Friday, July 10, 2009

PANDEMIC (H1N1) 2009 (02): MBDS REGION

In this update:
[1] Cambodia: 8 confirmed cases
[2] China: 1151 confirmed cases
[3] Thailand: 2925 confirmed cases, 14 confirmed deaths
[4] Viet Nam: 259 confirmed cases
[5] Viet Nam - patient data


******
[1] Cambodia: 8 confirmed cases
Date: Thu 9 Jul 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-07/09/content_11676297.htm>


Cambodia's Health Ministry on Wednesday [8 Jul 2009] confirmed the
country's 8th infection case, a 15-year-old Australian girl. The
ministry said the previous 7 patients have returned home after treatment.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Cambodia, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/cambodia_pol_97.jpg>.
For the interactive HealthMap/ProMED-mail map with links to other
recent PRO/MBDS and ProMED-mail postings in Cambodia and neighboring
countries, see <http://healthmap.org/r/00ul>. - Mod.YMA]

******
[2] China: 1151 confirmed cases
Date: Wed 8 Jul 2009
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/2009-07/08/content_11675893.htm>


China relaxes quarantine on A/H1N1 flu close contacts, mild cases
-----------------------------------------------------------------
Chinese people in close contact with A/H1N1 flu patients will no
longer be quarantined in specially reserved places, and patients with
mild symptoms may receive treatment at home, the Health Ministry said
Wednesday [8 Jul 2009]. Close contacts could observe home quarantine,
and the range of close contacts was narrowed down, according to a
notice on adjusting A/H1N1 flu prevention and control measures issued
by the ministry Wednesday [8 Jul 2009].

"The adjustment does not give up supervising close contacts. It's
just a different place for quarantine, and they still will be
restricted from going outside and contacting other people
," said
Liang Wannian, deputy director of the ministry's emergency office.

Close contacts now include people who diagnosed, treated, nursed or
visited a patient, people who worked or lived with a patient, and
people who contacted the spit or body fluid of a patient. And on
aircraft, close contacts include 8 passengers surrounding a patient,
the notice said.

According to the notice, mild flu cases may be quarantined and
treated at home, and health departments at provincial level have a
general discretion to decide. Liang said the adjustment is aimed to
ensure timely and effective treatment of severe cases. The notice
also urged all regions to strengthen prevention and control work on
special groups including the old, the sick and the pregnant.

China had confirmed 1151 A/H1N1 flu patients by Tuesday [7 Jul 2009]
and 870 of them had been discharged from hospital, according to the
Ministry of Health
. There have been no deaths directly caused by the
influenza so far.

[Byline: Wang Guanqun, editor]

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of China with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>.
For the interactive HealthMap/ProMED-mail map of China with links to
other ProMED-mail and PRO/MBDS postings in China and surrounding
areas, see <http://healthmap.org/r/008e>. - Mod.YMA]

******
[3] Thailand: 2925 confirmed cases, 14 confirmed deaths
Date: Thu 9 Jul 2009
Source: Bangkok Post [edited]
<http://www.bangkokpost.com/news/health/148426/thailand-records-13-deahts-from-flu>


The cabinet on Thursday [9 Jul 2009] approved the temporary closure
of tutoring schools for 15 days starting Monday [13 Jul 2009] to
limit the spreading of influenza A as the Public Health Ministry
confirmed 3 more deaths from the virus. The move came after the
Public Health Ministry reported that many students have caught the
virus while at tutoring schools. All tutoring schools throughout the
country will be closed from Monday until 28 Jul 2009, the cabinet decided.

The temporary closure was necessary because most tutoring classes
were in air-conditioned rooms, which facilitate the spread of the
virus because the students are in confined spaces, Deputy Education
Minister Chaiwuti Bannawat said.

The cabinet also asked owners of online game shops to cooperate by
closing their business during the same period, because many young
players had also caught the infection.

The Public Health Ministry on Thursday [9 Jul 2009] confirmed 3 more
deaths from influenza A and 211 new infections
.

The 12th victim was a 52-year-old traffic policeman in Bang Na,
Bangkok, who suffered from kidney failure.
The 13th victim was a
student in the 11th grade at Maha Sarakham University demonstration
school in the northeastern province of Maha Sarakham.

The 14th fatality was a 17-year-old girl who had been treated in
Srinagarind Hospital in Khon Kaen province since 3 Jul 2009. She died
on Tuesday, and her blood test on Thursday afternoon showed that she
was positive for the A(H1N1) flu.

The Maha Sarakham student was believed to have caught the disease
when he went to take an assessment examination for Chulalongkorn
University's faculty of medicine. At least 10 of his friends have
been admitted to hospitals for tests. After his death, the school
announced that it would close on Thursday and Friday.

Total influenza A infections had risen to 2925, the health ministry said.

Tourism and Sports Minister Chumpol Silpa-archa said the flu pandemic
was expected to continue for months and would add to the burden of
the country's suffering tourism sector. He said the flu outbreak
would have a psychological effect on foreign tourists, who were
likely to cancel overseas travel plans.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[For a map of Thailand showing the geographic regions, see
<http://thailandforvisitors.com/general/regions.html>. For the
interactive HealthMap/ProMED-mail map with links to other ProMED-mail
and PRO/MBDS postings in Thailand and neighboring countries, see
<http://healthmap.org/r/00cC>. - Mod.YMA]

******
[4] Viet Nam: 259 confirmed cases
Date: Thu 9 Jul 2009
Source: Thanh Nien News [edited]
<http://www.thanhniennews.com/healthy/?catid=8&newsid=50571>


Patients suspected of having antiviral resistant H1N1 strain
------------------------------------------------------------
The National Institute of Hygiene and Epidemiology is studying the
genes of H1N1 virus from 2 patients following suspicion about its
resistance to the antiviral drug oseltamivir or Tamilflu. The 2
patients were among the 19 people admitted to the institute so far,
Director Nguyen Van Kinh said Wednesday [8 Jul 2009]. 3 of these
cases were locally transmitted, he added.

The Health Ministry reported Wednesday [8 Jul 2009] 11 new influenza
A (H1N1) patients -- 7 in the south, one in the central and 3 in the
northern region -- raising the country's tally to 259. Of these, 186
patients have been discharged from hospitals after full recovery
.

The ministry also said they are closely monitoring treatment
resistance. The ministry will allow more hospitals to announce
official test results instead of having to wait for the results of
another test by authorized agencies. This would avoid waste of time
and reduce the government's expenditure on testing, which comes to
about USD 150 per case, the ministry said.

The Department of Health in Thua Thien-Hue Province, said Wednesday
[8 Jul 2009] they had instructed districts to set up facilities to
quarantine those suspected of carrying the virus and treating
confirmed H1N1 patients.

Nguyen Dung, the department director, said the facilities at the
districts would meet all criteria issued by the Health Ministry, and
help ease overload in the provincial level hospitals. This will also
prevent possible spread of the flu while transporting the patients, he added.

The World Health Organization (WHO) Wednesday [8 Jul 2009] said some
137 countries and territories have reported more than 98 000 cases
including more than 440 deaths.

WHO has been informed by health authorities in Denmark, Japan and the
Special Administrative Region of Hong Kong, China of the appearance
of H1N1 viruses which are resistant to Tamiflu based on laboratory testing.

--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

******
[5] Viet Nam - patient data
Date: Wed 8 Jul 2009
From: Rogier van Doorn <hrogier@gmail.com>


In the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam,
patients with flu symptoms and a positive RT-PCR result for pandemic
Influenza A (H1N1) 2009 virus infection with the CDC assay (specific
A(H1N1)v primers/probe) are hospitalized and treated with oseltamivir
(75mg bd) until RT-PCR results are negative.

We collected clinical data, haematology and biochemistry, and daily
virological data (nose and throat swabs) from the 1st 44 Influenza A
(H1N1)v RT-PCR positive patients in Viet Nam hospitalized between 29
May and 26 June 2009. The average age of the patients was 28.6 years
(3-62), 19 female and 25 male
. 5 patients contracted flu while in
Viet Nam but with a clear epidemiological link to someone with
"imported" H1N1, 39 cases were thought to be directly imported (14
US, 18 Australia, 2 Canada, 2 Thailand, 1 Japan, 1 China, and 1 Singapore).

Fever was present in 91 percent (n - 40), cough in 55 percent (n -
24), runny nose in 20 percent (n - 9), sore throat in 27 percent (n -
12), and diarrhea in 2 percent (n - 1). Average duration of fever on
presentation was 2 days. After 24 hours 75 percent (n - 33) of
patients had a normal temperature. All patients had a mild illness course.

Viral PCRs were positive on day 0 for all patients with an average Ct
value of 30.3. The number of PCR positive patients dropped to 25
after 1 day (average Ct 30.3). On day 2, 21 patients were positive
(average Ct 35.8) and on day 3 and 4, 8 patients were still PCR
positive (average Ct 37.0 and 37.2). No patients were positive on day
5, 6 and 7.

These data suggest that patients treated with oseltamivir have a
favourable clinical and virological response and are not shedding
viral RNA after 5 days of treatment. In comparison, Whitley et al
[Pediatr Infect Dis J 2001 20:127] found 55 percent (n - 51/93)
culture positive patients in oseltamivir treated children with
non-severe influenza on day 4.

There have been a few anecdotal reports from Viet Nam of patients
that remained symptomatic and PCR positive for a prolonged period,
and one patient in our hospital (not included in this report) had a
positive PCR after 18 doses of oseltamivir. Investigations into the
presence of the NA H274Y mutation in [virus isolated from] these
patients are ongoing but have so far been negative.

Tran Tinh Hien
Nguyen Thanh Truong
Nguyen van Vinh Chau
Tran Thuy Ngan
Jeremy Farrar
Rogier van Doorn
Hospital for Tropical Diseases
Ho Chi Minh City
Viet Nam

--
Rogier van Doorn
Hospital for Tropical Diseases
Wellcome Trust Major Overseas Programme
Oxford University Clinical Research Unit
190 Ben Ham Tu
District 5
Ho Chi Minh City
Viet Nam
<rvandoorn@oucru.org>

[For maps of Viet Nam with provinces,
see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg> and
<http://www.angelfire.com/co/hongnam/vnmap.html>. The interactive
HealthMap/ProMED-mail map with direct links to other outbreaks in
Viet Nam and surrounding countries reported on ProMED-mail and
PRO/MBDS can be accessed at <http://healthmap.org/r/008c>.

The strain of influenza A (H1N1) resistant to Tamiflu was 1st
detected in Denmark, and followed by Japan, United States, Hong Kong
SAR (see prior PRO/MBDS postings listed below) and Viet Nam.

According to the latest figures on confirmed cases of influenza A
(H1N1) infection in neighboring countries of the MBDS region, there
are 18 cases in Bangladesh, 1055 in Hong Kong SAR, 68 in Macau SAR,
61 in Taiwan, 52 in Indonesia, 158 in India, 2033 in Japan, 513 in
Malaysia, 1217 in Singapore, 19 in Sri Lanka, 333 in South Korea, and
1709 cases and one death in Philippines.


Update 58 of laboratory-confirmed cases of the new influenza A (H1N1)
as officially reported to WHO by states parties to the international
health regulations (2005), dated 6 Jul 2009, is available at
<http://www.who.int/csr/don/2009_07_06/en/index.html>.

The map of the spread of influenza A (H1N1) from WHO, which includes
the number of laboratory confirmed cases and deaths as of GMT 09:00,
6 Jul 2009 is available
at <http://www.who.int/csr/don/Map_20090706_0900.png>. - Mod.YMA]

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