1. Swine Flu update Jacob Kool Communicable Disease Surveillance and Response WHO South Pacific 29 April 2009 WHO/WPRO

2. Influenza Symptoms –Sudden onset of high fever (≥ 38 °C) –Cough and/or sore throat –Runny nose, other respiratory symptoms –Body aches, headache, fatigue. More severe influenza: –Difficulty breathing, death Transmission: –touching, shaking hands, or kissing –coughing, sneezing, or talking, at close distance (< 2 meters)

3. Swine Influenza A H1N1 A new virus Reassortment - four different genes: –North America swine –Asia/Europe swine –Human influenza –Avian (Non H5) Unique combination that has never been seen before Human to human transmission confirmed Level of immunity in general community: Unknown Effectiveness of seasonal influenza vaccine: Unknown Antiviral drugs –Sensitive to Tamiflu and Relenza –Resistant to amantadines WHO/WPRO

4. Latest update (29/4/09 AM) The outbreak started in Mexico in February or March –26 confirmed cases, 5 died –>2000 suspected cases, 152 deaths thought linked to swine flu –Many severe cases among young adults –Outbreak may be levelling off Confirmed cases in other countries –USA: 67 –Canada: 6 –Spain: 1 –New Zealand: 3 –UK: 2 –Israel (2) –Not yet in the Pacific? All cases outside of Mexico are mild; no deaths WHO’s Dr Fukuda: this pandemic may be mild WHO/WPRO

5. Google map updated 29/4

6. Clinical Presentation (Mexico) Range of symptoms – very mild to severe acute respiratory symptoms Vomiting and diarrhoea in some cases Incubation period – up to 7 days Fatal cases: ill for 6 days, then deteriorate WHO/WPRO

7. Why is the illness more severe in Mexico? No explanation yet Some theories: 1.Inaccurate information? Biased by panic? 2.Are many mild cases missed? 3.Did the virus change after it spread to other countries? 4.Multiple different viruses?

8. Control measures in Mexico Closed schools, churches, bars, restaurants, etc. People advised to stay home Ill people advised to quickly get medical attention Handing out of face masks in public places Intensive surveillance and case investigation

9. WHO: health emergency “Public Health Emergency of International Concern” under the International Health Regulations Pandemic alert -> phase 4 All countries must intensify their surveillance and report to WHO any suspicious cases or clusters Surveillance guidelines have been disseminated

10. Overview of WHO Pandemic Alert Phases

11. WHO pandemic alert phases Phase 4 is characterized by verified human-to-human transmission of a new virus, causing “community-level outbreaks.” –Emphasis on surveillance and rapid containment Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. –Focus on (preparing) mitigation efforts Phase 6, pandemic phase: outbreaks in at least one other country in a different WHO region in addition to the criteria in Phase 5. –Focus on mitigation and continuation of essential services

12. Pandemic Response Non-Medical interventions Medical interventi ons Security Security Food & water supply Food & water supply Power supply Power supply Transportation Transportation Telecommunication Telecommunication other essential services other essential services Personal hygiene Personal hygiene Travel restriction Travel restriction Quarantine Quarantine Social distancing Social distancing Risk Communication Risk Communication Antiviral drugs Antiviral drugs Vaccines, etc Vaccines, etc Medical care, PPE Medical care, PPE Social Services (keep a society running) Public Health Measures

13. What needs to be done - NOW Intensify surveillance –Report to WHO any cases or unusual outbreaks –Share samples Inform clinicians Inform travellers –screening was not effective in the past Inform the public

14. When cases are confirmed Inform the public, medical staff –How to protect themselves, seek medical care Social distancing –School, church closures –No public gatherings –Stay home

15. Advice to general public Wash hands frequently with soap and avoid touching your face. Cover your mouth or nose when coughing or sneezing Avoid close contact with obviously sick people Stay at home if you are unwell See your doctor if you have flu symptoms

16. Border control & International travel Health information and advice to international travellers –Protect yourself –Seek health care if you get ill Countries may consider entry screening Travel restrictions, border closures not recommended –But islands may benefit from temporary travel ban WHO/WPRO