, is currently in the country has no relevant reports. Experts say flu is now worried that integrate mutate into "super-flu."

Pok Oi Hospital, Zhongshan City, four pediatric director of Fu Mao said the number of children admitted to a flow of successive severe, Jun Cheng emerged in purulent sputum of a very high viscosity, "the latest symptom." A flow of hospitalized children with onset just a day or so, it appears extremely difficult breathing, nose flap, shallow and fast breathing severe symptoms. Currently in the country has no relevant reports.

A Beijing residents who wish to voice a journalist to reveal, Xuanwu District Public Security Bureau two police officers hospitalized because of flu, his condition deteriorated very quickly, "pretty weird and suddenly there are two days cough, can not stand, and to the hospital would have lost plasma , quite severe. "reporter called Xuanwu District Public Security Bureau asked on duty to avoid did not answer.

A stream of the virus caused the pneumonia in strict isolation of patients and their families do not understand the treatment process, some families can finally get the ashes. Beijing informed members of the public said: "He told you, the patient fever, then burned after the person has died, (ashes) can be handed over to family members. (Family members) know not, that is, the patient's immediate family members also know not, let see, more than The facility also strict, prison visiting hours there are, um, not. "

Beijing Municipal Health Bureau, side to England December 17 said that now is not really the core issue of concern of H1N1 influenza A, but worried that influenza virus in human, poultry, pigs integrate the three who mutate into "super-flu", That would be disastrous. "Therefore, in the face of each critically ill patients we would consider 'Is there something else'."

Starting from December 16, Shanghai, said that under the uniform provisions, expand a current vaccination crowd, the live poultry market in places such as livestock and poultry, there is occupational exposure of staff; zoo staff engaged in animal husbandry, construction, etc. concentration of labor units, particularly migrant workers into a stream of key target groups, free vaccination.

Ih-Jen Su, vice president of Taiwan's National Cheng Kung University Hospital, said the H5N1 bird flu mortality rate was 60%, than the H1N1 serious. China bird flu in many parts of the ground-based, that is, is popular in the community (3% of the land birds, water birds with this virus), it is now more concerned about the H1N1 influenza and avian flu H5N1 will restructure.

According to Chinese Ministry of Health, Director of the Office of Health Emergency Response Liang years December 11, said China is still in an active period of a stream in the next one to two months of the epidemic situation is still grim. With the New Year's Day, New Year facing a tide of peasant workers, students tide, visiting relatives, a large population influx of movement, population mobility are likely to make a source of infection the same as the fire spread to the areas where there is no infection. According to CDC Deputy Director of Guangzhou Yang Zhicong, at present in Guangzhou for a flow of all influenza patients.

According to the Ministry of Health informed the CPC, as of last weekend, a stream a total of 442 cases of patients died, of which 116 cases occurred in the last week, China has already confirmed that about 11 million people infected with a stream. However, the message displays only the Guangzhou City, nearly 1.7 million people have been infected by a stream. December 10, Guangzhou Municipal Health Bureau spokesman said Xiong Yuanda, Guangzhou City, Guangzhou City, CDC recently conducted in healthy people serum testing showed that 14% of people have produced antibodies, indicating that they had previously been infected by a stream .

World Health Organization, 18, released the latest outbreak reported that influenza A H1N1 flu has already caused more than 10,000 worldwide deaths. At present, WHO is closely following the situation in the global epidemic.

Vietnam Re: Conf. Case 11/30: 4 test negative, 18 in isolation, stable condition - who had contact w/confirmed



Localities urged to prevent A/H1N1 flu

The central province of Quang Binh and the northern province of Dien Bien have strengthened measures to cope with A/H1N1 flu while the deadly virus is expected to spread widely during this winter.

In Quang Binh, more than 500 people took part in a rehearsal to prevent A/H1N1 flu infections in humans in Ba Don town, Quang Trach district. The rehearsal aimed to assess the management skills of the steering committee for A/H1N1 flu prevention in humans and draw up experiences from health workers involved in the field.

Health workers from the provincial district preventive medical centres took turns checking suspected patients, isolating them and taking samples for test at the central hospitals.

Meanwhile, in Dien Bien, four more cases of A/H1N1 flu infection have been reported, bringing the total cases in the province to 19. So far, the disease has spread to 30 communes and 37 schools in the three districts of Dien Bien, Muong Cha and Dien Bien Phu.

According to the provincial preventive health centre, since the first H5N1 patient died in Dam Mun, Dien Bien district on November 30, 2009, no more deaths from the same disease have been reported in the province. Previously, four suspected cases tested negative for the A/H5N1 virus. Currently, 18 people contacting the deadly virus are being isolated and monitored strictly and they remain in stable conditions.

Monday, December 21, 2009

Vietnam: Influenza A/H1N1 and H5N1 remains complex, high mortality

Tuesday, December 22, 2009, 2:32 (GMT +7)
(VNA) .- On 21-12, at the conference national influenza surveillance was held in Hanoi, Prof. Dr. Nguyen-Tran Hien, head of Hygiene and Epidemiology Institute Central said that the current situation of influenza A translation / H1N1 in Vietnam is complicated development.

Do health sector currently does not make the test more determined, so the number of infected influenza A/H1N1 is recognized not increase much. However, the monitoring results in 15 points to monitor key national rate of ca showed positive for influenza virus H1N1 is still high among the ca are positive for influenza and 90% were influenza A/H1N1.

For monitoring results also showed that influenza A/H5N1, from the beginning of the year the country had recorded 5 cases including 5 deaths were ca. The cause of this situation is detected by monitoring avian influenza in animals also poor, the sick often slow to health facilities after disease onset. Moreover, for hospitals under the working diagnosis of cases not in time to the delayed transfer of patients to upper level. Institute chief Nguyen Tran Hien warned, the current avian influenza A/H5N1 have been recurrent in some localities, plus the service influenza A/H1N1 has complicated development in humans, the risk of a combination of two strains This flu vaccine together to create a new flu virus more dangerous is high.

Statistics of the Ministry of Health showed that the country has over 11,000 influenza A/H1N1 infected, with 50 cases of death. Although this early next month, the number of infected influenza A/H1N1 has tended to reduce the number of disasters that increase weight and mortality remained high.

Department of Animal Health (MARD) has said, after spreading in Thai Nguyen province, the bird flu are spread in Cao Bang. Thus, there are three provinces where bird flu re-appears as Thai Nguyen, Cao Bang and Ca Mau.

While they receive from now until the New Year, the illegal import, transport, sale birds will take place very exciting, the other poultry prices increased again so the risk of H5N1 spreading service very high. Furthermore, in the North are with air conditioning, are favorable conditions for bird flu virus to develop. Therefore, the Ministry of Agriculture and Rural Development asked localities to strictly control the poultry are livestock, managed trade, transport and prevent chickens smuggled into inland flooding to Home the response to avian influenza.

Vietnam: 100% of infected influenza A/H5N1 death

Tuesday, December 22, 2009

(Bloomberg) - At the workshop performance evaluation system to monitor influenza countries afternoon 21-12, in Hanoi, Prof. Dr. Nguyen-Tran Hien, Director of Institute of the Central Hygiene and Epidemiology, said mortality due to influenza A/H5N1 in Vietnam is very high - 100% in the 2003 and 2009. Most people with influenza A/H5N1 have been detected in contact with infected birds died.

About influenza A/H1N1, according to Mr. Show, the rate of infection in the national influenza surveillance points were very high in 2009. We translated influenza A/H1N1 has spread to most provinces.
N. Dung

Updated Interim Recommendations: Special Considerations for Clinicians Regarding 2009 H1N1 Influenza in Severely Immunosuppressed Patients

[Some excerpts, as this is a very large article]

December 16, 2009, 11:30 AM ET


Immunosuppression can result from a variety of clinical conditions, and the severity of immunosuppression may vary with the severity of the condition. Immunosuppression may also result from immunosuppressive treatments, the extent of which may depend on factors such as dosage or synergistic medication combinations. Some common conditions and treatments associated with immunodeficiency are shown in the tables below. These interim recommendations refer to patients who are severely immunosuppressed as a result of receiving treatment for malignancies; or as a result of receiving treatment related to solid organ or hematopoietic stem cell transplants; or as a result of autoimmune conditions and treatment. Such patients may be at high risk of influenza-related complications such as more severe illness and hospitalization. These recommendations may be updated as further information becomes available. In addition to this guidance, there are documents available for caregivers of adult and adolescent HIV-infected patients as well as for patients with rheumatological diseases.

Patients with severe immunosuppression from the following conditions or treatments may be at high risk for influenza-related complications.

Some Conditions and Treatment that Suppress the Immune System*

  • Hematopoietic stem cell transplant recipient receiving anti-rejection medication
  • Solid organ transplant recipient receiving anti-rejection medication
  • Congenital immunodeficiency disorder
  • Chemotherapy for cancer
  • Autoimmune conditions and treatments
  • Chronic corticosteroid use

* HIV and Rheumatologic conditions are included in other guidance

Patients with conditions that confer some degree of immunosuppression, e.g., asplenia, may not necessarily have increased risk for influenza-associated complications, but may be at high risk for secondary invasive infection with encapsulated bacteria (e.g., pneumococcal disease).

Patients who use short courses of treatments that weaken the immune system for mild, common ailments (e.g., corticosteroid use for poison ivy), are likely NOT at increased risk of complications from influenza unless they also have other high-risk conditions for influenza complications such as asthma, chronic obstructive pulmonary disease, diabetes, heart disease, pregnancy, cancer, etc.

Clinical Issues

While some severely immunosuppressed patients may develop typical signs and symptoms of influenza, fever may not always be present1. Therefore, clinicians should suspect influenza in any severely immunosuppressed patient with acute respiratory symptoms, with or without fever, and initiate empiric antiviral treatment as soon as possible and send respiratory specimens for real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) (see Influenza diagnostic testing and Antiviral treatment sections below). Appropriate infection control including isolation should be implemented for any suspected patient as soon as possible even before testing results are available.

Although the type and severity of immune dysfunction that correlates with increased risk of influenza-associated complications is not well defined, transplant patients with significant lymphodepletion (i.e., lymphopenia due to immunosuppression for recent hematopoietic stem cell transplant) or lymphocyte dysfunction have had serious complications of influenza virus infection, prolonged viral shedding, and have acquired resistance to antiviral medications2. Sporadic cases of oseltamivir-resistant 2009 H1N1 influenza virus infection have been reported; some of these cases were in severely immunosuppressed patients in whom resistance emerged during treatment for symptomatic illness and who experienced prolonged viral shedding3. Therefore, some experts have recommended that immunosuppressed patients with 2009 H1N1 influenza virus infection should strictly adhere to recommended personal protective equipment and infection control measures until symptoms have resolved and there are serial respiratory specimens that test negative for 2009 H1N1 viral RNA by rRT-PCR 4, 5.


Antiviral treatment

Antiviral therapy with a neuraminidase inhibitor (oseltamivir, zanamivir) should be initiated empiricallyas early as possible for severely immunosuppressed patients with suspected influenza. Although efficacy of early antiviral treatment (<48>10, 11, 12, 13. Although there are no prospective data available for neuraminidase inhibitor treatment of immunosuppressed patients with influenza, initiation of therapy beyond 48 hours after symptom onset should be considered.

Clinicians should be aware that severely immunosuppressed persons with influenza may experience prolonged influenza viral replication; those with significant lymphopenia will typically shed for longer than 5 days even with antiviral treatment2. Therefore, some experts have recommended consideration of longer duration of neuraminidase inhibitor treatment (e.g. 10 days versus standard 5 days). Infection control precautions should be maintained for as long as such patients have evidence of prolonged influenza viral shedding as detected by rRT-PCR and/or remain symptomatic – whichever is longer. Sporadic cases of oseltamivir resistant 2009 H1N1 virus have been reported in severely immunosuppressed patients who were treated with oseltamivir. This oseltamivir resistance is associated with an H275Y mutation in viral neuraminidase. Patients with suspected or confirmed oseltamivir-resistant 2009 H1N1 influenza virus who require antiviral treatment should receive zanamivir. If orally inhaled zanamivir is contraindicated or not tolerated, then IV zanamivirExternal Web Site Icon is available for compassionate use from its manufacturer via an emergency Investigational New Drug (IND) application to the FDA. Patients with highly suspected or documented oseltamivir resistance should not be treated with peramivir because clinical isolates expressing the oseltamivir resistance-associated substitution H275Y in neuraminidase have demonstrated reduced in-vitro susceptibility to peramivir, although the clinical significance of this is currently unknown. Development of resistance to other antiviral medications during treatment is also possible. Such antiviral resistance would be associated with different mutations and can only be detected by robust screening assays that are not specific for the H275Y mutation. Clinicians managing 2009 H1N1 hospitalized patients who have not improved clinically and who have persistent laboratory-confirmed viral shedding may wish to consult infectious disease specialists, their state health department or CDC for questions about antiviral resistance, additional testing and antiviral treatment.

Optimal therapy for severely immunosuppressed patients with oseltamivir-resistant 2009 H1N1 influenza virus has not been defined. Some severely immunosuppressed patients with 2009 H1N1 have been treated with a combination of IV zanamivir and aerosolized ribavirin3, 14 therapy, or IV zanamivir monotherapy15. Clinicians should note that orally inhaled zanamivir may not be tolerated by critically ill patients with lower respiratory tract disease. Clinicians should be aware that intravenous antiviral medications are available, IV peramivir16 through an Emergency Use Authorization; and IV zanamivir15 through an Emergency Investigational New Drug Application) for treatment of critically ill 2009 H1N1 patients or for hospitalized patients who cannot tolerate orally inhaled zanamivir or oral oseltamivir when treatment is indicated. Critically ill immunosuppressed patients are particularly susceptible to secondary bacterial and fungal infections that can cause pneumonia and disseminated infection, including sepsis, and should be empirically treated with antibiotics based on clinical judgment.


Egypt: The higher number to 93 victims The death of 4 new cases of swine flu Monday, December 21, 2009 - 22:30

[I spoke too soon....see post below this]

The Ministry of Health on Monday evening, the death of 4 new cases due to infection (er 1 The HP 1), known as swine flu, bringing the death since the disease appeared in Egypt to 93 cases.

A statement from the Ministry of Health, No. 90, the situation is a woman from the Cairo Governorate (23 years)
Was admitted to a hospital suffering from severe respiratory symptoms and condition of health is precarious, with
Been transferred to the intensive care unit and placed on a respirator, has been
Patient was pregnant in the eighteenth week.

The statement added that the situation No. 91 Lady from Qalyoubia province (26 years) was admitted to
Hospital has been suffering from severe respiratory symptoms and was transferred to the intensive care unit
And placed on a respirator, he said, adding that the situation is No. 92 to a man from Qena Governorate
(40 years) and was detained in hospital suffering from severe respiratory symptoms and health
Critical, where he was transferred to the intensive care unit and placed on a respirator,
The history of the situation to patients suffering Bromatesm heart, shortness of valve
Mitral and aortic, reflux valve trio.

The statement pointed out that the situation is No. 93 for a girl from the Cairo Governorate (14 years) was admitted to
The hospital has been suffering from severe respiratory symptoms and condition of health is precarious, where he was transferred
To the intensive care unit and placed on a respirator, and history suggests patients
Of the situation to her chronic lung fibrosis and conduct open-heart surgery.

Egypt: Compilation of Stories For Today

[I do not see any reports of deaths today so far]

The high number of infected swine flu Sohag to 44

Monday, December 21, 2009 - 18:32

11 injured in the case of swine flu in Alexandria
Monday, December 21, 2009 - 15:55

Swine flu closes private school crossing [in Balqlliopip]
Monday, December 21, 2009 - 15:25

Swine flu close a new school the city of Sinai
Monday, December 21, 2009 - 13:12

10 cases of influenza infection in Fayoum, Port Said, Assiut,
Monday, December 21, 2009 - 12:48

Swine flu hit 4 new cases in Alexandria
Monday, December 21, 2009 - 11:21

Within one week ..
2538 influenza infection, including 1270 school
Monday, December 21, 2009 - 16:04

WHO Avian influenza - situation in Egypt - update 26

21 December 2009 -- The Ministry of Health of Egypt has reported a new laboratory confirmed human case of avian influenza A(H5N1) on 19 December 2009.

The case is a 21 year old female from the El Tanta District of Gharbia Governorate. She developed symptoms of fever and cough on 15 December 2009.

She was admitted to Tanta Fever Hospital where she received oseltamivir treatment on the same day. She is in a stable condition. Investigation revealed that the case had close contact with dead poultry and was involved in slaughtering sick birds.

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Of the 90 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 27 have been fatal.

Sunday, December 20, 2009

Egypt: 5 new swine flu deaths in a single day lift the number to 89

Cairo - Egypt Online

Health Ministry announced Sunday the death of 5 cases of HIV, "1 H-1 The" swine flu known from the governorates of (Cairo, Gharbia, Dakahlia), increasing the number of deaths to 89 cases.

The Health Ministry statement that the situation for a young Egyptian 87 at the age of 19, from Cairo Governorate has been detained in hospital suffering from severe respiratory symptoms in critical condition and was transferred to the intensive care unit and put on a respirator, and the date the patients of the situation indicates the failure of chronic liver injury and sensitivity in the chest and a rise in blood pressure.

The statement said that the situation for a young Egyptian 88 at the age of 22 years of conservative Dakahlia booked a hospital suffering from severe respiratory symptoms and was transferred to the intensive care unit and placed on a respirator.

The statement added that the situation for the 89-old woman, aged 57, from Cairo Governorate booked a hospital suffering from severe respiratory symptoms were transferred to the intensive care unit and placed on a respirator, explaining that the case history of patients referred to her chronic liver failure and diabetes.

The statement noted that the situation for the 85-month pregnant woman from the fifth Western Province was caught in hospital suffering from severe respiratory symptoms and condition of health is precarious, and was Nkulha to the hospital's intensive care unit and placed on a respirator, and died Sunday.
The ministry confirmed to start in the vaccination of pregnant women from the end of December the current Baattabarhn most vulnerable to infection.

The situation is of a girl 86 year old and 7 months of Dakahlia Governorate was admitted to a hospital suffering from severe respiratory symptoms and health status in critical condition and transferred to the intensive care unit and placed on a respirator, and history suggests the girl child patients diagnosed with epilepsy and brain atrophy and pneumonia frequently.

And in context, the Ministry of Health decided to start vaccination of women pregnant women against the disease from the end of December the current Baattabarhn most vulnerable to infection.

Al-Ahram newspaper quoted the Cyber Sunday Abdel-Rahman Shahin, spokesman for the Ministry of Health said it was proven absence of a minimum risk to embryos of vaccination, and are advised Dr. Fathi Shabana, Director of Fever Hospital Imbaba any holder warmed to 38 degrees Celsius to proceed immediately to the hospital, and to avoid dependence on fever reducers without consulting your doctor.

The deaths from the epidemic has increased significantly over the last two weeks up to 84 cases, including 13 pregnant woman, the subject of more than 75 carrier of the treatment after testing is currently contracting the disease.

On the other hand, sees Dr. Alaa Mohieddin Consultant Obstetrics and Gynecology, Faculty of Medicine, Cairo University, it is not a threat to the holder of Tamiflu, as long as the virus has not been able to overcome the placenta.

And begins the critical phase of the spread of HIV 1 The 1 with the low temperatures significantly from early next month, and break-proliferation unit for the month of March, and then resumes his attack the virus at the beginning of April.
hat-tip Dutchy