Main developments
Pandemic A (H1N1) Virus 2009 (Special Edition of "Health – EU" Newsletter (2009 09)
Travellers notice!
World Health Organizations Office in Lithuania +370 5 212 4763
Ministry of Health of Lithuania
Free phone line +370 800 66 004
Public Health Department +370 5 266 1466
Public Relations Divisions +370 5 266 1411, 266 1415
Communicable Disease and AIDS Center +370 5 277 9051
State Public Health Care Service + 370 5 277 8036
Information on the weekends and out of labour hours:
Health Emergency Situations Center +370 5 261 9888
 Information in Lithuanian
Information about new virus A(H1N1) Influenza:
World Health Organization information about Swine Influenza
World Health Organization
European Commission information
EC Health Security Committee Communication Network Contact List
Health–EU portal information
 Health Map. Global Disease Alert Map
WHO Key Messages
Pandemic H1N1
19 February 2010
Topics:
1. Pandemic activity declining but not over – current situation.
2. Moving towards a transitional post-peak period, and Emergency Committee to meet
3. Influenza vaccine for northern hemisphere 2010
Issues:
1. Pandemic activity declining but not over – current situation
The overall pattern of disease suggests that we may be seeing a general decline in pandemic activity but that the pandemic itself has not yet run its full course, according to WHO surveillance.
What we are hoping for is that the worst of the pandemic influenza is behind us and that we are on a general decline in activity. Highest levels of activity in parts of eastern Europe, northern Africa and parts of Asia. In addition, Senegal and Mauritania are seeing reports of community-level transmission.
19 February 2010 -- As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.
The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.
2. Moving towards a transitional post–peak period, Emergency Committee to meet
The ending of a pandemic cannot be considered an abrupt on or off situation. A post–peak period, if determined, is a time of transition when pandemic activity may be continuing at various levels in different parts of the world or in different countries.
The Emergency Committee, as per the International Health Regulations, will meet on Tuesday 23 February 2010 to review the temporary recommendations and recommend whether they should be continued or cancelled. (The EC must meet every 3 months to review temporary recommendations.) The Committee will also review the epidemiological situation worldwide and provide WHO with guidance on whether we are entering a transitional post–peak period. (The committee makes recommendations to WHO.)
WHO will continue to work very closely with countries to provide recommendations on what to do if we enter a post-peak, transition period.
The WHO 2009 Pandemic Preparedness Guidelines – developed between 2007 and 2009 and involving About 138 scientists from 45 countries – defines the post–peak period.
3. Recommendations for influenza vaccine for northern hemisphere 2010
As the pandemic unfolds, WHO continues to work on other influenza activities. This would be true whether we were dealing with a pandemic situation or a regular seasonal situation.
After four days of an expert consultation to finalize analyses of influenza viruses that have been shared with WHO and the Global Influenza network, WHO recommended the following strains for use in the 2010-11 northern hemisphere influenza vaccine:
- an A/California/7/2009 (H1N1)-like virus
- an A/Perth/16/2009 (H3N2)-like virus
- a B/Brisbane/60/2008-like virus
The seasonal influenza strain selection is part of WHO's routine yearly work and occurs whether or not there is a pandemic. Consultations take place every February for the northern hemisphere, and every September for the southern hemisphere with countless hours put into virus analysis, epidemiological and clinical information.
This year of course, with pandemic H1N1 blanketing the earth and crowding out other H1 viruses, it was logical that it constitute the H1N1 component of the recommended vaccine for the 2010-11 northern hemisphere (NH) winter.
The inclusion of the pandemic H1N1 influenza virus in the next seasonal influenza vaccine for the NH does NOT signal that the pandemic is over. It indicates that the available data suggests that the pandemic A (H1N1) viruses have become much more common than current seasonal influenza A (H1N1) viruses.
The group of experts convened by WHO for this consultation consider it likely that other A (H1N1) viruses will not pose a major public health risk in the northern hemisphere for in the 2010-11 winter.
The inclusion of the pandemic H1N1influenza virus in the next seasonal influenza vaccine for the NH does not signal that the pandemic is over.
It is still prudent to be vaccinated against H1N1- either with the pandemic vaccine or a trivalent influenza vaccine with the H1N1 strain. Healthcare workers, pregnant women, young children and those people with respiratory conditions, should be particularly encouraged to get vaccinated.
The decision as to whether the vaccine will be monovalent or trivalent will be taken by individual Member States.
Press Releases and Reccomendations
Travellers notice! ( 329.6 kb )
Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home ( 60.5 kb )
For your attention – Influenza A(H1N1) Infection Situation Report, provided be the European Centre for Disease Prevention and Control (18 May, 2009) ( 620.5 kb )
ECDC frequently asked questions for human swine influenza A(H1N1) ( 49.5 kb )
Swine influenza frequently asked questions (25 April 2009)
What is swine influenza?
What are the implications for human health?
Where have human cases occurred?
How do people become infected?
Is it safe to eat pork meet and products?
What about the pandemic risk?
Is there a human vaccine to protect swine influenza?
What drugs are available for treatment?
What is swine influenza?
Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols and direct and indirect contact, and asymptomatic carrier pigs exist. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza.
Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a "reassortant" virus.
Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.
What are the implications for human health?
Outbreaks and sporadic human infection with swine influenza have been occasionally reported.
Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death. Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition, therefore the true extent of this disease among humans is unknown.
Where have human cases occurred?
Since the implementation of IHR(2005)1 in 2007, WHO has been notified of swine influenza cases
from the United States and Spain.
How do people become infected?
People usually get swine influenza from infected pigs, however, some human cases lack contact history with pigs or environments where pigs have been located. Human-to-human transmission has occurred in some instances but was limited to close contacts and closed groups of people.
Is it safe to eat pork and pork products?
Yes. Swine influenza has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The swine influenza virus is killed by cooking temperatures of 160F/70C, corresponding to the general guidance for the preparation of pork and other meat.
Which countries have been affected by outbreaks in pigs?
Swine influenza is not notifiable to international animal health authorities (OIE, ww.oie.int), therefore its international distribution in animals is not well known. The disease is considered endemic in the United States. Outbreaks in pigs are also known to have occurred in North and South America, Europe (including the UK, Sweden, and Italy), Africa (Kenya), and in parts of eastern Asia including China and Japan.
What about the pandemic risk?
It is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus established efficient human-to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors. Swine influenza viruses can give a rise to a hybrid virus by mixing with a human influenza virus and can cause pandemic.
Is there a human vaccine to protect from swine influenza?
No. Influenza viruses change very quickly and the match between the vaccine and the circulating virus is very important to give adequate protective immunity to vaccinated people. This is why WHO needs to select vaccine viruses twice a year for seasonal influenza protection, once for the northern hemisphere winter and another for the southern hemisphere. Current seasonal influenza vaccine produced based on WHO recommendation does not contain swine influenza virus. It is unknown whether the seasonal vaccines can provide any cross protection to ongoing swine influenza virus infection in the United States and Mexico. WHO is working closely with its partner institutions for further advise on the use of seasonal influenza vaccine in preventing the swine influenza infection. This section will be updated as more information becomes available.
What drugs are available for treatment?
1 International Health Regulation (2005) http://www.who.int/ihr/about/en/
Antiviral drugs for seasonal influenza are available in some countries and effectively prevent and treat the illness. There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir).
Most of the previously reported swine influenza cases recovered fully from the disease without requiring medical attention and without antiviral medicines.
Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of chemoprophylaxis and treatment. The viruses obtained from the recent human cases with swine influenza in the United States were sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine.
Information is insufficient to make recommendation on the use of the antivirals in prevention and treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical and epidemiological assessment and harms and benefit of the prophylaxis/treatment of the patient.
For the ongoing outbreak of the swine influenza infection in the United States and Mexico, the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment and
prevention of the disease based on the virus’s susceptibility profile.
For benefits and harms of influenza-specific antivirals, see
http://www.who.int/csr/disease/avian_influenza/guidelines/
pharmamanagement/en/index.html
Where to get more information:
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Ministry of Health of the Republic of Lithuania Public Health Department
Tel. +370 5 266 14 66, + 370 5 266 14 64
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Ministry of Health Public Relations Depertment
Tel. +370 5 266 1411, 266 1415
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Ministry of Health Free hotline + 370 800 66 004
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State Public Health Service under the Ministry of Health, tel. +370 5 277 80 36
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Commucable Disease Prevention and Control Centre under the Ministry of Health, tel. +370 5 277 90 51
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Health Emergency Situations Center under the Ministry of Health
Hotline 24/7 +370 5 261 98 88
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Communication and information
Questions?
bga@who.dk
www.euro.who.int
www.who.int/csr/gip
www.ecdc.eu.int
The links to ECDC’s influenza web addresses are:
1. Weekly update – latest epidemiology including EISS, news and scientific and public health developments with ECDC commentaries. Updated every Thursday
http://www.ecdc.eu.int/influenza/update_influenza.php - worth checking each week and using the content
2. Influenza Index (closest thing to an Influenza web-site) http://www.ecdc.eu.int/influenza/index.php
3. Avian Influenza Index (the Bird Flu ‘web-site’) http://www.ecdc.eu.int/avian_influenza/index.php
4. Avian Infuenza Portfolio of Technical Information http://www.ecdc.eu.int/avian_influenza/Scientific_Technical_Guidance.php
5. Influenza Questions and Answers – Ordinary Influenza http://www.ecdc.eu.int/Influenza/Influenza_QA_2.php
6. Avian Influenza and Pandemic Influenza http://www.ecdc.eu.int/influenza/influenza_QA.php Note these are going through a review at present
7. EU Pandemic Plans http://www.ecdc.eu.int/Influenza/National_Influenza_Pandemic_Plans.php
8. EC-ECDC-Euro Assessment Tool http://www.ecdc.eu.int/Influenza/Assessment_Tool.php
There are in addition frequent articles in Eurosurveillance Weekly www.eurosurveillance.org
http://sena.sam.lt/sritys/visuomenes-sveikata/pauksciugripas/pandemicinfluenzawho/ | 
