MANILA, 28 May 2009, 1600 hrs—New laboratory confirmed cases of influenza A(H1N1) were reported in Australia, China, Japan, the Philippines and Singapore, bringing the number of cases in the Western Region to 506. So far no deaths from influenza A(H1N1) have been reported in the Western Pacific Region.
Singapore announced its first confirmed case of influenza A(H1N1), a 22-year-old Singaporean woman who returned from the United States via Frankfurt, Germany, on 26 May. Four new cases were confirmed in the Philippines, all of them Filipinos. Two children aged 13 and 1 had travel history to affected countries. The other two cases were aged 27 and 55. These two attended a wedding in the Philippines on 17 May that had also been attended by a confirmed case from Taiwan (China).
The Western Pacific Region has reported a total 506 laboratory confirmed cases of influenza A(H1N1):
- 67 in Australia
- 36 in China
- 364 in Japan
- 2 in Malaysia
- 9 in New Zealand
- 6 in the Philippines
- 21 in the Republic of Korea
- 1 in Singapore
Australia reported 17 additional cases, taking its total to 67 cases clustered mainly in the more populous states of Victoria and New South Wales, where 34 and 19 cases respectively have been confirmed.
China declared nine new cases, three of which were detected in Hong Kong (China), including a 56-year-old woman who recently traveled with her husband from the United States of America, and a 38-year-old mother of two children who already tested positive for influenza A(H1N1). China now has a total 34 cases.
Japan reported four new cases to increase its count to 364 cases. It now has 185 cases in Hyogo Prefecture and 155 at Osaka Prefecture, the two prefectures where the majority of infections have occurred. Chiba has reported eight cases, with three in Tokyo, three in Shiga, two each in Saitama, Kyoto, Shizuoka and Kanagawa, and one each in Fukuoka and Wakayama.
The new cases in Japan are mainly associated with schools and, at this stage, there is no clear sign of the virus transmitting into local communities. Although the majority of cases are related to the initial school outbreaks around Kobe and Osaka, there are a small number of cases where public health authorities are finding it difficult to make a clear link to an affected school. Further information on those cases is expected in the near future as investigations continue.
Dengue fever threatens again in Western Pacific Region
As the number of influenza A(H1N1) cases climbs in the Western Pacific Region, another virus is having a serious but under-recognised impact. Dengue fever causes outbreaks in many parts of the world, including the Western Pacific Region, and early symptoms can be similar to seasonal influenza and the new influenza A(H1N1) virus.
Last year 213 248 cases of dengue were reported in the Western Pacific Region. As the Southern Hemisphere enters its influenza season, with the new influenza (H1N1) virus infecting more people, it is important that communities be aware that a range of febrile illnesses including dengue can be accompanied by symptoms in their initial stages which could be mistaken for influenza.
Nearly half the world's population, or 2.5 billion people, are at risk from dengue. WHO estimates there may be 50 million cases worldwide every year. In the Western Pacific Region, the current dengue season seems to have started early and has the potential to be the most serious in recent years, unless Member States strengthen outbreak preparedness.
Dengue has killed 14 people across 35 provinces in Vietnam since early this year from 16 635 cases reported since January. This is a significantly higher infection rate than 2008, when 11 447 people contracted the illness over the entire year.
From January to April this year dengue outbreaks were reported in Malaysia, Australia, Viet Nam, Fiji, Tonga and New Caledonia. Some countries and areas in the Region reported very high incidence rates: 2 983 cases per 100,000 inhabitants in New Caledonia, 797 per 100,000 inhabitants in Cook Islands, and 249 in 100 000 inhabitants for Tonga. Compared to the same period in last year, dengue has risen significantly, particularly in New Caledonia, Australia, Vietnam, and Malaysia.
Dengue is characterized by a sudden onset of headaches, severe muscle and joint pains and often also a rash. Nausea and vomiting may also ensue. In its initial phases, dengue as well as other febrile illnesses such as typhus and leptospirosis can be confused with influenza.
The ability to pick dengue from influenza is crucial, as dengue can progress into a more serious illness called Dengue Haemorrhagic Fever (DHF). Communities should be on the alert for possible complications from dengue, such as fainting, a rash, lingering acute fever, less frequent urination, nose and gum-bleeding, and severe pain behind the eyes. Care-givers and health-workers should be particularly vigilant with children, who are vulnerable to complications from dengue and are more likely to die from them.
Globally, complicated cases of dengue hospitalise an estimated 500 000 people each year, mostly children, though this number could be higher due to under-reporting. Without proper treatment, fatality rates can increase significantly. But with early recognition and treatment, death rates can be cut to less than 1%.
Dengue treatments include bed rest and proper management of fluids and aggressive emergency treatment in severe cases. On a community level, the response focuses on the eradication of breeding sites of mosquitoes whose bite causes the illness. Communities are their own first-lines of defence against dengue, as controlling mosquito numbers at the local level is crucial in reducing infections.
Influenza, on the other hand, can be treated with antiviral drugs in combination with isolation and quarantine protocols. Community messaging about hand-washing and social distancing is also very effective.
Global influenza A(H1N1) case count
As of 06:00 GMT, 28 May 2009, 50 countries have officially reported 14 674 cases of influenza A(H1N1) infection, with 96 deaths. Mexico has reported 4 541 laboratory-confirmed human cases of infection, including 83 deaths. The United States of America has reported 7 927 laboratory-confirmed human cases, including 11 deaths. Canada has reported 921 laboratory confirmed human cases, including one death. Costa Rica has reported 33 laboratory-confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths: Argentina (19), Australia (67), Austria (1), Belgium (8), Brazil (9), Chile (86), China (36), Colombia (16), Cuba (4), Czech Republic (1), Denmark (1), Ecuador (28), El Salvador (11), Finland (2), France (20), Germany (18), Greece (3), Guatemala (5), Iceland (1), India (1), Ireland (3), Israel (11), Italy (25), Japan (364), Kuwait (18), Malaysia (2), Netherlands (3), New Zealand (9), Norway (4), Panama (76), Peru (27), Philippines (6), Poland (4), Portugal (1), Republic of Korea (21), Russia (2), Singapore (1), Spain (142), Sweden (3), Switzerland (4), Thailand (2), Turkey (2), and the United Kingdom (185).
WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.
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