April 27, 2009
Current WHO information suggests that we are at Phase 5, but WHO places it at Phase 4
Here's the latest from WHO -- it appears to be lagging about 8 hours:
27 April 2009 -- The current situation regarding the outbreak of swine influenza A(H1N1) is evolving rapidly. As of 27 April 2009, the United States Government has reported 40 laboratory confirmed human cases of swine influenza A(H1N1), with no deaths. Mexico has reported 26 confirmed human cases of infection with the same virus, including seven deaths. Canada has reported six cases, with no deaths, while Spain has reported one case, with no deaths.
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.
Daily updates will be posted on this site.
Interestingly enough WHO is not following its own description of pandemic phases -- based on its description, we are at phase 5. Until the swine flu affects another country outside of North America at a sustained level, the events won't be considered phase 6 (the Spanish case may not have any epidemiological connection to North America and an isolated case is not a sustained community level impact).
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.
CDC Guidance regarding Swine Flu
US Count at 40 cases in California, Kansas, NYC, Ohio, and Texas as of 11 am PST
Here's the latest from CDC:
Swine Flu website last updated April 27, 2009 1:00 PM ET
|State||# of laboratory
|New York City||28 cases|
|TOTAL COUNT||40 cases|
|International Human Cases of Swine Flu Infection
See: World Health Organization
Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current U.S. case count is provided below.
An investigation and response effort surrounding the outbreak of swine flu is ongoing.
CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support.
CDC activated its Emergency Operations Center to coordinate the agency's response to this emerging health threat and yesterday the Secretary of the Department Homeland Security, Janet Napolitano, declared a public health emergency in the United States. This will allow funds to be released to support the public health response. CDC's goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus. To this end, CDC has issued a number of interim guidance documents in the past 24 hours. In addition, 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. Laboratory testing has found the swine influenza A (H1N1) virus 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.
Day late and a dollar short on swine flu response
Reasonably intelligent people could tell on Saturday morning that the appropriate pandemic level was Phase 4 (or even 5), that people should be advised not to travel to Mexico, California, and Texas, and I would argue that travel be stopped. And I can understand not saying anything until consultation occurred and measures were in place. But it appears to me that WHO, CDC, and the White House, were a day or two late in treating this situation as a genuine pandemic risk. I hope that we will not live (or die) to regret that delay. Obviously, the cat may have already been out of the bag as WHO argues, but I still think that closing borders would have been wise. Now, today WHO raised the level to phase 4, but says that closing the borders will no longer do any good given the spread to the U.S. and Canada. Apparently there are other countries reporting influenza like illnesses not yet confirmed as swine flu. But absent a spread outside North America, I still think that it make sense to close borders, even if only to delay the spread across these large countries.
Here's WHO's statement after the second meeting of the Emergency Committee today:
27 April 2009
The Emergency Committee, established in compliance with the International Health Regulations (2005), held its second meeting on 27 April 2009.
The Committee considered available data on confirmed outbreaks of A/H1N1 swine influenza in the United States of America, Mexico, and Canada. The Committee also considered reports of possible spread to additional countries.
On the advice of the Committee, the WHO Director-General decided on the following.
The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.
The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.
As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.
This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.
Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.
The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.
The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus.
The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.