Pandemic A(H1N1) 2009

ECDC situation update to EPSCO CouncilZsuzsanna Jakab, DirectorEuropean Centre for Disease Prevention and Control

Brussels, 1 December 2009

ECDC key messages (1)

• ECDC is continuously monitoring the pandemic and regularly updates its risk assessment.

• People most at risk from pandemic influenza are people with significant underlying health conditions, pregnant women and young children.

• Most people who catch pandemic influenza will experience only mild illness but a few, including some young healthy individuals, will develop severe disease and die.

• EU citizens can help protect themselves and others by simple measures such as regularly hand washing and good respiratory hygiene.

ECDC key messages (2)

• Given the significant risks to health from the pandemic ECDC would strongly advise all those Europeans who are offered the vaccine to be vaccinated.

• EU citizens rightly require assurance that vaccines are both safe and effective. Rigorous testing and monitoring mechanisms are in place in the EU. So far all vaccines appear to have consistent safety profiles.

What is happening in Europe?Pandemic now a very significant health threat

Number of confirmed deaths among pandemic (H1N1) influenza cases

5

1 1 212

17

2 5 3

1723 21 17 15

2216 15 12

24

4943

84

100

169

188

0

20

40

60

80

100

120

140

160

180

200

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

Number of deathsCalendar weeks 2009

By week of notification in EU and EFTA countries, week 25 to 48, 2009

Source ECDC Daily Update, 30 November 2009. Available from: http://ecdc.europa.eu/en/healthtopics/Documents/091130_Influenza_AH1N1_Situation_Report_0900hrs.pdf

Reported cumulative number of confirmed fatal cases of influenza A(H1N1)v in EU/EFTA countries, as of 30 November 2009, 09.00 CEST

Week 47: Geographic spread

Weekly influenza surveillance output

=H1 Type A, subtype H1v. Stable clinical activity.

=H1N1 Type A, subtype H1N1v. Stable clinical activity.

Type A, subtype H1v. Increasing/decreasing clinical activity.

Type A, subtype H1N1v. Increasing/decreasing clinical activity. *

* A type/subtype is reported as dominant when > 40 % of all samples are positive for the type/subtype.

No report

No activity No evidence of influenza virus activity; clinical activity remains at baseline levels.

Sporadic Isolated cases of laboratory-confirmed influenza infection.

Localoutbreak Increased influenza activity in

local areas (e.g. a city) within a region, or outbreaks in two or more institutions (e.g. schools) within a region (laboratory confirmed).

Regional activity Influenza activity above baseline

levels in one or more regions with a population comprising less than 50% or more of the country's population (laboratory confirmed).

Widespread Influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population (laboratory confirmed).

=H1 =H1N1

=H1

=H1

=H1N1

H1N1

H1N1

H1N1

Forward look:What is likely to happen over the next two months?

Recommended planning profiles

• Real pandemic waves are not as smooth at this.

• National and local pandemic waves last about 15 weeks.

• They do not occur at the same time in different countries in Europe.

• Nor do they occur at the same time in different parts of the same country.

• Local peaks are higher.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

week

Recommended planning curve

Local planning profile

Less peaked local profile

Source: Department of Health, UK – see www.ecdc.europa.eu

Perc

enta

ge o

f popula

tion

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Three curves – more hospitalisations and deaths after the peak

Animated slide: Press space bar

Not drawn to scale

Cases

Clinical cases

Hospitalisations

Deaths

Forward look – December to New Year

• Illnesses will peak soon in the first affected countries.

• Hospitalisations and deaths will continue rising in those countries for a while.

• Illness will rise in the eastern, central and south-eastern countries.

• There may be pressures at Christmas and New Year in many countries.

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Meeting the challenge:Key factors to consider in the EU

ECDC advice on meeting the challenge

• Plan to reinforce capacity of intensive care units for peak of pandemic and immediate aftermath.

• Antivirals and pandemic vaccines can help reduce morbidity and mortality.

– Prioritise risk groups and seriously ill for antivirals.

– Prioritise risk groups and health workers and essential services for

vaccine.

• Effectiveness on simple measures such as hand washing and respiratory hygiene should also be emphasised.

• Member States should learn from each others’ experiences.

• Member States and EU should work together to ensure coherence of risk communication.

Acknowledgments

• European Member States

• European Commission

• European Medicines Agency

• ECDC Staff

• Centers for Disease Control and Prevention, USA

• WHO Geneva

• WHO Regional Offices for Europe

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Sources of data and analyses

ECDC Daily Update – every weekday http://www.ecdc.europa.eu/en/healthtopics/Pages/Influenza_A(H1N1)_Outbreak.aspx

ECDC Weekly Influenza Surveillance Output http://www.ecdc.europa.eu/en/activities/surveillance/EISN/Pages/EISN_Bulletin.aspx

Updated ECDC Risk Assessment http://www.ecdc.europa.eu/en/healthtopics/Pages/Influenza_A(H1N1)_Risk_Assessment.aspx

EU Member States

World Health Organization, Geneva and Regional Office for Europe e.g. new WHO Clinical Guidance http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html

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