2009 swine flu pandemic by country

See also: 2009 swine flu outbreak timeline

This article deals with the status and efforts regarding the 2009 swine flu outbreak by country and continent/region. Template:2009 swine flu outbreak table

Affected countries

  Confirmed cases followed by death

  Confirmed cases

  Unconfirmed or suspected cases

See also: H1N1 live map, WHO updates

  500+ cases

  50+ cases

  5+ cases

  1+ cases

See also: Live map of swineflu, H1N1 live map

Africa

Benin

Results are expected next week on a European woman who returned from Mexico to Benin showing flu like symptoms.

Egypt

The Egyptian government has increased numbers of medical officers at Cairo Airport and will monitor passengers from Mexico during their stay.

The government ordered the mass slaughter of all pigs in Egypt on April 29, even though the current strain is a human-human transmittable, human influenza that has already previously hybridized with avian and swine flu. The World Organization for Animal Health called the swine killing "scientifically unjustified".

Ghana

Ghana has banned the importation of pork and pork products.

Nigeria

Nigerian Health Minister Babatunde Osotimehin said that the country is stockpiling antiviral treatments, informing the public and increasing surveillance.

South Africa

On April 29, South Africa reported two possible cases of swine flu from two women who had recently travelled in Mexico.

Zambia

An emergency task force has been set up by the Zambian government.

Asia

Azerbaijan

On April 27, Azerbaijan imposed a ban on import of animal husbandry products from America. According to the Chief of the State Veterinary Service under the Agriculture Ministry Ismayil Hasanov, products brought to the country by April 27 received certificates and it was confirmed that those products were safe. AZAL took additional safety measures and a sanitary quarantine unit of the Health Ministry started to operate in Heydar Aliyev International Airport with all aircraft and passengers being checked.

Azeri Minister of Health Ogtay Shiraliyev said the order prepared by him considers implementation of necessary measures in the epidemiological and various medical centers. "Azerbaijan is ready for this issue", he said. According to the Agriculture Minister Ismat Abbasov, the State Veterinary Service is holding monitoring in the regions and pigs are kept in closed places in farms. Abbasov also said: "I can say with full responsibility that the situation on prevention against swine flu virus is stable in Azerbaijan".

On May 2 all checkpoints on borders with Russia passed to the medium security and disinfection barriers for both cars and pedestrians were installed at the Samur, Shirvanovka and Khan Oba checkpoints in Qusar and Khachmaz Raions. The veterinary services at checkpoints intensified their activities while hog farms in the northern regions passed to the closed farming regime.

Cambodia

Cambodia's health authorities remain alert but confident that the country is prepared for a swine flu pandemic. In terms of ensuring that infected pigs do not spread the disease to Cambodia, the Cambodian Pig Raiser Association said it has told the government it should ban live pig imports. But Khlauk Chuon, the deputy director of Camcontrol at the Ministry of Commerce, said they would only ban live pig imports from a country that has been hit with swine flu.
"We are very worried about this new disease because it can transfer from pig to human, from human to human and from human to pig," Khlauk Chuon added.

China

Outbreak evolution in mainland China:

  Confirmed cases

  Unconfirmed or suspected cases

Main article: 2009 swine flu outbreak in China

See also: Disease surveillance in China

The first suspected case found on mainland China was reported on May 10, 2009

The General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) of China issued an emergency notice on the evening of April 26 that visitors returning from flu-affected areas who experienced flu-like symptoms within two weeks would be quarantined. The Ministry of Health has started prevention measures, and initiated cooperation with the WHO and the relevant departments of the Mexican and U.S. governments to help contain the outbreak. According to Wang Jing of the China Inspection and Quarantine Science Research Institute, the measures already in place in China against bird flu are sufficient for this new disease.

May 2, the Chinese government has decided to suspend flights from Mexico to Shanghai, the Foreign Ministry said. Meanwhile, the Civil Aviation Administration of China also assigned a charter to transport stranded Chinese visitors back home. Among all carriers, China Eastern Airlines was the first choice as it is based in Shanghai, where the original and the only Sino-Mexican flight disembarks, but later the job has fallen onto the Guangzhou based China Southern Airlines, as China Eastern's aircrafts don't fit the facility at Tijuana Airport. The replacing China Southern flight would leave Guangzhou at 21:00 on May 3 as a normal flight until it reaches the stop-over at Los Angeles, and then fly empty toward Mexico City to pick up the 120 stranded tourists. The charter flight estimates to be back in Shanghai 11:00 in the morning on May 5, and all passengers onboard will then go through health to see if further action is needed.

Hong Kong

Outbreak evolution in Hong Kong:

  Confirmed cases

Metropark Hotel Wanchai under swine flu quarantine

The Food and Health Bureau of Hong Kong issued travel advice for Mexico on April 26, 2009, which advised Hong Kong residents not to travel to Mexico unless absolutely necessary. The first case reported was a Mexican who flew in from Shanghai. The most recent case (the 10th) was found in an American at 56 years of age. He flwe in from San Francisco. The Bureau also escalated the alert level from "alert" to "Serious" on the same day, which activated health protection measures in all port of entries of Hong Kong. As such, temperature screening machines are used at all checkpoints to identify passengers with fever and respiratory symptoms. Any passenger who fails the temperature test and confirmed having a fever will be quarantined and sent to public hospital for further investigation. Hong Kong also became one of the first countries to declare the swine flu as a notifiable disease, and much of the procedures against the spread of the swine flu were learned from the 2003 SARS outbreak, of which Hong Kong was the epicenter of the outbreak.

The Secretary for Food and Health Dr. York Chow states that special attention will be paid to passengers who come from countries where human infection of swine influenza cases have been reported.

As of April 30, according to the Hong Kong Government, there are no confirmed human case of swine influenza A (H1N1) infections in Hong Kong. There were 9 patients who fulfilled the designated reporting criteria, 8 of which tested negative in swine influenza.

On May 1, one case became the first confirmed case of swine flu in Hong Kong and also the first in Asia after being tested positive by the University of Hong Kong and the Department of Health of Hong Kong. The Mexican patient, who travelled with two companions from Mexico to Hong Kong with a stopover in Shanghai Pudong Airport, arrived in Hong Kong on April 30. Metropark Hotel Wanchai, where the patient stayed, was cordoned off by the police and health officials from the Centre for Health Protection. All 350 guests and hotel staff have to remain inside the hotel for seven days. After the first swine flu case was confirmed by laboratory, Chief Executive Sir Donald Tsang raised Hong Kong's response level from "serious" to "emergency".

On May 2, a total of 12 Metropark Hotel guests who were not willing to stay in the hotel were moved to Lady MacLehose Holiday Village in Sai Kung for quarantine.

India

The Government of India has decided to screen all people entering India via the main airport hubs of Mumbai, New Delhi, Goa, Jaipur, Kochi, Chennai, Bangalore and Hyderabad. It said the primary focus will be on passengers entering from the United States of America, The United Kingdom, Canada, Mexico, France, and New Zealand. A team of 32 medical professionals have been posted at these airports. The Ministry of Health is also trying to track down people who have entered India from Mexico in the last 10 days. It has been reported that one person recently traveled from Texas to Hyderabad with flu symptoms and was quarantined, but authorities refused to divulge his identity. Government health officials & WHO subsequently stated that there is no Swine flu in India and the said patient recovered from a common cold. Three other suspected cases of swine flu have been noticed. Two of them were flying from Chicago and the other one, who is UK citizen, aged 35, arrived from London. All of whom have been kept under observation in a hospital. First case of Swine Flu case has been confirmed in Hyderabad City on May 16 2009. This confirmation was shown on NDTV 24X7 at 7:54 AM GMT

Indonesia

After a coordination meeting about the flu on April 27, 2009, the Indonesian government halted the importation of pigs and initiated the examination of 9 million pigs in Indonesia. Thermal scanners which can detect human body temperature have been installed at Indonesian ports of entry. Temperatures above 38 degrees Celsius (100.4 Fahrenheit) cause the devices to beep, indicating fever. The devices have been installed in Soekarno-Hatta International Airport and Halim Perdana Kusuma Airport in Jakarta, Juanda Airport in Surabaya, Hang Nadim Airport in Batam, Hasanudin Airport in Makassar, Ngurah Rai Airport in Denpasar, Sepinggan Airport in Balikpapan, and Tanjung Priok Seaport, gates one and two in Jakarta.

Israel

Outbreak evolution in Israel:

  Confirmed cases

  Unconfirmed or suspected cases

Seven cases have been confirmed in Israel. In response to the outbreak, the Israeli Deputy Minister of Health, Yaakov Litzman, has said that because swine are unclean, the outbreak needs to be renamed, and so in Israel, out of respect for the religious sensibilities of Jews and Muslims, it should be called "Mexican Flu". This was done so as to not confuse the population into thinking that they could not acquire the virus if they did not eat pork. The Israeli government retracted this proposal following Mexican complaints.

Japan

H1N1 in Japan

Main article: 2009 swine flu outbreak in Japan

The Ministry of Agriculture, Forestry and Fisheries of Japan instructed animal quarantine offices across Japan to examine any live pigs being brought into Japan to make sure they are not infected with the influenza. Japanese Agriculture Minister Shigeru Ishiba appeared on television to reassure customers that it is safe to eat pork. The Japanese farm ministry said that it would not ask for restrictions on pork imports because the virus was unlikely to turn up in pork, and would be killed by cooking.

On 30 April 2009, the first suspected case was detected at Narita Airport. However, the case turned out to be a conventional strain of influenza A subtype H3N2 (Hong Kong A strain). On 1 May 2009, the second suspected case was detected in Yokohama. This case also turned out to be a conventional strain of influenza A subtype H1N1 (Russian A strain). Meanwhile Japan has not stopped any flights or means of travelling between Japan and Mexico.

On 8 May, the first three cases were confirmed. The infected patients had spent time in Oakville, Canada and returned to Japan via Detroit. On 10 May, another case was confirmed from a student who came from a school trip to Canada, making it the fourth case of Japan.

On 16 May, the first domestic infection was confirmed in Kobe city. The male high school student did not have a history of travel abroad and thought it was a seasonal flu, and PCR test was not done in timely manner. Two other students are suspected, and 17 other students are claiming influenza-like symptoms. The route of the infection was not traceable.

On 18 May, 130 cases had been confirmed, including employees of a railway kiosk and a bank. Several railway kiosks in Kobe were closed, and 70 other bank workers who had worked with the infected person were told to stand by at home. All schools in the Osaka and Hyogo prefectures were suspended.

Kuwait

About 18 people on U.S. military bases in Kuwait have tested positive for swine flu, a U.S. Central Command spokeswoman said Friday.

They are the first cases reported in Kuwait. It remains unclear whether the virus has spread to the civilian population.

The names and units of the infected people were not immediately available.

Maj. Kristi Beckman, speaking from Central Command headquarters in Tampa, said everyone who tested positive for the virus was quarantined in military health facilities approved by officials from the Kuwaiti Ministry of Health.

The World Health Organization said Friday that H1N1 influenza has infected 11,168 people in 42 countries and caused 86 deaths.

Kuwait was not on its list of countries where the virus is present.

Kuwait is used as a staging area for soldiers heading to or from the war in Iraq.

On April 28, the Kuwait Times newspaper reported that the country was free of the virus.

The country is aggressively screening anyone arriving in Kuwait to prevent the virus from entering the country, Beckman said. Anyone who exhibits symptoms of the illness is immediately isolated and tested using WHO and Centers for Disease Control guidelines, Beckman said.

“The embassy in Kuwait has been working with the Kuwait Ministry of Health and other U.S. military elements in Kuwait just to assure we’re safeguarding the health of all residents in Kuwait,” Beckman said.

The U.S. has about 135,000 troops fighting in Iraq, Kuwait’s northern neighbor. About 4,000 soldiers from the 30th Heavy Brigade Combat Team of the North Carolina National Guard deployed to Iraq last month. And about 3,500 paratroopers from the 82nd Airborne Division’s 3rd Brigade Combat Team started a yearlong deployment to Iraq in December.

Laos

The Lao government agreed to buy 10 thermal imaging machines and install them at the country's major immigration border checkpoints. The machines would help officials identify anyone entering the country with a high temperature and create confidence among Lao people, foreigners living in Laos and people traveling to Laos. Health officials would be on hand at international border checkpoints to ensure anyone found to be infected could be treated immediately. Each machine could cost about US$25,000. The decision to buy them was made after the government found visitors to Laos included people coming from the United States, Spain and other affected countries.

The Prime Minister Bouasone Bouphavanh said masks should be made available and health officials would be assigned to work at border checkpoints. The machines would help officials identify anyone entering the country with a high temperature and create confidence among Lao people, foreigners living in Laos and people travelling to Laos. Health officials would be on hand at international border checkpoints to ensure anyone found to be infected could be treated immediately.

Lebanon

The Lebanese Health Minister Mohammad Khalifeh asked citizens to stop the social habit of kissing. He also requested that affected schoolchildren be kept at home and that travel to countries in which cases have been confirmed be avoided. Beirut also banned the import of pork.

Malaysia

According to the Malaysian Ministry of Health, headed by Liow Tiong Lai, health screenings were carried out on passengers traveling to and from Mexico via sea, air and land beginning April 17. The Health Ministry's disease control division has activated its operations room to monitor the swine flu situation and informed medical practitioners who are treating cases with symptoms of influenza-like illness or severe pneumonia and persons who had visited Mexico, California or Texas to inform the district health office immediately for preventive and control measures. As has several Asian countries, thermal scanners had been installed at entry points at the Kuala Lumpur International Airport (KLIA) following the start of the global alert on the flu. Screenings were imposed in Pengkalan Hulu, at the border with Thailand, in late April. Quarantine rooms had been allocated in 28 hospitals, and the country has stockpiled more than 2 million doses of Tamilflu, as of May 2009.

The country had reported no suspected cases before May 4, 2009, but all cases tested negative between May 4 and May 15. On May 15, the Health Ministry confirmed Malaysia's first case of A (H1N1) infection of a 21 year-old male student who had arrived at the KLIA on May 13 via a Malaysia Airlines flight (MH091) from Newark and on transit at Stockholm-Arlanda Airport, followed by a second case on May 16 of a female student in Penang who shared the same flight as the first victim and boarded an AirAsia flight (AK5358) from KLIA to Penang International Airport. This makes Malaysia the 36th country to detect A (H1N1) within its borders.

The first victim has been warded at the Sungai Buloh Hospital, while house quarantines were undertaken on two of the second victim's friends who boarded the same flight, along with their family members. All passengers of the flights were also asked to contact the Health Ministry or head to any any hospital, clinic or health office or further action, and crew members of MH091 and AK5358 were located and grounded. As the first victim has indicated, the use of thermal scanners is revealed not to be entirely effective as symptoms of his flu had yet to manifest; the Health Ministry resumes the use of the scanners nevetheless.

In response to the country's first case of A (H1N1), the health ministry urged calm among the populace "as the situation is under control" and "the ministry has taken all the possible precautionary measures to control and contain the disease after the WHO issued a level-five alert." In addition, schools were issued strict hygiene procedures on May 16 to contain any H1N1 outbreak among students and teachers.

Maldives

A ministerial committee has been established to supervise swine flu preventive measures to avoid an outbreak. All visitors arriving at the Malé International Airport on Hulhule Island and the country’s three commercial seaports are being screened.

Myanmar

Deputy Health Minister inspects human flu preventive measures at airport YANGON, May 1-Chairman of Global Human Flu Prevention and Response Work Committee Deputy Minister for Health Dr Mya Oo inspected preventive measures against the human flu at Yangon International Airport today.

Pakistan

Pakistan has taken precautionary measures at the international airports to check passengers coming from swine flu affected countries. Doctors are checking the incoming passengers and allow entry only to those with no flu symptoms. The major hospitals in all the big cities are on high alert.

Philippines

File:RP- 2 cases of A(H1N1).png

A(H1N1) Flu case in The Philippines:

  Confirmed cases

  Unconfirmed or suspected cases

The Philippines Health Secretary Francisco T. Duque III has ordered the Bureau of Quarantine to use thermal imaging equipment at airports to screen passengers coming from the US for flu symptoms. The Philippines may quarantine travelers arriving from Mexico with fevers. Also, the Secretary of the Department of Agriculture of the Philippines issued an order banning the importation of hogs from the U.S. and Mexico, and the retraction of the restriction of swine influenza vaccine use. The medical alert phase is already Code White, the lowest.

A Filipina girl who arrived from the US in Monday was the first confirmed case of H1N1 virus in the Philippines. Health Secretary Duque advised that the girl is in stable condition and is in quarantine.

Department of Health in The Philippines on Sunday reported its second confirmed case of Influenza A(H1N1) virus infection in The Philippines. The 50 years old patient who arrived in the country from the United States last May 20, who has a symptoms of the dreaded flu, including coughs and fever. The patient is currently under observation at the Research Institute of Tropical Medicine (RITM) in Manila.

As of May 27, 2009. DOH confirmed its new 4 cases of A(H1N1) virus in the Philippines. Bringing the total of confirmed cases in the Philippines to six.

Saudi Arabia

In the Kingdom of Saudi Arabia all airports and borders, both land and sea, are being installed with thermal cameras to monitor the incoming passengers, announced the ministry of health and quarantine officials at airports and seaports have been instructed to be on alert to check passengers who come from infected countries for fever until all the digital surveillance starts. Beginning next week, the ministry would launch a nationwide awareness campaign, Health Ministry spokesman Khaled Mirghalani said. Flights from affected countries have also been halted as a precautionary measure.

Singapore

On May 27 2009, Singapore confirmed its first case of Influenza A (H1N1-2009). The patient, a 22 year-old Singaporean female is currently being treated at the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) and is in stable condition. She was in New York from May 14- 24 and arrived back in Singapore on 26 May at 06.30hrs. She began to develop a cough while onboard. Later in the morning, she consulted a GP who decided to send her to TTSH via a 993 ambulance, given her travel history. She was immediately admitted for testing. Laboratory confirmation of her infection was made by midnight of 26 May.

As of May 27, 5pm, Singapore had the first confirmed case and three additional suspect cases for investigations today. Of the 48 cases investigated thus far, 1 case has tested positive for the Influenza A (H1N1-2009) virus, 39 cases tested negative for Influenza A, and 8 tested positive for the usual circulating seasonal flu strains.

As of May 27, the Disease Outbreak Response System is at alert Yellow, the second alert of a 5 colour system.

Singapore's Minister of Health Khaw Boon Wan has urged citizens to limit travel to affected areas such as Mexico and the United States. The Health Ministry has advised the public to seek immediate medical attention if they experience influenza symptoms within seven days after arriving from affected areas, to maintain good hygiene, and for those who are sick with respiratory illnesses to avoid crowded areas and wear masks.

South Korea

Main article: 2009 swine flu outbreak in South Korea

South Korea warned against travel to Mexico City and three Mexican states. The government has also stepped up quarantine and safety checks on travelers arriving from the United States and Mexico, and pork imports from those countries. An emergency quarantine system is also in place, with simple tests conducted on people arriving with flu symptoms at airports. On April 28, South Korea reported its first probable case of swine flu after positive preliminary tests on a nun who had recently returned from a trip to Mexico. Several sources have informed that one case has been confirmed by lab in South Korea, on April 30. On May 2, the first suspected woman turned out to be infected with the influenza A subtype H1N1. South Korea became the second infected nation in Asia.

Taiwan

On May 20, 2009, the first case of the influenza has been confirmed in Taiwan

The government had previously taken several steps to prevent the possible outbreak of Swine Flu, including a command center set up, travel alerts for infected nations, and more severe health check been conducted at international ports. Taiwan said visitors who came back from affected areas with fevers would be quarantined. According to The Department of Health (DOH), Taiwan has a sufficient supply of surgical masks and vaccine to deal with the flu. The DOH also stated that they have 50 million to 60 million masks in stock and local manufacturers have the capability of producing 200,000 doses of the flu vaccine a month. In an effort to prevent the entry of the swine influenza, the Centers for Disease Control has announced on April 28 that every flight from the Americas, specifically Canada and the United States, that arrives in Taiwan from April 29 and onward will be subject to a strict on-board screening procedure.

Thailand

File:Suvarnabhumi Therml Scan.jpg

Travelers are being scanned at Suvarnabhumi Airport to prevent the spreading of swine flu.

On the April 28, 2009, the Thai Public Health Ministry issued a warning for Thais to avoid visiting the United States and Mexico which have been hit by the swine flu outbreak. The Thai Government has installed thermal scanners in Suvarnabhumi Airport and other key airports. Airport health officials began using thermal screening equipment to monitor passengers.

Thailand raised its swine-flu preventive measures to "maximum", with all visitors entering the country subjected to thermal scanners and even dignitaries not exempt. Deputy Public Health Minister Manit Nopamornbodee said the Public Health Ministry had stepped up surveillance after the first cases of the virus were confirmed in Hong Kong and South Korea. He said the six thermal scanners at Bangkok's Suvarnabhumi Airport would check every passenger coming through the regional travel hub round the clock. Four million masks are ready for public distribution, and all hospitals nationwide are to set up swine-flu screening centres as was done for bird flu, Paijit added. Permanent Secretary for Public Health Prat Boonyawongwirot said all passengers from countries at risk would be asked to fill in a questionnaire. All who pass the scanners will get a "health-awarenss card" to watch for flu-like symptoms throughout their first fortnight in Thailand. The ministry has printed one million cards. Those who pass thermal scanning and physical examination will be followed by a medical team for a week, he said, and those with high body temperature will be put under close surveillance in hospital.

The Thai cabinet has formed a national emergency committee to oversee prevention operations against swine flu, Prime Minister Abhisit Vejjajiva said. An initial test on a 42-year-old woman who had flu-like symptoms after returning from a trip to Mexico and the US between April 3 and 19 proved negative. She was admitted to Chulalongkorn Hospital after having a fever since Thursday when she travelled to Singapore.

Public Health Minister Witthaya Kaewparadai instructed provincial public health offices to stock up influenza drug to cope with possible outbreak of the swine flu. Witthaya said he had instructed chief provincial public health officers nationwide to check stock of Oseltamivir anti-viral drug, used for influenza treatment, in their provinces and make sure the drug is available.
Bangkok governor Sukhumbhand Paribatra will hand out a hundred thousand free face masks to taxi drivers and tourists in Bangkok in an effort to prevent swine flu from spreading to the Thai population, deputy governor Malinee Sukavejworakit said. The gauze masks would be handed out to foreigners staying at guesthouses. The Bangkok Metropolitan Administration (BMA) is also encouraging taxi drivers to wear face masks while driving passengers. General public could go and get free masks at the BMA on Friday.
Thailand will send 5,000 face masks and hand washing gels to Mexico which has been hard hit by Mexico human flu, Foreign Ministry's spokesman Tharit Jarungwat said Thursday. The Thai embassy in Mexico will distributed the masks and the gels to Thais living there, he said.

The Government Pharmaceutical Organisation has produced an extra million antiviral tablets to make sure there are enough supplies if the country is hit by an outbreak of swine flu. The emergency production of anti-flu drugs by the state pharmaceutical company comes as the World Health Organisation raised the level of the influenza pandemic alert from phase 4 to phase 5, under which all countries are required to immediately activate their pandemic preparedness plans.Prime Minister Abhisit Vejjajiva said Bangkok would host a meeting of the Association of Southeast Asian Nations public health ministers next Thursday and Friday (May 7-8) to map out regional cooperation in combating the potential flu pandemic.

The Government Pharmaceutical Organisation (GPO) is stockpiling antiviral medicine, aiming to have 6 million tablets of Oseltamivir available by June, but says the existing supply is enough if H1N1 infections are found in the country. GPO managing director Witit Artavatkun said the government aimed to raise the local supply of the antiviral drugs to 6 million tablets, which would cover 10% of the total population, by stepping up local production at the GPO facility. Currently, 3.2 million tablets of Oseltamivir are stored at the Bureau of Emerging Infectious Diseases with another 1.2 million kept at the GPO. Oseltamivir phosphate is the generic term for Tamiflu. The drug would be prescribed to suspected swine flu cases or to people who developed a fever after visiting countries affected by the H1N1 flu virus outbreak, Dr Witit said.Suspected cases would be given the medication within 48 hours for five days, he said. The Government Pharmaceutical Organisation has been instructed to buy ingredients for oseltamivir to produce two million tablets of the influenza drug. Public Health Minister Witthaya Kaewparadai said Thailand had put in place a national influenza preparedness scheme in response to the pandemic alert level being raised.This included increasing staff at the swine flu "war room" to improve surveillance and response operations, the minister said.
Fourteen Thais, who returned from Mexico, were discharged from the Bamrasnaradura Hospital, Public Health Minister Witthaya Kaewparadai said. They left the hospital at 10 am after they were tested negative to A(H1N1) influenza. Two Thais and a German who were detected with high temperature have been quarantined to check whether they have contacted the A(H1N1) influenza virus. Public Health Minister Witthaya Kaewparadai announced that all 3 'suspected' cases "were found to be 'free' of the virus."

Public Health permanent secretary Prat Boonyawongwiroj confirmed on May 9, 2009 that a suspect case of Influenza A(H1N1) has been detected in Thailand. He said the person is under quarantine and has been healed from the illness. The Public Health Ministry has request a test by the a US lab to confirm the finding, Prat said.

Vietnam

Vietnam's Ministry of Health released an emergency dispatch and urged agencies to take precautionary measures against swine flu. In addition, the Preventive Health and Environment Bureau requested all health facilities to carefully monitor any suspected H1N1 case and Bureau head Nguyen Huy Nga also warned that the pandemic could enter Vietnam through imported swine or border gates. Thermal imaging devices were dispatched to airports and border gates to screen passengers. In response to WHO's warnings, Vietnam on April 30, 2009 raised its swine flu alert level to 4 which indicated a "threat of community level outbreaks" while local authorities have been executing precautionary measures.

On May 1, 2009 an Vietnam's Ministry of Industry and Trade official said that Ministry was considering a ban on pork import "under certain situations" to prevent swine flu from entering Vietnam.

Europe

Outbreak evolution in Europe:

  Deaths

  Confirmed cases

  Suspected cases

  No reported cases

Outbreak evolution in Europe:

  500+ cases

  50+ cases

  5+ cases

  1+ cases

European Union

On April 27, the European Union health commissioner advised Europeans not to travel to the United States or Mexico unless urgent. This followed the discovery of the first confirmed case in Spain.

EU Foreign relations commissioner Benita Ferrero-Waldner said on April 29 the halt of all travel to Mexico and disinfecting all airports due to the global flu outbreak is being considered.

Austria

Outbreak evolution in Austria:

  Confirmed cases

Several possible cases in Austria turned out to be negative, whereas one test, that of a 28-year-old woman from Vienna, had a positive result. Therefore Austria is the 9th country affected by a confirmed case of swine flu. There are still two suspected cases being tested.

Belgium

Six suspected cases of swine flu in Belgium ultimately tested negative.

The Belgian interior ministry announced the first case of A/H1N1 flu in Belgium on 13 May 2009. The infected person is a 28-year old man who lives in Ghent and returned from a holiday in the United States.

Also a second person tested positive for Mexican flu in Belgium on 14 May 2009.

Two new persons tested positive for A/H1N1 flu on 15 May 2009.

A sixth and seventh case of swine flu was discovered on 21 May 2009. An eighth infection was reported on 26 May2009.

Croatia

On April 29 it was announced that a 22-year old traveller from Florida had been held in quarantine in Osijek under suspicion of swine flu. However, later that day director of infectious disease epidemiology agency, Dr. Ira Gjenero Margan, stated results of the testing were negative "with 99% certainty". On April 30, a child was held in quarantine in Zagreb but the results were negative.

Denmark

Authorities confirmed on May 1 that a Danish citizen had tested positive for swine flu, making it the first reported case in Scandinavia.

Finland

The H1N1 strain of influeza has been added to the official list of infectious diseases dangerous to public ("yleisvaarallinen tartuntatauti"), which guarantees free-of-charge treatment to all residents and allows for involuntary quarantine, effective from May 1 2009. Finland's first two H1N1-cases confirmed 12.5.2009 in Helsinki metropolitan area. They were together in Mexico and came to Finland via Amsterdam 6.5.2009

France

Outbreak evolution in France:

  Confirmed cases

As of April 28 there were twenty suspected cases of swine flu being investigated in France. Since April 25, over 100 cases of Influenza-like illness have been reported, of which 30 were identified as possible cases. 10 of those cases have since been excluded. On April 30, the number of suspected cases was revised to 50 (including 4 probable cases).

On May 1, the French Health Minister has confirmed, during the 8 p.m. TF1 news, that 2 cases of A(H1N1) flu have been detected in France.

On May 4, two new cases have been confirmed bringing to 4 the total number of people infected.

May 6, a fifth case is confirmed in Paris region. Two new cases are also confirmed at the end of the afternoon by the INVS (National Institute for Sanitary Watch ), 7 are probable and 32 are suspected ()

On May 7, three new cases were announced by the National Institute for Sanitary Watch. There are now 10 confirmed cases, 5 probable, and 27 are suspected.

Germany

File:H1N1 Germany Map-2009-29-04.svg

Outbreak evolution in Germany:

  Confirmed cases

Main article: 2009 swine flu outbreak in Germany

Two men and a woman from Bielefeld who had been firstly suspected of having the virus tested negative on influenza type A. On April 29, the first case of swine flu in Germany was confirmed by the Robert Koch Institute in the area of Regensburg. A 22-year-old woman from Hamburg is also confirmed to have been infected by swine flu during a trip to Mexico. A 37-year-old woman from Kulmbach is also confirmed to have become infected during a similar trip.

On May 1, Robert Koch Institute confirmed the first case of human-to-human spreading of swine flu in Munich. Infected was the nurse who had contact with one of the infected people. At approx. 10:00 she was claimed to be already healed. At the time of 13:00 one further infection in Bavaria was confirmed, but the patient is also claimed to be healthy again.

On May 2, a new human-to-human infection, in the same hospital in Munich, was confirmed. The new patient, who was in the same room with the original infected German that came from Mexico, is currently being reported to show no signs of the new influenza strain anymore. Two further cases of swine flu in Brandenburg were reported on May 3. Infected are two people from the same flight as patient in Hamburg. On May 5, one new case in Saxony-Anhalt has been confirmed bringing to 9 the total number of people infected. Two days later on May 7, another new case in Saxony-Anhalt is reported. A further new case was confirmed on May 8 with an adult male living in Bavaria who had recently been to USA. On May 11 the case of a 27 years old Bavarian woman, who stayed for some weeks in Mexico and medicated patients in a hospital, is reported. There were two further cases reported on May 15. A female human and her son from Saxony-Anhalt have been infected obviously by her husband / his father, who returned from Mexico.

On May 21 a case was found in a 43 year old woman from Düsseldorf in North Rhine-Westphalia who returned from New York. One day later, Robert Koch Institute confirmed that that her husband has been tested positiv in swine influenza, too. Furthermore their six years old daugther who didn´t stay in New York has been infected by her parents, bringing the total to 17.

Greece

On May 19 the authorities confirmed the first case of the new flu in Greece. The infected person is a 19 year old Greek student who studies in New York and who flew to Greece a few days ago. He is hospitalised at Sismanogleion but is not gravely ill. The authorities have contacted many of the passengers who sat near this patient on the plane and are examining them for suspicious symptoms. At this point in time Greece has enough antivirals to cover 12% of the population (at least 10% is the amount proposed by the EU directives). The 19-year-old is now out of the hospital and none of the passengers in his flight are infected.

Hungary

According to the MTI as of April 29 six suspected cases have been reported in Hungary, none of them confirmed to be the swine flu. Samples of the virus from the US health authorities are due to arrive to Hungary in a few days enabling the start of vaccine production.

Iceland

The first case of A(H1N1) in Iceland was reported on May 23 2009. The infected person came to the country from New York and got sick shortly after he arrived in Iceland. It is suspected that additional four people might be infected. All the cases are within the same family and they are located in the Greater Reykjavík area and Suðurland regions.

Iceland is currently being briefed by the WHO and is cooperating closely with ECDC, CDC and the EU in terms of monitoring and response. Initially the directorate of health warned people traveling to Mexico and the United States (especially California and Texas) to exercise caution and to contact a doctor immediately if they started showing symptoms of swine flu but on April 28 people traveling to Mexico were advised to cancel their trip unless its very urgent.

On April 28, it was announced that passengers arriving in Iceland from the United States or Mexico would be monitored and will undergo medical examination even if the slightest signs of influenza are detected.

Iceland has stocks of Tamiflu and Relenza for one-third of its population.

In a risk assessment made by the Icelandic government in 2008 in case of a influenza pandemic two scenarios are envisioned:

• A worst-case scenario where 50% of the Icelandic population are infected and 3% of the infected population die.
• A milder scenario where precautionary measures prevent infection, 25% of the Icelandic population are infected and 1% die.

Ireland

Ireland has over two million doses of anti-virals and a pandemic plan in place should the outbreak reach the country.

On April 29, notices were put in place at Irish ports and airports offering advice to people returning from countries affected by the Influenza

On April 30, the Department of Health's Chief Medical Officer, Doctor Tom Holohan, announced the first probable confirmed case in Ireland.

The case was an adult male living in Dublin who had recently been to Mexico. He has been on anti-viral treatment as have any people he has come into close contact with as a precaution.The man was confimed to be Ireland's first case of Influenza on May 2.Swine flu confirmed in Ireland'

The Chief Medical Officer of Ireland, Dr. Tony Holohan said the man was recovering well, and that all appropriate clinical and public health actions had been taken. However the Health Service Executive in the country also admitted that there is still a probable chance of further cases being reported in Ireland.

On 6 May, The Heath Service Executive (HSE) confirmed that there were no more confirmed or suspected cases at this time.

On 25 May, the Department of Health's Chief Medical officer, Dr. Tom Holohan, announced a second confirmed swine flu case in Ireland. The case is an adult woman in the east of the country who has recently returned from New York.

On 26 May, Dr. Tom Holohan confirmed a third case of swine flu in Ireland. The case is another woman who has recently returned from New York.

Italy

Italy's agriculture lobby, Coldiretti, warned against panic reaction, noting that farmers lost hundreds of millions of euros due to consumer boycotts during the 2001 mad cow scare and the 2005 bird flu outbreak.

A woman who returned from San Diego was hospitalised in Venice for suspected swine flu.

As of April 30, about 20 suspected cases of swine flu are monitored in Italy.

On May 2, Reuters confirmed that Italy had a case of the swine flu. It was recorded in a 50 year old man in Massa after he returned from Mexico City. However, he had very mild symptoms (i.e aches, coughing, but no fever) and is recovering well.

Lithuania

As of April 29, one possible case (tourist returned from Mexico) in Lithuania is currently under investigation. The institutions already confirmed that it is the A type influenza, but the details as to whether it is H1N1 are still not known. For further investigation sample was sent to the laboratory located in London.

Macedonia

On April 27 2009, the government of the Republic of Macedonia prohibited all exports and imports of live pigs. Even though Macedonia is not affected from the Swine Flu, the government ordered a ten days health monitoring period for everybody that comes from an affected country.

Netherlands

The Netherlands National Institute for Public Health and the Environment advised any traveller who returned from Mexico since April 17 and developed a fever of 38.5 degrees Celsius (101.3 degrees Fahrenheit) within four days of arriving in the Netherlands to stay at home. On April 30, 2009 a three year old child tested positive for the swine flu. The child returned from Mexico to the Netherlands on April 27, 2009. The parents tested negative to the swine flu. The girl was very ill at first according to her parents, but made a full recovery. On 7 May a second case and a day later a third case of swine flu in the Netherlands were announced, concerning a 53 year old woman and a 52 year old man, respectively. Both of them had returned from Mexico recently and are being treated with Tamiflu. The woman made a full recovery, the man is doing well. There are no connections between each of the three cases. People who were seated close to the infected people in the plane were contacted and are being treated with Tamiflu as a precautionary measure.

Norway

Outbreak evolution in Norway:

  Confirmed cases

Norway has a stockpile of 1.4 million doses of Tamiflu, and have ordered 200,000 doses of Relenza. The Norwegian government projects that in the worst case, 1.2 million Norwegians may fall ill and 13,000 may die.

Since the initial outbreak, many other Norwegians have been tested negatively for swine flu. The Norwegian center for disease control FHI updates their homepage with information about the swine flu outbreak in Norway every day at 20:30 GMT+2.

On May 9, two Norwegian students from Oslo and Skien, were confirmed to be infected with swine flu after they came home from studies in Mexico. None of them became seriously ill and they are recovering quickly. A member of one of their families is suspected of being infected as well. One of them (A 20 year-old man from Oslo) completely recovered. Bringing the total to 2.

On May 19, a Norwegian woman was confirmed infected with the swine flu after coming home from USA. This brings the total number of infected in Norway to 3.

On May 20, a Norwegian man from Vest-Agder was confirmed with the swine flu after returning from a trip to USA. The man followed advice from his doctor and has recovered. Bringing the total to 4 cases.

Poland

Outbreak evolution in Poland:

  Confirmed cases

As of May 12, Poland has one confirmed case - a 58 year old woman from Mielec, who came back from the USA. She was already released from the hospital, because all of her symptoms had been successfully cured . As of May 8, eight cases are under investigation, according to the National Institute of Public Health and news channel TVN 24. At least 19 other patients had been previously investigated but tests turned out negative. The Polish Foreign Ministry issued a statement on April 25 or earlier recommending that citizens avoid travel to affected areas until the outbreak is totally contained.

Portugal

Outbreak evolution in Portugal:

  Deaths

  Confirmed cases

  Unconfirmed or suspected cases

As of May 4, there has been one confirmed case in Portugal.

Romania

Outbreak evolution in Romania:

  Confirmed cases

  Suspected cases

In Sâmbăteni, Arad County, a child of a year and six months and his mother who recently returned from a trip to Portugal and Spain were suspected of having contracted influenza A(H1N1). Tests returned negative. On Wednesday, 27 May a woman returning from America was confirmed with swine flu in Bucharest.

Russia

Russia has banned the import of pork meat from Guatemala, Honduras, Dominican Republic, Colombia, Costa Rica, Cuba, Nicaragua, Panama, El Salvador, 9 US States (Alabama, Arizona, Arkansas, Georgia, Kansas, Louisiana, New Mexico, Oklahoma and Florida) and all types of meat and meat products from Mexico and 5 US States (California, Texas, Kansas, New York and Ohio).

The President instructed the regional governors to take urgent steps to prevent swine flu from spreading to Russia. Dmitry Medvedev also instructed the presidential plenipotentiary envoys in the federal districts to personally supervise the preventive measures to ensure the disease did not spread [in Russia] and stipulated monthly reports on the situation.

On May 1 officials confirmed that two women who came from USA trip were suspected to have swine flu. Currently both are in hospital for further treatment. As on May 2, both tourists are reported not to be infected with new strain.

Serbia

According to Deputy Health Minister Svetlana Mijatović, Serbia will adhere to all WHO recommendations for monitoring the swine flu epidemic. "A sanitary inspection, together with Serbian Ministry of Internal Affairs (MUP), is checking travelers, [...] while the media and all the agencies throughout the world, as well as our own, are constantly informing the public that if anyone feels ill, or is coming from a contaminated area, to consult the authorities at any airport in the world [...]," Mijatović said. Serbia's Health Minister stated on May 8, 2009 that there have been no registered cases of swine flu, and that Serbia has stockpiles of anti-viral medicine, although he admitted it would not stop a pandemic of swine flu in that country.

Flights and holidays to Mexico and the U.S. have yet to be canceled, and the advice to citizens traveling to infected countries is to take precautions in terms of immunity and to maintain personal hygiene.

A 71 year old tourist from Texas asked to be tested for swine flu at the Provincial hospital in Novi Sad, on April 30. Results were negative.

Slovenia

Institute of Public Health of the Republic of Slovenia has established a web site with information about H1N1 induced influenza. Status of this webpage is updated once a day. As of May 25, there were 17 people tested, all negative.

Spain

Main article: 2009 swine flu outbreak in Spain

  Confirmed cases

  Unconfirmed or suspected cases

On April 27 the Spanish Ministry of Health and Social Policy announced that a man in Castilla-La Mancha who had recently returned from Mexico had contracted the disease. The man, aged 23, had returned from Mexico on April 22 and had been quarantined on the 25th. This was the first confirmed case in Europe.

The Spanish government is also observing other 35 possible swine flu cases in the Basque Country, Catalonia, the Balearic Islands, Andalusia, Murcia, Madrid and the Valencian Community.

AENA, the Spanish state owned company who manages all Spanish airports and Air Traffic Control established a protocol for the flights coming from and to Spain from the affected areas. Three patients who had just returned from Mexico were under observation in multiple regions of Spain.

Sweden

On April 28, at least eighteen Swedish people were tested for swine flu after returning from trips in Mexico and the USA, but the results were negative. On April 29 two people, recently returned from Mexico with flu like symptoms were tested.

As of May 6, the Swedish Institute for Infectious Disease Control confirms 1 case of influenza A(H1N1). 186 negative test results have been reported. No suspected cases remain to be analysed.

The number of confirmed cases has reached 2 in Sweden, with 435 negative cases reported as of May 15.

A third case was confirmed on Friday 15, and reported on the following Saturday, where the patient, a woman in her sixties, has recovered. In all of the 3 cases the influenza was contracted in the USA.

Switzerland

  Confirmed cases

  Unconfirmed or suspected cases

The first suspicious case was officially confirmed on April 27. A young man returning from holiday in Mexico informed his family doctor about fever and flu-like symptoms. He was immediately put under quarantine in a hospital. 8 more people are under observation. A container of inactive swine flu virus samples packed in dry ice exploded on a Swiss train, injuring one person but posing no other risks to humans.

Switzerland has confirmed its first case of swine flu in a 19-year-old student who returned from Mexico on April 30. The state hospital in Baden said in a statement that the National Influenza Center in Geneva confirmed the disease shortly after the student was mistakenly released from hospital day before.

Switzerland has confirmed its second case of swine flu in a young woman of 24. She was returning from a trip to Mexico and USA. She is now in the Hospital in Bern.

On May 24, a third case of swine flu has been announced in a woman who came back from Washington. She is in Basel at home.

Turkey

The Government of Turkey has taken measures at the international airports, using thermal imaging cameras to check passengers coming from international destinations. . Turkey confirmed its first case of swine flu on May 16 in a US tourist arriving into the country.

Ukraine

Imports of pork and live pigs from all affected countries have been banned. The ban also applies to all shipments after April 21.

United Kingdom

Main article: 2009 swine flu outbreak in the United Kingdom

  Deaths

  Confirmed cases

  Unconfirmed or suspected cases

  No confirmed cases

On April 25, 2009, a member of British Airways cabin crew was taken to Northwick Park Hospital in Harrow and quarantined after falling ill with flu-like symptoms on a flight from Mexico City though he was later found not to have swine flu.

On April 26, two people were admitted to hospital in Scotland suffering from mild flu-like symptoms after returning from Mexico, later confirmed as swine flu. The Scottish Health Minister reported that seven of the 22 people who were in "close contact" with the two confirmed Scottish cases after they returned home were showing flu-like symptoms. Four people were given medication and advised to stay in their home in Stanwick, Northamptonshire, again after returning from Mexico with mild flu-like symptoms. On May 1 a friend of the Falkirk couple was awaiting results of tests which would make him the first British person to have caught the swine flu virus from another person

On April 27 the UK Health Secretary Alan Johnson told the House of Commons that 25 possible cases had been reported. He also stated that protective facemasks were not planned, as despite their use in Mexico, scientific evidence did not suggest that they proved an effective preventative measure. On the same date, passengers were held on planes arriving at Heathrow, from Mexico City, whilst officials carried out health checks.

On April 29 the government officially made public three more confirmed cases in the UK. These were two adults (one in Redditch, and one in London), and a 12-year-old girl in Torbay, Devon. All three new cases had recently arrived back from Mexico.

As of late April 2009 Britain has a stockpile of about 33 million courses of antiviral drugs effective against this strain. There is a pandemic plan covering topics from distributing the drugs and setting up helplines to closing schools and banning public events which was tested in a large exercise in 2007.

On April 30 three new cases of swine flu were diagnosed in the UK, bringing the total number to eight, the Department of Health has confirmed. Two of the cases are in London and one in Newcastle, where two students who shared a house with the patient are now being treated with an antiviral drug. The unidentified person recently returned from a trip to Mexico.

On May 1 the first UK person to person transmission was confirmed. Graeme Pacitti, 24, of Falkirk, picked up the virus after contact with the UK's first cases Iain and Dawn Askham.

A child from Downend, South Gloucestershire is also confirmed to have the disease.

A 42 year old man, also in South Gloucestershire is thought to be the second "onward transmission" case in the United Kingdom, although officials said the two South Gloucestershire cases were not connected.

On May 2 the Department of Health confirmed that an adult in the North West and a child in the South East had contracted the virus. On May 3, Scottish health authorities reported a case in Ayrshire, where a man reportedly caught the virus in the U.S. state of Texas.

On May 4 seven new cases were reported with six in London and one in the West Midlands.

On 6 May a case was found in a man from Berkshire, and a further four cases were reported in the UK with cases in Greater Manchester, Essex, the East Midlands and West Midlands regions of England.

On May 14 three new cases were confirmed in UK bringing total to 71

On May 23 two new cases of swine flu were confirmed in the UK. One in the east of England and one in London, bringing the current total of cases in the UK to 122.

On May 24, 11 new cases were confimed. The new cases were six adults and five children from the East Midlands, London, the South East and the West Midlands.This brings the total to 133

On May 26, 44 new cases were confirmed. The new cases were three adults and forty one children. These cases were from a primary school in Birmingham.

North America

Outbreak evolution in North America:

  Deaths

  Confirmed cases

  Unconfirmed or suspected cases

A semi-logarithmic chart of laboratory-confirmed A(H1N1) influenza cases by date according to WHO reports. Mexico, USA, and Canada are shown as a breakdown of the total.

Canada

Main article: 2009 swine flu outbreak in Canada

Outbreak evolution in Canada:

  Deaths

  Confirmed cases

  Unconfirmed or suspected cases

Outbreak evolution in Canada:

  500+ cases

  50+ cases

  5+ cases

  1+ cases

As of May 26, there has been 2 deaths and a further 921 confirmed cases of swine flu, most of which was contracted in-country, have been confirmed in the country; 68 in Nova Scotia, 114 in British Columbia, 86 in Alberta, 284 in Ontario, 106 in Quebec, 2 in New Brunswick, 6 in Manitoba, 3 in Prince Edward Island, 49 in Saskatchewan, and 1 in Yukon Territory. Nova Scotia's chief medical officer, Dr. Robert Strang, said on April 26 that the National Microbiology Laboratory in Winnipeg confirmed late the previous day, that four young people in the province were recovering from "relatively mild" cases of the disease. The four all attended King's-Edgehill preparatory school in Windsor; and one of the four infected students had been on a recent school trip to the Yucatán Peninsula. There is evidence that the disease is spreading beyond the first 4 Nova Scotia cases, as friends and relatives are starting to show symptoms. Dr. Robert Strang indicated that he expects the disease to spread to the rest of Nova Scotia within a few weeks. On April 30, the first case of swine flu affecting someone who had not travelled to Mexico was confirmed in Nova Scotia.

Dr. Michael Gardam, director of infectious disease prevention and control at Ontario's public health agency, said in an interview with the CBC that an outbreak of swine flu in Ontario, Canada's most populous province, would not be as serious as the 2003 SARS epidemic. In preparing for and dealing with an influenza pandemic, the Public Health Agency of Canada follows the WHO's categories, but has expanded them somewhat. Despite initial reports of two swine influenza cases in a Montreal hospital, an official on the Montreal regional health board confirmed negative results for all quarantined patients at the hospital and that no quarantines were currently in effect at the hospital.

Canada's Chief Public Health Officer, Dr. David Butler-Jones, stated that the six affected Canadians suffered from only mild symptoms and have already started to recover. Butler-Jones warned against complacency though, stating that the fact that only mild cases have been reported so far "doesn’t mean we won’t see either some more severe illness or potentially deaths." In both provinces, the cases either involved people who had recently returned from Mexico or those in close contact with them. On May 4, it was announced that a girl from Alberta was diagnosed with a severe case of the H1N1 virus, the first severe one in Canada. The girl was hospitalized on April 30 and the case is still being researched. On May 8, the first confirmed death from the H1N1 virus was reported in Alberta. On may 25th Ontario Health Minister David Caplan confirmed that a Toronto man in his 40s has died of the H1N1 swine flu virus.

Mexico

Main article: 2009 swine flu outbreak in Mexico

Outbreak evolution in Mexico:

  Deaths

  Confirmed cases

Probable and confirmed Mexican cases by date of illness onset, March 15 – April 26. —CDC

Outbreak evolution in Mexico:

  500+ cases

  50+ cases

  5+ cases

  1+ cases

Mexican soldiers distributing protective masks to citizens

Dr. José Ángel Córdova Villalobos, Mexico's Secretariat of Health, stated that since March 2009, there have been over 1,995 suspected cases and 149 deaths, with 20 confirmed to be linked to a new swine influenza strain of Influenza A virus subtype H1N1. As of April 26 there had been 1,614 cases, with 103 deaths and about 400 patients in hospital; approximately two-thirds of the sick patients had recovered. "'As many as 23,000 Mexicans were likely infected with the swine flu virus,' Neil Ferguson of Imperial College London and colleagues reported in the journal Science."

Soldiers mobilized by the government have handed out six million surgical masks to citizens in and around Mexico City. On April 24, 2009, schools (from pre-school to university level) as well as libraries, museums, concerts and any public gathering place, were shut down by the government in Mexico City and the neighboring State of Mexico to prevent the disease from spreading further; the schools in Mexico City, the State of Mexico, and the state of San Luis Potosí will remain closed until at least May 5. Marcelo Ebrard, Mexico City's mayor, has also asked all night-life operators to shut down their places of business for ten days to prevent further infections. José Ángel Córdova, federal Secretary of Health, said on April 24 that schools will probably be suspended for at least the following week then, and that it will take around ten days to see the evolution of the virus' behavior, and to consider other measures after such. On April 25, President Felipe Calderón declared an emergency which granted him the power to suspend public events and order quarantines. Hours later, Córdova announced that classes in Mexico City would be officially suspended through May 6. On April 26, Natividad González Parás, governor of the northeastern State of Nuevo León, announced that state-wide schools will remain closed until 6 May, and established a quarantine system in airports, central bus stations and the creation of observation points mainly in the southern part of the state at the nearest highways to the borders with other states, in order to realize tests conducted on people arriving from other states. However, as for April 27, there are no confirmed reported cases of infection in this state.

On April 26, the World Bank announced US$ 25 million in immediate aid loans to Mexico, an additional US$ 180 million for long-term assistance to address the outbreak, and advice on how other nations have responded to similar crises.

On April 27, the Secretariat of Public Education announced that all schools in Mexico will remain closed at least until May 6.

On April 28, the Mexico City government closed all restaurants and cinemas. The National History and Anthroplogy Institute also closed all its archaeological sites and museums, including the most famous Mayan and Aztec ruins, until further notice.

United States

Main article: 2009 swine flu outbreak in the United States

Confirmed USA cases with known dates of illness onset (April 27). —CDC

Outbreak evolution in the United States:

  Deaths

  Confirmed cases

  Unconfirmed or suspected cases

Outbreak evolution in the United States:

  500+ cases

  50+ cases

  5+ cases

  1+ cases

Initial reports of atypical flu in two individuals in southern California led to the discovery of the novel swine flu virus by the CDC in mid-April. More than a hundred cases were confirmed in the next two weeks, spread through a dozen states. Outside of California and Texas, initial cases were all tied to recent travel to Mexico or close contact with those who had recently visited Mexico. St. Francis Preparatory School, a private school in New York, was the center of a large cluster of cases after a Spring Break trip by several students, and perforce one of the first U.S. schools to be closed as a public health measure during the early outbreak. Most of the cases in California and Texas are not linked and may reflect localized outbreaks of this virus in those areas. As of April 30, the disease was not as virulent outside of Mexico as within Mexico, for reasons not fully understood.

The United States of America declared a state of Public Health Emergency but this was said to be standard procedure in cases as divergent as the recent inauguration and flooding. According to the New York Times, "the emergency declaration frees resources to be used toward diagnosing or preventing additional cases and releases money for more antiviral drugs," including the transfer of approximately 12 million influenza medications from a federal stockpile to states. The U.S. plans followed a guidebook developed over the past five years to fight a pandemic flu such as H5N1. The situation developed rapidly with the White House initially looking into the matter on April 24 according to press releases, but rapidly adopting a serious stance as the WHO and CDC issued stronger recommendations.

On April 29, the US suffered its first confirmed death of swine flu. On April 28, the Centers for Disease Control and Prevention had officially confirmed through tests that a 23-month old child was infected with the flu. When the sickness continued to worsen the next day, he was transferred to Texas Children's Hospital in Houston, where he died.

On May 5, Judy Trunnell, a woman in her 30's suffering from "chronic underlying health conditions" died of swine flu in Cameron County, near the US-Mexico border. She was the first US citizen to die from the disease. The woman, a special education teacher, had recently given birth to an eight-month-term healthy baby, delivered by caesarian section. She had been in a coma after being admitted to the hospital with breathing problems on April 19. The woman had also suffered from asthma, rheumatoid arthritis and a skin condition.

On May 10, a 30-year-old man with underlying health problems died in Washington from H1N1, the first fatality in that state.

On May 17, 55-year old Mitchell Wiener, an assistant principal at Intermediate School 238 in Hollis, Queens died from H1N1, making it the first H1N1 related fatality in the state of New York. Wiener suffered from many other underlying health problems, weakening his resistance to the disease.

On May 19, 2009, a St. Louis County man became the first death in Missouri due to the Swine Flu.

As of mid-May 2009 many states had abandoned testing for likely influenza cases unless serious illness and/or hospitalization were present. Because reported numbers represent only confirmed cases, they are a "very great understatement" of the total number of cases of infection, according to the CDC.

The real number of swine flu cases in the United States could be “upwards of 100,000,” a top public health official estimated on Friday — far higher than the official count of 7,415 cases confirmed by laboratories.

Central America and Carribean

File:H1N1 America Central Mapa.svg

H1N1 in Central America and Caribbean

Aruba

Trevor van Gellecum, the Director of the Aruban Department of Health, announced that all passengers arriving by airplane or cruise ship will have to fill out a health questionaire beginning on April 27, 2009. Hotels and resorts are required to report to authorities if any tourists are showing flu-like symptoms. The government of Aruba also ordered antiviral medication and other supplies from the Netherlands and the United States. No swine flu cases have been reported.

The Bahamas

Ten students and teachers who arrived from Mexico in the last week of April are in quarantine.

Barbados

The Minister Of Health, Donville Inniss has confirmed that 2 samples have been sent off to the Caribbean Epidemiology Centre (CAREC) in Trinidad and Tobago to be tested for the virus.

Belize

There are two suspected cases of swine flu currently under investigation in Belize. As a result, all major public events have been canceled. This includes the National Agriculture and Trade Show. People are been ask to be very careful and use preventative measures.

Costa Rica

Main article: 2009 swine flu outbreak in Costa Rica

Costa Rica

  Confirmed cases followed by death

  Confirmed cases

  Unconfirmed or suspected cases

A 21 year old woman was confirmed as carrying the swine flu virus on April 28. The woman came back from Mexico by airplane. A second case was confirmed on the same day, a 30-year old man who traveled to Mexico the week before. On May 2 the Costa Rican Ministry of Health confirmed two more cases. Four more cases were confirmed on May 4 by the Costa Rican "Centro Nacional de Referencia en Virología." As of May 4, a total of 424 suspected cases have been reported, but 369 have been already discarded as swine flu. All of these patients have recently traveled to Mexico. Since April 29 the Ministry of Health recommended to avoid travel to Mexico, Canada, and the U.S. as the number of confirmed cases by local authorities reached eight.

A 53 year-old man became the first confirmed death from the disease in the country, as reported by the Minister of Health on May 9. Out of the seven remaining cases confirmed by the US Center for Disease Control, three are children infected by the patient who died, and their condition is not critical. This is the first death outside of a North American country and the fourth country in the world to present a mortal case. The deceased man was suffering other chronic diseases. The Minister of Health informed he had diabetes and also was suffering from chronic obstructive pulmonary disease (COPD). She also informed the man was infected inside Costa Rica because he had not traveled to Mexico.

On May 12 the Minister of Health announced that an alert was received from U.S. authorities informing that three members from a Boston chorus that traveled to several places in Costa Rica in April, showed symptoms of AH1N1 flu after returning to the U.S. On May 13 Costa Rican health authorities announced four new probable cases, three of which had contact with the Boston chorus. An English language newspaper published in Costa Rica is questioning whether the chorus members had infected locals, or rather the Boston youngsters picked up the disease in Costa Rica. As of May 16 two of the probable cases under observation had contact with the Boston chorus.

As of May 25 the Costa Rican Ministry of Health had 33 confirmed cases of influenza A (H1N1), leading to one fatality, two probable cases pending confirmation, 103 suspected cases, and 1,174 already discarded.

Cuba

Cuba's Health Ministry is adopting precautionary measures to prevent the illness from coming into the country. The government has advised citizens to go to seek medical treatment if experiencing flu-like symptoms. Cuba has also banned flights to and from Mexico for 48 hours.

Cuba has reported its first case of Influenza A H1N1 as a Mexican student who travelled to Cuba on April 25 for study

The ministry statement said that in all of Cuba, authorities have tested 84 possible cases in people of eight nationalities for the virus. Only one case was positive - the Mexican student.

Dominican Republic

According to the Dominican Republic Government there are two people confirmed to be infected with the AH1N1 flu. One is a 58 year-old woman from Santiago de los Caballeros and the other one is a 20 year-old woman from Santo Domingo Province. Each of them visited the United States (Orlando and Seattle, respectively) before being diagnosed.

Guatemala

A 29-year-old, who had recently visited Mexico, was being tested for a suspected case of swine flu.

Guatemala is checking all travelers arriving from Mexico for signs of flu and stopping anyone with symptoms of the virus at border crossings.

On May 5, in a meeting with Health Minister and the Vicepresident, it was announced that an 11-year-old girl was infected with the AH1N1 virus. It was told that the family of the girl came from Mexico a few days ago, but no one else in the family it is infected.

On the same press meeting, Rafael Espada said: "We've to prepare ourselves for the worst, and just hope for the best".

The government has stated that they're prepared for a first wave of AH1N1. Nevertheless, other institutions have started to help population by giving them masks and information about the virus. University of San Carlos de Guatemala by the Faculty of Farmacy and Pharmaceutics has started to prevent the virus among the students population, as the Rector Estuardo Gálvez said: "This people are prepared to counteratack the virus inside and outside this campus"

Honduras

Honduras reported its first comfirmed case of swine flu(H1N1) on 22 May, 2009.

Jamaica

There have been no reports of the swine flu in Jamaica. Health Minister Ruddy Spencer told Parliament that the country has been placed on high alert. There has been heightened surveillance at health care facilities and port entry's.

Panama

H1N1 in Panama

As on May 16, 54 confirmed cases had been reported by Panamanian health authorities :

27 male and 27 female
30 cases in kids under 15
24 cases in ages between 15 and 45
53 cases in the Province of Panama, 1 in Coclé.
No deaths reported.
Schools with positive cases are being closed and disinfected.
Thermal cameras had been deployed in Tocument Int´l Airpot to identify sickness in arriving passengers.

As on May 16, Panama occupies -beside Canada- the second place in number of cases on a per country habitant basis; see chart:

Confirmed cases per number of habitants
Country	Population	Confirmed cases (including the deaths)	Percentage
Mexico	111,157,200	4,254	0.00382%
Canada	31,612,897	806	0.00255%
Panama	3,309,679	76	0.00229%
USA	306,433,000	6,562	0.00214%
Spain	46,157,822	126	0.00027%
Japan	127,433,494	342	0.00026%
UK	58,789,194	122	0.00020%

Trinidad and Tobago

The members of the Under 17 Trinidad and Tobago football team have taken Flu tests after returning from a World Cup qualifying football match in Mexico City.

Oceania

Australia

Main article: 2009 swine flu outbreak in Australia

Australia

  20+ Confirmed cases

  5-19 Confirmed cases

  1-4 Confirmed cases

  Suspected cases only

  None

As of May 27 2009, Australia has 67 confirmed cases, at least two of which were contracted in country. The alert level has been lifted from "delay" to "contain", giving authorities in all states the option to close schools if students are at risk.

Australia has a stockpile of 8.7 million doses of Tamiflu and Relenza. Airlines have been required to report passengers from the Americas with influenza symptoms, and nurses have been deployed at international airports.

On May 9, the first confirmed case in Australia was reported.

On May 20, four additional cases were reported, one in New South Wales and three in Victoria.

On May 21, an additional case was reported in Victoria. Victorian health authorities close Clifton Hill Primary School for two days (initially) after three brothers return to the school from a trip to Disneyland and are confirmed to have H1N1

On May 22, cases were reported in South Australian and Victoria, including the first reported cases where the virus was contracted in Australia.

On May 25, the first confirmed case in Western Australia was reported.

On May 26, 3 additional cases were reported in Sydney. The newly confirmed cases involved two children who arrived in Sydney on the cruise ship named Pacific Dawn and another child who had recently returned from a trip to the United States. NSW Health issued a directive to the 2000 passengers who arrived in Sydney on the Pacific Dawn requiring that they stay at home for 7 days.

Fiji

Fiji on Wednesday moved to high alert against the swine flu virus, with the authorities admitting the Pacific island nation was not immune to the rapidly spreading global threat.

On Thursday April 30, 2009, a traveller suspected of being infected by the swine flu virus is under close surveillance at Lautoka Hospital, said the Health Ministry. Hours later, the Health Ministry said there are two suspected cases.

French Polynesia

French Polynesia has reported no cases of swine flu so far. Officials installed a thermal imaging camera on April 27, 2009, at Faa'a International Airport in Tahiti to screen all arriving international passengers. French Polynesia has 48,000 Tamiflu anti-viral treatments available in case of an outbreak, and more can be flown into Tahiti within twenty-four hours.

New Zealand

The impact in New Zealand has been almost negligible with no fatalities reported in this country. There is no evidence of community transmission in New Zealand. All of the cases are people who have recently returned from travelling to affected areas, or are close contacts of known cases.

On Saturday April the 25th 2009 ten students from Rangitoto College, a secondary school in North Shore City, Auckland, exhibited influenza symptoms on returning from a three week language trip to Mexico. All 22 students and three accompanying teachers from the trip and those in close contact with them were placed in voluntary home isolation and treated with oseltamivir. The ten students tested positive for an influenza A virus, with three of them later testing positive for swine flu. The symptoms were reportedly mild and all affected individuals have since recovered.

New Zealand has had a well developed Influenza Pandemic action plan since 2006. Following this plan New Zealand immediately upgraded its influenza pandemic alert status to code yellow. The national stockpile of 1.4 million doses of oseltamivir was released to regional health authorities. The initial response as specified in the Pandemic Action Plan is a policy of border control and cluster control via voluntary quarantine and treatment of contacts with oseltamivir. As of May 24, this policy appears to have been successful in preventing the Mexican Flu from spreading within New Zealand.

As of May 28, New Zealand has had 9 laboratory confirmed cases and 11 probable cases.There are 26 suspected cases currently undergoing testing. Confirmed cases have tested positive for the Mexican swine flu strain of influenza type A. Probable cases have tested positive for influenza type A after possible recent exposure to the Mexican strain. Suspected cases have flu symptoms after possible recent exposure to the Mexican strain.

New Zealand had about 48,000 influenza cases in the 2008 flu season – 42% of which were type A – and approximately 100 deaths a year directly attributed to influenza viruses.

Palau

Palau has issued a health alert for swine flu.

Health Minister Dr. Stevenson Kuartei told reporters that although there is no reported case in Palau, a Task Force has been convened to increase screening of passengers entering the country.

Solomon Islands

A multi-sectoral task force has been activated by the Solomon Islands Ministry of Health to deal with the swine influenza virus.

Permanent Secretary of the Ministry of Health and Medical Service Lester Ross said a task force is managing the Solomon Island Ministry of health's response to recent threat of swine flu epidemic.

Tokelau

Most supplies and food shipments to Tokelau are sent by ferry from the neighboring country of Samoa. The Samoa Health Ministry had cancelled all travel to Tokelau until further notice as a precaution against the introduction of swine flu to the Tokelauan population. The Operations Manager for the Tokelau Office in Apia, Samoa, Makalio Ioane, confirmed that some ferry travel would still be allowed to Tokelau, but the ship's crew would not be allowed to leave the boat or dock in Tokelau. The boat will be off loaded without any physical contact with the Tokelauan population. No cases of swine flu have been reported on either Tokelau or Samoa, so the cessation of travel to Tokelau is considered a precaution.

Tonga

Tonga has set up an Emergency Taskforce and is performing screen checks at its International Airport for passengers experiencing influenza symptoms, most importantly from flights originating from Los Angeles.

Nauru

One suspected case of swine flu has been identified in Nauru. Travelers entering Nauru are now screened for influenza symptoms, most importantly from flights originating from North America.

South America

Outbreak evolution in South America:

  Confirmed cases

  Unconfirmed or suspected cases

Argentina

Outbreak evolution in Argentina

According to an Epidemic Alert order issued by the Ministry of Health, Airlines have been required to report passengers with influenza symptoms arriving from Mexico and United States. Passengers from these countries must fill out a form to be located should they experience any symptoms. In addition, the government has also stepped up safety checks, and thermal scanners are being used on airports to detect passengers with fever and other influenza symptoms. As of April 28, the Government has suspended all flights originated from Mexico until May 15 as a precautionary measure.

On May 7, Health Authorities confirmed the first case, a tourist that had recently returned from Mexico. 55 other suspected cases continue to be studied under isolation.

On May 22, Health Authorities confirmed the second case, a woman who had arrived from the United States about 20 days ago.

At May 23, there were 221 possible cases, two have been confirmed, 173 were negative for influenza A (H1N1) and 46 cases are under study.

On May 24, three more cases were confirmed.

On May 25, 14 more cases were confirmed. Rising the cases to 19.

On May 27, 18 more cases were confirmed. Rising total cases to 37.

The World Health Organization does not exclude new infections in Argentina, and warned about the arrival of the southern winter, where there are seasonal peaks of flu.

Brazil

Outbreak evolution in Brazil:

  Confirmed cases

  Unconfirmed or suspected cases

Main article: 2009 swine flu outbreak in Brazil

Two people who had arrived in Brazil from Mexico with symptoms of an undefined illness were hospitalized in São Paulo on April 25. It was initially suspected that they were suffering from the swine flu virus. The Brazilian Ministry of Health later issued a press release stating that while the exact cause of the two patients illnesses remained unknown, they "did not meet the definition of suspected cases of swine influenza because they did not have signs and symptoms consistent with the disease: fever over 39 °C, accompanied by coughing and/or a headache, muscle and joint pain."

The press release also stated that airports would monitor travelers arriving from affected areas, under the direction of the National Sanitary Surveillance Agency (ANVISA). Air crews were trained on signs and symptoms of swine influenza so that passengers displaying symptoms would receive guidance from ANVISA upon arrival.

By May 11, the Minister of Health had confirmed the existence of 34 suspected cases in Brasil.

Chile

Outbreak evolution in Chile:

  Confirmed cases

  Unconfirmed or suspected cases

On April 27, the Assistant Secretary of Health Jeanette Vega, confirmed that there are eight suspected cases of swine influenza in the country, which are being examined at the Hospital del Tórax in Santiago. Five other cases have been dismissed by the authorities.

On April 28 the Health Ministry announced 26 cases under investigation: 16 in Santiago; 2 in Atacama; 2 in Valparaíso; 4 in O´Higgins Region; 1 in Biobío and 1 in Araucanía. 16 other cases have been dismissed.

On May 1, the Health Ministry announced that it continued to investigate 4 suspected cases: 2 in Santiago, 1 in Valparaíso and 1 in Araucanía. To date, 80 suspected cases have been examined by the Health Ministry; 76 of those have been dismissed. Another suspected case was identified on May 2, bringing the number of cases under investigation to 5.

On May 10, the Health Ministry announced that 116 cases have been dismissed, and there are no cases pending test results.

On May 17, the Chilean Health Minister confirmed, the first case of A(H1N1) flu in Chile , the same day two more cases were confirmed

Colombia

File:AH1N1 Colombia Map.svg

Outbreak evolution in Colombia:

  Confirmed cases

  Unconfirmed or suspected cases

The Minister of Social Protection, Diego Palacio Betancourt, announced on April 26, 2009, that 12 suspect cases had been detected, 9 in Bogotá and 3 on the Caribbean coast. Samples of the virus have been sent to the USA for comparisons and analysis. Results of the testing were expected within few days. On April 27, the Government declared a "national disaster" state in order to face the emergency, which allowed health authorities to have a special budget to do so. As of April 28, most of the suspect cases were excluded, with only four remaining: three Mexican teachers in Bogotá, and one person in Cartagena. Another 38 suspect cases were under observation. On April 29, the suspect cases raised to 49, with 10 of them "highly" suspect. The government purchased 400,000 oseltamivir(Tamiflu) doses, which will be distributed through the Social Protection ministry to the affected if there are confirmed cases.

On May 3, 2009, Minister Palacio confirmed the first case of A(H1N1) in Colombia, in a 42-year-old person from Zipaquirá, who recently travelled to Mexico. According to Palacio, only one out of 18 tests sent to Atlanta was positive. The patient was isolated and put under medical treatment. On the same day, Palacio stated there were 108 suspect cases in the country.

Ecuador

File:H1N1 Ecuador Map.svg

Outbreak evolution in Ecuador:

  Confirmed cases

  Unconfirmed or suspected cases

Health officials are carrying out checks on people with flu symptoms entering the country from sea or air. On April 29, Ecuador closed its borders to Mexican citizens and foreigners of other nationalities arriving from Mexico for a period of 30 days. On May 15, Health officials confirmed the first case of AH1N1 flu in Ecuador . On May 20, the Health Department confirmed 7 more new cases of AH1N1, raising the total number of infected people to 8, the number has now risen to 28.

Peru

Outbreak evolution in Peru

The Governor of Callao, Alex Kouri, ordered that all passengers from any infected country, mainly Mexico, Canada and USA, must be checked before their arrival on Peruvian territory. Also, the Peruvian government must be warned of any case or symptom of fever. This step is in order to prevent any infections, since the main port and airport of Peru are located in Callao. Also, the government has prepared a special area at the Hospital "Daniel Alcides Carrión" to treat cases of this disease.

The first suspicious case has been detected in the morning of April 27, 2009. It was a Peruvian woman who returned from Mexico.

In Peru 5 people were considered suspects with the virus, but as of April 28 have been confirmed to be healthy and not carrying the H1N1 virus. The government has stated that the country is clean, but efforts are being made to examine slaughterhouses and they are screening incoming passengers from problem areas.

On April 29, Peru's Health Minister Oscar Ugarte confirmed one case of swine flu. On April 30, he said the case is not entirely confirmed. Having recently visited Mexico, the patient was flying in a Copa Airlines airplane from Panama to Buenos Aires on April 28, but the flight was diverted to Lima due to her illness. The crew only notified of the suspicion of swine flu only after the passenger had checked in the airport. Three more suspected cases were being investigated. Ugarte also announced the suspension of all commercial flights from Mexico to Peru. On May 14, Ugarte totally confirmed a case of swine flu from a peruvian woman who returned from New York, plus another suspected case in Trujillo from another woman in the same flight. On May 17, the second case was confirmed, an American born man residing in Arequipa. He had returned from the US on May 12, not showing any symptoms until two days later.

On May 18 a new case was confirmed, a scholar returning from a trip to Dominican Republic, that studied in the Altair school. Classes for her class in that school had being suspended until May 25. 19 May, another case of a scholar from the same trip to Dominican Republic. Student had contact with 3rd victim and both studied in the same school.

Venezuela

Controls have been raised at airports to prevent contagion from spreading. Travellers from the United States and Mexico with flu symptoms are being isolated until they are given the all clear. Pig farms in the country are being "closely inspected" and stockpiles of medicines built up.

Reporting bias

In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention.
See also: See this video with subtitles in YouTube

Epidemiologists caution that the number of cases reported in the early days of an outbreak can be very inaccurate and deceptive. This can be due to several causes, including selection bias, media bias, and incorrect reporting by governments.

One selection bias in epidemiology pertains to authorities in different jurisdictions looking at different sets of patient populations. For example, doctors in Mexico may be concentrating on patients in hospitals, rather than the larger vulnerable population, which may in part explain the higher mortality recorded in the country. Media bias in reporting swine flu cases and deaths may skew incidence maps based on these media reports. Countries with poor health care systems and poor laboratory facilities may take longer to identify suspected cases, analyse those cases, and report them. Passive data collection methodologies (waiting for the patient to arrive at a health care facility) are considered inferior to active data collection techniques (performing random stratified sampling) due to various forms of selection bias. and because laboratory facilities to perform swift genetic tests on patient samples are not widely available. As of April 2009 there are no properly controlled epidemiological studies for the 2009 swine flu outbreak.

External links

• Template:Dmoz
• Swine influenza, at the World Health Organization
• WHO's current Pandemic Influenza Phase

• Centres for Disease Control and Prevention (CDC): Swine Influenza (Flu)
• Medical Encyclopedia Medline Plus: Swine Flu
• Medical Encyclopedia WebMD: Swine Flu Centre
• H1N1 Statistics and Confirmed Worldwide Cases