NBTA

December 3, 2009

Africa - Pandemic Influenza Update
Reports of pandemic (H1N1) 2009 influenza vary widely throughout Africa. After reporting widespread influenza activity August-September, South African officials announced Nov. 22 that pandemic influenza cases dropped to nearly zero in the warmer months of October and November. South African authorities confirmed a total of over 12,600 pandemic influenza cases and 92 associated deaths.

In Tanzania, Mwanza regional health officials reported an outbreak of more than 220 pandemic influenza cases on Dec. 2, including at least 30 with severe complications requiring hospitalization. Authorities closed 150 primary schools and 27 secondary schools to curb the spread of disease. More than 560 pandemic cases and one death were reported nationwide.

As of Nov. 30, officials reported pandemic influenza infections in 29 African nations. Outbreaks of over 100 confirmed cases have been reported in Kenya, Madagascar, Mozambique, Rwanda and Uganda; outbreaks of over 50 confirmed cases have been reported in Cape Verde, Ghana, Lesotho, Mauritius, Namibia and Zambia. Pandemic-related deaths have been confirmed in Ghana (1), Madagascar (1), Mauritius (8), Mozambique (2), Namibia (1), Sao Tome & Principe (2), Sudan (1) and Tanzania (1). On Nov. 24, WHO officials announced plans to donate 200 million doses of pandemic (H1N1) 2009 influenza vaccine to African nations. The 200 million donated doses will only cover approximately 10 percent of the population in each country.

iJET Analysis: Pandemic influenza is probably endemic in much of Africa, with true numbers of pandemic influenza infections likely much higher than confirmed cases. Most African countries do not have adequate facilities to test patient samples for pandemic (H1N1) 2009. Many rely on South African labs or send samples to Europe. A large number of infections are likely going unreported, and experts predict the highest rates of mortality associated with the pandemic could occur in Africa. With a large proportion of the world's population living with HIV/AIDS in southern Africa, officials are carefully watching the pandemic situation as the disease takes hold.

China, Taiwan - Pandemic Influenza Activity Intensifies in Mainland China
Pandemic (H1N1) 2009 influenza activity in mainland China continued to increase rapidly in recent weeks. As of Dec. 1, Chinese officials reported more than 90,000 cases, not including Hong Kong or Macao. Officials reported a total of 178 associated deaths, compared to just 53 deaths two weeks earlier, after the government ordered more accurate reporting because of suspicions of a cover-up. About 15,500 people remained hospitalized for influenza complications. (H1N1) 2009 now accounts for around 90 percent of all flu cases on the mainland. As of Dec. 1, more than 27 million people were vaccinated against pandemic influenza in mainland China. The State Council ordered government departments to increase measures to prevent large-scale pandemic influenza outbreaks, especially in schools.

In Hong Kong, pandemic influenza activity remained low and continued to decrease. Doctor visits dropped dramatically from nearly 9,000 in late September to less than 1,000 during the week ending Nov. 25. Authorities ordered 3 million doses of pandemic vaccine - enough to vaccinate half of the population. Meanwhile, Macao reported over 2,400 pandemic infections and two deaths. The region received 200,000 doses of vaccine in late November and expects another 500,000 in January.

Since July 1, Taiwan has reported over 700 pandemic influenza-related hospitalizations and 30 deaths. The rates of outpatient visits and emergency room visits for influenza-like illness increased Nov. 22-28; both were significantly higher than normal. However, the proportion of deaths involving pneumonia and influenza was still below baseline levels. Officials launched the second round of pandemic influenza vaccination on Nov. 17, offering free vaccines to pre-school and elementary students, pregnant women and seriously ill patients.

iJET Analysis: Officials continue to take the temperature of all individuals arriving in China, Hong Kong and Taiwan and require travelers to fill out health declaration forms and provide local contact information. Sick travelers may be taken to local hospitals for testing and treatment, but healthy passengers nearby are rarely quarantined. However, on Sept. 25, the US State Department warned that local Chinese officials may strengthen disease control and mitigation measures in the fall and winter. These policies may vary by location and are likely to be unpredictable..