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2009 flu pandemic

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(Redirected from 2009 swine flu outbreak) Jump to: navigation, search This article documents a current pandemic. Information may change rapidly as the event progresses. Laboratory-confirmed human cases by country
Cases Country
Laboratory confirmed Confirmed (Suspected)

Deaths

WHO total[1] ECDC total[2] Reports Total United States Mexico Argentina Canada Chile Australia United Kingdom Thailand Guatemala Costa Rica Dominican Republic Colombia

70,893 73,153 75,731 27,204[3]# 9,028[5][6] 1,599[9] 7,983[11] 6,211[12] 4,090[14] 5,937[15] 1,414[17] 262[2] 229[19] 108[1] 80[2]

311 324 361 149[4] 119 (77)[7][8] 31[9][10] 25[11] 12[13] 7[14] 3[16] 3[18] 2[1] 2[19] 2[1] 2[1]

Spain Philippines Brazil Uruguay Honduras Other

541[2] 864[20] 627[21] 195[1] 118[1] 9,782

1[1] 1[2] 1[22] 1 [23] 1[1] 0

[hide]Countries with no deaths


Country Confirmed cases Deaths

Japan China Hong Kong New Zealand Singapore Peru Israel Panama Germany Nicaragua France El Salvador South Korea Venezuela Malaysia Ecuador Bolivia Netherlands Vietnam Italy India Greece Paraguay Saudi Arabia Sweden Egypt

1,211 766[25] 726[26] 653[27] 629[28] 549[29] 469[30] 403[31] 388[32] 281[33] 288[34]## 226[2] 210[35] 193[33] 144[36] 140[33] 150[37] 124[38] 123[39] 117[40] 93[41] 88[2] 79[1] 75[42] 68[2] 61[2]

[24]

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Taiwan Trinidad and Tobago Switzerland Cuba Denmark Belgium Cyprus Ireland Finland Lebanon Brunei Kuwait Jamaica Turkey Norway Romania Jordan Macau Poland Bahrain Morocco Qatar Portugal Suriname Austria Estonia Palestinian Territories Serbia Barbados Bulgaria Fiji Sri Lanka Cayman Islands Czech Republic Iraq Slovakia Bangladesh Hungary

61[2] 59[43] 54[44] 46[45] 44[1] 43[2] 40[46] 39[2] 36[47] 35[48] 32[49] 30[1] 27[50] 26[1] 25[2] 25[2] 18[51] 18[52] 15[1] 15[1] 15[53] 14[54] 13[55] 13[56] 12[1] 12[2] 11[57] 11[58] 10[1] 10[2] 10[59] 10[60] 9[1] 9[1] 9[61] 9[2] 8[62] 8[1]

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Indonesia United Arab Emirates South Africa Yemen Cambodia Netherlands Antilles Bahamas Iceland Luxembourg Cape Verde Jersey Laos Nepal Oman Russia Slovenia Algeria Antigua and Barbuda Cte d'Ivoire Ethiopia Isle of Man Tunisia Vanuatu Montenegro Bermuda British Virgin Islands Dominica Guernsey Iran Kenya Latvia Lithuania Mauritius Monaco Myanmar Papua New Guinea Samoa Solomon Islands

8[63] 8[64] 7[65] 6[1] 6[2] 5[66]### 4[1] 4[1] 4[2] 3[1] 3[1] 3[1] 3[67] 3[1] 3[1] 3[1] 2[1] 2[1] 2[1] 2[1] 2[68] 2[1] 2[1] 2[69] 1[1] 1[1] 1[1] 1[1] 1[1] 1[70] 1[1] 1[71] 1[72] 1[67] 1[73] 1[1] 1[1] 1[74]

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Ukraine 1[1] 0 [75] U.S. Virgin Islands 1 0 [76] Bosnia and Herzegovina 1 0 The following countries have suspected cases, but no confirmed cases: Democratic Republic of Congo[77] and Guyana[78]. [show]Graphs of case progression

Number of countries, etc., with confirmed cases: 121


#

Includes Puerto Rico. Includes French Polynesia and Martinique. Includes Curaao, St. Maarten and Bonaire.

##

###

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The 2009 flu pandemic is a A(H1N1) pandemic and a global outbreak of a new strain of influenza A virus subtype H1N1, identified in April 2009, commonly referred to as "swine flu", which is transmitted between humans. It is thought to be a mutationmore specifically, a reassortmentof four known strains of influenza A virus subtype H1N1: one endemic in humans, one endemic in birds, and two endemic in pigs (swine). Experts now assume that the virus "most likely" emerged from pigs in Asia, and the virus was carried to North America by infected people. There is further evidence that the new strain has been circulating among pigs, possibly among multiple continents, for many years prior to its transmission to humans. Virtually all transmission is from human to human; cooked pork products are safe for humans and the virus cannot be transmitted from foods. The World Health Organisation (WHO) officially declared the outbreak to be a pandemic on June 11 as a result of the global spread of the virus, while noting that the virus has "moderate severity".[80] They anticipate a bleaker picture as the virus spreads to less developed countries having poor health care and other underlying medical problems. As of June 24 the Centers for Disease Control and Prevention (CDC) is predicting the pandemic will be "Category 2" in severity.[81] A category 2 pandemic has a Case Fatality Ratio (CFR) between 0.1% and 0.5%, with between 90,000 and 450,000 deaths in the U.S. (compared with 36,000 deaths during a typical influenza season).[82] The virus typically spreads from coughs and sneezes or by touching contaminated surfaces and then touching the nose or mouth. Symptoms are similar to those of the seasonal flu, and may include fever, sneezes, coughs, headache, muscles or joint pain, sore throat, chills, fatigue and runny nose. The CDC notes that most hospitalizations have been people with underlying conditions such as asthma, diabetes, obesity, heart disease, or a weakened immune systems. In an attempt to slow the spread of the illness, a number of countries, especially in Asia, have enforced strict quarantines on travelers showing any symptoms, along with travelers seated nearby any infected persons.

WHO Director-General Margaret Chan says a vaccine for the 2009 flu pandemic strain is unlikely to be available until September 2009, and by mid October in the U.S., but even then the supply will be limited. They expect that two or three vaccine injections will be required for maximum immunity. There is concern that the virus could mutate later in the year and become more virulent and less susceptible to any vaccine developed to protect from an earlier strain. This concern is partly due to the memory of the 1918 flu pandemic, which is thought to have killed between 40 and 100 million people, and was preceded by a wave of milder cases in the spring.
[83]

The outbreak began in Mexico, and there is speculation that they may have been in the midst of an unrecognized epidemic for months prior to the date the outbreak was officially announced. Soon after the outbreak began in Mexico, the government closed down most of Mexico City's public and private offices and facilities. As of late June the virus is continuing to spread worldwide, especially in Southern Hemisphere countries, where the winter flu season has started.

Contents
[hide]
y y

1 Historical context 2 Initial outbreaks o 2.1 Mexico o 2.2 United States 3 Response o 3.1 Data reporting and accuracy o 3.2 Travel advisories o 3.3 Actions concerning pigs 4 Virus characteristics o 4.1 Virus origins o 4.2 Rate of infection o 4.3 Virulence o 4.4 Mutation potential 5 Pandemic declared o 5.1 WHO to focus on developing countries o 5.2 Northern Hemisphere o 5.3 Southern Hemisphere 6 Symptoms and expected severity o 6.1 Most cases mild o 6.2 Symptoms that may require medical attention o 6.3 Underlying conditions may worsen symptoms 7 Prevention o 7.1 Containment o 7.2 Quarantines  7.2.1 Travel alerts for China

y y

y y y

7.2.2 Other government quarantines 7.2.3 Pre-screening advisories by some governments o 7.3 School closures o 7.4 Spread in the workplace o 7.5 Hygiene  7.5.1 Airborne transmission  7.5.2 Contact with infected surfaces  7.5.3 No danger from pork consumption  7.5.4 Airline hygiene precautions 8 Vaccination 9 Treatment o 9.1 Home treatment remedies o 9.2 Antiviral drugs 10 Emergency planning o 10.1 Crime risk 11 See also 12 References o 12.1 Sources and notes o 12.2 Further reading
 

[edit] Historical context


Annual influenza epidemics are estimated to affect 515% of the global population. Although most cases are mild, this still causes severe illness in 35 million people and around 250,000 500,000 deaths worldwide. In industrialized countries severe illness and deaths occur mainly in the high-risk populations of infants, the elderly, and chronically ill patients.[84] In addition to these annual epidemics, Influenza A virus strains caused three major global epidemics during the 20th century: the Spanish flu in 1918, Asian flu in 1957 and Hong Kong flu in 196869. These pandemics were caused by strains of Influenza A virus that had undergone major genetic changes and for which the population did not possess significant immunity.[84][85] The overall effects of these pandemics and epidemics are summarized in the table below.

20th century flu pandemics

Pandemic

Year

Influenza A virus subtype

People infected (approx)

Deaths (est.)

Case fatality rate

1918 flu pandemic

1918 19

H1N1[86][87]

500 million - 1 billion

20 to 100 million[88][89][90]

>2.5%[91]

Asian flu

195658

H2N2[86]

2 million[90]

<0.1% ? [91]

Hong Kong flu

1968 69

H3N2[86]

1 million[90]

<0.1%[91]

Seasonal flu

Every year

mainly A/H3N2, A/H1N1, and B

5-15% (340 million - 1 billion)[92]

250,000500,000[84]

<0.05%

Not a pandemic, but listed to compare the several flu strains endemic in humans which produce seasonal flu with the rare new strain that results in a flu pandemic The influenza virus has also caused several pandemic threats over the past century, including the pseudo-pandemic of 1947, the 1976 swine flu outbreak and the 1977 Russian flu, all caused by the H1N1 subtype.[85] The world has been at an increased level of alert since the SARS epidemic in Southeast Asia (caused by the SARS coronavirus).[93] The level of preparedness was further increased and sustained with the advent of the H5N1 bird flu outbreaks because of H5N1's high fatality rate, although the strains currently prevalent have limited human-to-human transmission (anthroponotic) capability, or epidemicity.[86][94] People who contracted flu prior to 1957 may have some immunity. A May 20, 2009 New York Times article stated: Tests on blood serum from older people showed that they had antibodies that attacked the new virus, Dr. Daniel Jernigan, chief flu epidemiologist at the Centers for Disease Control and Prevention, said in a telephone news conference. That does not mean that everyone over 52 is immune, since some Americans and Mexicans older than that have died of the new flu.[95]

[edit] Initial outbreaks


Further information: 2009 flu pandemic timeline Further information: 2009 flu pandemic table It is not known where the virus originated.[96][97] Analysis has suggested that the H1N1 strain responsible for the current outbreak first evolved around September 2008 and circulated in the human population for several months before the first cases were identified as being due to a new strain.[96][98][99]

[edit] Mexico
Further information: 2009 flu pandemic in Mexico The virus was first reported in two U.S.children in March, but health officials have said that it apparently infected people as early as last January in Mexico.[100] The outbreak was first detected in Mexico City on March 18, 2009 where surveillance began picking up a surge in cases of influenza-like illness. "In early April, Mexico had noticed that it had high numbers of serious respiratory illnesses and some deaths. It began sending samples to Canada and the United States, asking for help genotyping the new virus."[101] Health Secretary Jose Angel Cordova confirmed that a 4-year-old boy was part of an outbreak in Veracruz state that began in February. Residents of the town of Perote worried at the time that they had contracted a new and aggressive flu, and publicly demonstrated against the pig farm they initially blamed for their illness. It was only after U.S. labs confirmed a swine flu outbreak that Mexican officials sent the boy's sample in for testing, and it tested positive for swine flu.[102] While there was speculation that the outbreak may have started at the pig plant in Veracruz,[103] the plant owners said that no pigs had tested positive for the virus.[104] After the outbreak was officially announced, Mexico immediately requested material support from the U.S. and worked closely with the CDC and Canada, sending them suspected samples for testing. Soon after, the CDC helped Mexico build their own lab capability to do faster diagnosis and confirmation of the H1N1 virus in Mexico. According to one commentator, "in the face of mounting hysteria, the response of both Mexico and the United States was an almost perfect display of the cooperation and partnership . . . ."[105] Within a few days Mexico City was "effectively shut down," and some countries hastily canceled flights to Mexico while others halted trade. Although many in the U.S. called for shutting the border to help contain the spread, President Obama rejected the idea and Homeland Security Secretary Janet Napolitano called it "pointless," as the virus had already crossed into the U.S., and felt that "closing the border would have done nothing more than wreak economic havoc on both economies."[105] As the outbreak spread throughout Mexico and into the U.S., however, scientists were trying to understand why there were so many deaths in Mexico while infections in the United States and Canada were relatively mild and not unusually dangerous compared to seasonal flus. "If that continues to be true," wrote the Washington Post, "then it may help explain the mysteriously high mortality in Mexico." The newspaper noted that "it may be that Mexico already has had hundreds of thousands, and possibly millions, of casesall but the most serious hidden in the 'noise' of background illness in a crowded population."[106] They added, "the fact that most people infected in other countries had recently been to Mexicoor were in direct contact with someone who had beenis indirect evidence that the country may have been experiencing a silent epidemic for months."[106][107] A study published May 11, 2009 in the journal Science estimated Mexico alone may have already had 23,000 cases of swine flu by April 23, 2009, the day it announced the epidemic.[108] As experts struggled to explain why so many deaths had initially occurred in Mexico and nowhere else, the CDC on May 1, 2009 suggested a simple explanation: "there are many cases in Mexico, most are mild, and just the bad ones have been seen so far."[109] It noted that recent

severe cases had focused on patients seeking care in hospitals and acknowledged that there could in fact be a large number of undetected cases of illness, which would explain the much higher mortality rate. Other experts agreed: "The central question every flu expert in the world would like answered, is how many mild cases Mexico has had," said Dr. Martin Cetron, director of global migration and quarantine for the Centers for Disease Control, in an interview. "We may just be looking at the tip of the iceberg, which would give you a skewed initial estimate of the case fatality rate," as he also speculated that there may have been tens of thousands of unreported mild infections, which would then make the number of deaths seemingly low, and as the flu spreads, the number of people who become seriously ill would remain relatively small.[101]

[edit] United States


Further information: 2009 flu pandemic in the United States The new strain was first diagnosed in two children, neither of whom had been in contact with pigs, by the CDC, first on April 14, 2009 in San Diego County, California and a few days later in nearby Imperial County, California[110][111] (it was not identified as a new strain in Mexico until 24 April[112]).

[edit] Response
See also: 2009 swine flu outbreak by country

Deaths

Confirmed cases

Unconfirmed or suspected cases See also: H1N1 live map, WHO

updates According to Dr. Thomas Frieden, the new CDC director on June 8, 2009: "Theres no question that a new strain of influenza spreading rapidly throughout the world is a major problem and requires a major response. So far, it doesnt seem to be any more severe than seasonal flu, but seasonal flu kills 36,000 Americans a year."[113] Federal officials and other groups felt that six years of worrying about H5N1 avian flu did much to prepare for the current swine flu outbreak. Jeffrey Levi, executive director of the monitoring group Trust for Americas Health, notes that after H5N1 emerged widely in Asia in 2003, killing about 60 percent of the humans infected by it, many countries took steps to prevent any crisis that would emerge if that virus were to acquire the ability to jump easily from human to human,

and the measures taken in preparation were helpful. Levi also said that little vaccine would be available by this autumn, if there were no major delays in production.[114] Dr. Schuchat, summarizing much of the country's quick response says "This really was a wakeup call for the world. We actually have been preparing for a pandemic for many years now." The avian flu outbreak more than five years ago led the CDC and state and local public health departments to prepare for a nationwide pandemic. "I would say these exercises worked immensely," Schuchat said, especially development of disease diagnosis and tracking and communication. "There has been a lot of payoff for worrying about bird flu."[115] But recognizing that the responses were not perfect, she also said the CDC will now use the current lull to take stock of the United States's response to the new H1N1 flu and attempt to patch any gaps in the public health safety net before flu season starts this autumn. She cited a new report which found that recent cuts in public health departments have meant many did not have adequate resources to carry out flu plans. The U.S. Government Accountability Office also said the U.S. flu preparedness plan needed improvement, including better coordination between federal, state and local governments and the private sector.[116] On May 6, the Public Health Agency of Canada announced that the National Microbiology Laboratory (NML) in Winnipeg, Manitoba had mapped the world's first full genetic sequencing of the H1N1 swine flu virus. Canada at that time had the third highest number of cases of swine flu after the United States and Mexico. [117]