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| |  Confirmed Influenza A(H1N1) Cases Continue to Climb; Most Cases 'Mild' WASHINGTON, DC -- May 5, 2009 -- According to the World Health Organization (WHO), 21 countries have officially reported 1,490 cases of influenza A(H1N1) infection. Mexico has reported 822 laboratory-confirmed human cases of infection, including 29 deaths. The United States has reported 403 laboratory-confirmed human cases, including 1 death. Influenza A(H1N1) now affects 38 US states (detailed list provided below). The following countries have reported laboratory-confirmed cases with no deaths: Austria (1), Canada (140), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (4), Germany (9), Ireland (1), Israel (4), Italy (5), Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (2), Spain (57), Switzerland (1), and the United Kingdom (27). More cases of community transmission were confirmed in Europe today -- in Spain and the United Kingdom; however, sustained community transmission remains confined to North America. "Right now, we don't believe that we are seeing community transmission [in Europe] in the same way that we are seeing community transmission in the United States or Mexico," Keiji Fukuda, MD, MPH, WHO's Assistant Director-General for Health Security and Environment ad interim, said in a media briefing today. "When we talk about community transmission, what we are looking for is not just transmissions in institutions [as seen in Spain], but transmissions in the broader community, and right now we don't feel that we are seeing that." According to the European Centre for Disease Prevention and Control (ECDC), the contexts in which the European cases of community transmission have been recorded include: 1) Close household or social contact: 8 confirmed cases (5 in the United Kingdom and 3 in Spain); 2) Contact in educational facility: 5 children in the United Kingdom attending the same school as a previously confirmed case who had travel history to the United States; 3) Contact in healthcare facility: 1 nurse and 1 patient in Germany, both exposed to the same confirmed case with travel history to Mexico. Until sustained community transmission outside North American is confirmed, the WHO pandemic alert level will remain at phase 5. Available data indicate that the people being infected are relatively younger -- younger than 60 years -- and the average age of those infected "is in the 20s," said Dr. Fukuda. However, the reasons for this remain unknown and continue to be investigated. Dr. Fukuda explained that the A(H1N1) virus may naturally affect younger people, or the data could be skewed because younger people are more likely to travel. "But it could be that older people have some level of protection that we don't quite understand yet," he added. The Centers for Disease Control and Prevention (CDC) reported yesterday that the median age of confirmed cases in the United States is 16 years, and 62% of confirmed cases are younger than 18 years. Still, most cases remain mild. "With this [A(H1N1)] virus, more people have had mild illness than severe illness. The reasons for this are unclear," Dr. Fukuda said. For those with milder illness, the symptoms are similar to those seen with seasonal influenza, including fever, cough, body aches, and headaches. However, "we have seen that diarrhoea is reported more often than we typically see with influenza," he added. Severe cases are generally marked by severe respiratory illness, such as pneumonia. CDC has issued updated interim guidance for clinicians on how to identify and care for people who are sick with influenza A(H1N1). CDC recommends that testing and antiviral treatment (oseltamivir, zanamivir) be prioritised for those with severe respiratory illness and those at highest risk of complications from seasonal influenza. This includes children younger than 5 years old, pregnant women, people with chronic medical conditions and weakened immune systems, and people 65 years and older. The 38 US states affected include: The Canadian provinces/territories affected include: WHO advises no restriction of regular travel or closure of borders. Nonetheless, the agency recommends that people who are ill delay international travel and people who develop symptoms following international travel seek medical attention. 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.
SOURCES: Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, Health Canada, World Health Organization
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