PSI Health Blog

Staff cuts and flu pandemic prompt global nurse protests

Protests in California, Australia and Ireland

(Reprinted from Nursing Times*)

18 August 2009 | By Steve Ford

Staff cuts and swine flu have been the focus for organised protests by nurses around the world this month.

More than 100 nurses attended a rally in San Francisco protesting at the lack of safety preparation for the flu pandemic in California’s hospitals.

The event, organised by the California Nurses Association/National Nurses Organizing Committee, followed the death from swine flu of a 51-year-old nurse who worked at a Sacramento hospital.

The two organisations claim hospitals in California are not adequately prepared to protect their nurses from infection. A survey of their members has uncovered ‘systemic problems with safety gear for nurses and infection control procedures for patients’, they said.

Nurses in the north coast area of the state of New South Wales in Australia also held a series of rallies in protest against a decision to amalgamate senior nurse management positions. Under management proposals 15 hospitals could lose their directors of nursing.

Closer to home, health service bosses in Ireland agreed to postpone planned nurse job cuts until a patient risk assessment has been carried out. Ireland’s Health Service Executive agreed to defer the termination of 21 fixed-term and temporary nursing contracts in three hospitals following talks with unions.

The deferral has been made to allow time for detailed assessments of the potential clinical risks that may result from the cuts.

Lorraine Monaghan, industrial relations officer at the Irish Nurses Organisation, said: ‘We have no doubt, that such risk assessments, when carried out in an open and transparent manner, will uncover dangerously low staffing levels in all three hospitals’.

* NOTE: Nursing Times is the leading weekly magazine for nurses in the United Kingdom. In April 2009, Nursing Times and PSI affiliate UNISON established a working agreement

Influenza A (H1N1) reaches all corners of the world

Many countries still display a lack of preparedness. While H1N1 2009 displays moderate severity, it still poses a serious threat.

Influenza A (H1N1) is now truly a global pandemia. Cases have now been confirmed in most countries and territories around the world. As of July 30, the number of countries reached 168 according to the WHO and 210 according to the BBC .

While most cases are now escaping detection, the number of confirmed cases is reported at 162,380 with 1,154 deaths directly attributable to Influenza A (H1N1) infection.

The following are four areas that should raise concern:

1. Current estimated fatality rate

Using the latest figures available from WHO and other sources, the rate would seem to have risen from 0.45% or 4 to 5 per each thousand, to 0.71 % or 7 per one thousand.

Swine flu will be biggest pandemic ever, warns world health chief

Extracts from an interview by Aida Edemariam published in The Guardian on Thursday 16 July, 2009

As swine flu sweeps the planet, Margaret Chan, head of the World Health Organisation, tells how she is leading the battle against it – and the personal price she is paying

....On 11 June 2009, [ Margaret Chan, director-general of the World Health Organisation,] found herself the first WHO chief in 41 years to stand before the world and announce that a new virus had reached pandemic proportions. Right up until the last minute, scientists were calling her up and warning her to be careful about raising the threat alert so high — but the strict definition of "pandemic" is a new disease spreading uncontrollably through numerous countries, and on that count her decision has been completely borne out. On 11 June, swine flu had been registered in 74 countries; when we meet in Geneva four weeks later, it has just been confirmed in 140 countries.....

......A 2007 WHO report, A Safer Future, estimated that a flu pandemic could affect more than 1.5 bn people, or 25% of the world's population. Could swine flu be that big? "Quite likely. Quite likely. But it probably won't happen in one run. It will probably come back [in two or three waves]."

How does she expect it to compare to other pandemics? "In terms of the number of countries affected and the number of people infected, this has got to be the biggest."

Influenza A (H1N1): health workers must be protected

"All countries should immunize their health-care workers as a first priority to protect the essential health infrastructure." Dr. Margaret Chan, WHO

 

First health worker casualty: Dr. Michael Day, an NHS doctor, died after becoming infected with Influenza A while caring for patients in the UK

The spread of the Influenza A (H1N1) virus is now considered unstoppable. Therefore, the key element to contain and mitigate the effects of the pandemic is to strengthen health systems, improve preparedness, stock up with medications and, most of all, to develop and distribute a vaccine.

That is the background to the decision by the WHO to convoke a meeting of the Strategic Advisory group of Experts on Immunization. The objective of the meeting was to develop recommendations for WHO member countries.

At the top of their list, was the need to protect health workers, the essential resource to deal with this health emergency.

Influenza A (H1N1): The pandemic puts health systems to the test

As the pandemic spreads to over 122 countries and 13 territories, some governments begin to grasp the magnitude of the problem. Others continue to fail to adopt adequate measures. The mortality rate reflects the strength of national health systems.

The WHO map plotting the advance of the pandemic illustrates the undeniable reality: its spread can no longer be contained and it reaches all regions of the world. The number of laboratory confirmed cases reported to the WHO has risen to 94,512 and the fatalities to 429. The global fatality rate is 0.45. It is clear, however, that the reality has exceeded the monitoring capacity of global and national institutions and that the real figures are likely to be higher. The WHO has recommended that countries cease to try to obtain laboratory confirmation of each case, as it is becoming an unsustainable burden.

There are three facts which should not be missed:

First, in the northern hemisphere, Influenza A continues to spread in spite of the highly unusual fact that it is summer. It is highly unusual to have high rates of infection with summer temperatures and lower indoor concentrations of people than in winter.

Second, in the southern hemisphere, where it is winter, the flu is spreading at a faster rate than it did in the northern hemisphere, as it would be expected.

Third, in both hemispheres, though more clearly in the south, it is clear that negative trends reflect both the degree of preparation by government institutions and the strength of their health systems. The private health sector, on the other hand, is showing itself to be irrelevant.

In those countries which took preventive measures, the virus took longer to appear and for community transmission to be established. Similarly, the spread within those countries has been slower.

INFLUENZA A (H1N1): the pandemia takes root and grows

Less than two months after the WHO first raised the alert, the seriousness of the threat becomes clear. The influenza A pandemic has taken root, cases have been detected in 109 countries, and even with the "moderate" strain of the virus, it has the potential of causing millions of deaths.

The Influenza A (H1N1) virus has now infected more than 55,867 persons in 109 countries and  territories and caused 238 deaths since it was first detected in April. These are the latest figures reported to the WHO by States parties to the International Health Regulations. It is evident that many cases and deaths are escaping detection and reporting mechanisms.

The pandemia has now spread to all continents and in at least 11 countries, it is clear that there is community human to human transmission. That is, the virus has taken root and is spreading, slowly at the moment, but inexorably, amongst the population. 

In the next few weeks, we will witness its expansion to the rest of the world and an exponential increase in the number of cases of infection.

What are the possible consequences?

The mortality rate has stayed constant between 0.45 and 0.5. This means that, as the virus spreads and the number of infected persons increases, the number of deaths will increase. With nothing to stop it, the virus will infect at least 10 percent of the world's population. With that mortality rate, the number of deaths would increase to between 2.7 and 3 million people.

The virus is very infectious. The observed attack rate is over 20%, meaning that 1 in 5 persons exposed ends up infected. With multiple exposures becoming inevitable, the proportion of the world population that will become infected can rise to 30 percent, which would result in millions more deaths.

With millions of infected people, an each patient turned into an incubator of a population of a virus with a high mutation rate, it will only be a matter of time before a more virulent strain emerges, and the mortality rates increases to 2 percent, as was the case in previous Influenza pandemics. In the worst case scenario, a minimum of 12 million people would lose their lives, especially if health systems are overwhelmed by a massive influx of patients.

At this point, the pandemia has exceeded the possibility of geographical containment. There is no immunity against it amongst the human population and existing medications have limited effectiveness. The first vaccine will not be available until September, at the earliest.

The only option is to gain time until a vaccine is developed and health systems improve their readiness. What is required is a vast improvement in measures to detect and slow down the spread of the virus.  Education of the public about precise, well-reasoned, effective measures is essential. It is essential to intensify public education measures, especially in workplaces.

Workplaces can be one of the main foci of infection or --if unions promote the appropriate measures-- effective places to promote education and prevention measures.

Health workers unions and professional organizations have the responsibility to lead the way in the promotion of effective public health policies to deal with the threat we face.  We also have the responsibility of insisting on the protection of health workers, not only as their right, but as a way to preserve the integrity of the most essential resource our societies will have to protect the public and provide treatment to patients.

We must also educate the public on the deadly consequences of the health policies promoted over the last few years. The pandemic will tragically expose the consequences of insufficient funding of health systems, of not addressing the critical shortages of health workers, and of allowing the privatization and commercialization of health services.

The flaws of promoting the proliferation of private health care providers --creating a fragmented landscape, all competing against one another, and motivated by profit, as well as the faith in the "invisible hand of the market"--, are being exposed by this emergency. The organization of health services under that model, in substitution for strong, integrated public health systems,  makes it impossible to organize effective responses to public health challenges. The current emergency will only illustrate dramatically what is always true but less evident.

Tools for Unionists:

    * Go to PSI's nfluenza A information site for current information on the outbreak

    * Go to PSI's influenza resources site for tools for unionists

ILO Task Force on Influenza and Pandemic Preparedness

The ILO established an internal task force addressing the critical issues raised by the recent influenza outbreak in relation to the world of work. The task force has been active since the begining of the outbreak and has posted useful tools on its website.

• www.ilo.org/influenza
  

1) For an updated, interactive map of the spread of the virus, click here.

2) For a graphic display of the global advance of the outbreak, use this link to a BBC map that displays the daily advance by moving a  the cursor at the bottom of the map.

INFLUENZA A (H1N1): update on the pandemic

As WHO declares pandemic, 76 countries have officially reported 35,928 cases (see map) of influenza A(H1N1) infection, including 163 deaths.

The pandemic has clearly entered a  new phase. Several countries are now facing community transmission. Deaths are now reported in Chile, Colombia, Guatemala, Dominican Republic and the United Kingdom. We are still at a very early stage, however, and the worst, unfortunately, is yet to come.

Incomprehensibly, many still talk about this strain of Influenza A (H1N1) as a mild one. But a simple examination of the ratio of deaths to the number of cases of infection as the virus has spread, yields a fatality rate of around 0.5. This translates to only 163 deaths simply because the number of cases of infection is low. But the strain is contagious, displaying an attack rate of at least 20% (meaning 1 in 5 of those exposed becomes infected).

With community transmission now in several countries in all continents except Africa, it is hard to see how further spread can be contained. By the time 1 percent of the world's population becomes infected, and there is no reason to expect it will not, the current "low" 0.5 fatality rate will yield 300,000 deaths. When the virus has infected 10 percent of the population--a low number compared to the annual rates of infection with seasonal influenza--, the fatalities will climb to 3 million.

How likely is this scenario? First, there is no human immunity to this strain. Second, the virus may carry a mutation in its neuraminidase protein that renders antivirals like Tamiflu less effective. Third,  the earliest a vaccine is expected to be ready is in September, and there are questions about its distribution in those countries which are most vulnerable.

Thus, there is every reason to expect an exponential increase in the number of cases of infection and, therefore, fatalities. Unless, that is, strong preventive measures are set in place now. But this requires a recognition, which is still lacking in many quarters, of the seriousness of the threat.

All that, of course, if we are lucky and a mutation does not emerge which renders the virus more lethal. As the number of infected humans grows, and with them, the population of the virus, the chances will increase for the emergence of a more virulent subtype. An increase in the fatality rate to 2 percent, as was the case during the 1918 pandemic, would result in a much higher number of deaths.

The often repeated statement that "the vast majority of people who contract the virus will not experience serious symtpoms and will recover in a few days" misses the point. During the 1918 pandemic, 98 percent of those infected recovered in a few days. But with influenza being a highly contagious disease which spreads easily, a fatality rate of 2 percent was enough to cause millions of deaths.

During the recent World Health Assembly, it was clear that many of the skeptics were concerned about the economic impact of preventive measures. This is a legitimate concern, and all measures should be thoughtful and targeted. But failure to contain the spread of the pandemic, at least to gain time for the development of a vaccine and to allow adequate preparations by health systems, can result in much more costly losses, not only in human lives, but health care costs, lost productivity and reduced trade and travel.

It is time to take this emergency as seriously as it deserves.

For the latest WHO interactive map showing the countries reporting  cases click here

WHO raises pandemic alert to phase 6

The following was the announcement by Dr. Margaret Chan

Espanol: ISP Salud (http://blogsalud.world-psi.org)

World now at the start of 2009 influenza pandemic
Dr Margaret Chan
Director-General of the World Health Organization

Ladies and gentlemen,

In late April, WHO announced the emergence of a novel influenza A virus.

This particular H1N1 strain has not circulated previously in humans. The virus is entirely new.
The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.

This is only part of the picture. With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place.

Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable.

I have conferred with leading influenza experts, virologists, and public health officials. In line with procedures set out in the International Health Regulations, I have sought guidance and advice from an Emergency Committee established for this purpose.

On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met.

I have therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6.
The world is now at the start of the 2009 influenza pandemic.

We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch.

No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.

We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.
Thanks to close monitoring, thorough investigations, and frank reporting from countries, we have some early snapshots depicting spread of the virus and the range of illness it can cause.

We know, too, that this early, patchy picture can change very quickly. The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time.

Globally, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity. As we know from experience, severity can vary, depending on many factors, from one country to another.

On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.

Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.

We know that the novel H1N1 virus preferentially infects younger people. In nearly all areas with large and sustained outbreaks, the majority of cases have occurred in people under the age of 25 years.

In some of these countries, around 2% of cases have developed severe illness, often with very rapid progression to life-threatening pneumonia.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

This pattern is significantly different from that seen during epidemics of seasonal influenza, when most deaths occur in frail elderly people.

Many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

Without question, pregnant women are at increased risk of complications. This heightened risk takes on added importance for a virus, like this one, that preferentially infects younger age groups.

Finally, and perhaps of greatest concern, we do not know how this virus will behave under conditions typically found in the developing world. To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.

Let me underscore two of many reasons for this concern. First, more than 99% of maternal deaths, which are a marker of poor quality care during pregnancy and childbirth, occurs in the developing world.

Second, around 85% of the burden of chronic diseases is concentrated in low- and middle-income countries.

Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems.

Ladies and gentlemen,

A characteristic feature of pandemics is their rapid spread to all parts of the world. In the previous century, this spread has typically taken around 6 to 9 months, even during times when most international travel was by ship or rail.

Countries should prepare to see cases, or the further spread of cases, in the near future.

Countries where outbreaks appear to have peaked should prepare for a second wave of infection.

Guidance on specific protective and precautionary measures has been sent to ministries of health in all countries. Countries with no or only a few cases should remain vigilant.

Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities.

WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Pending the availability of vaccines, several non-pharmaceutical interventions can confer some protection.

WHO continues to recommend no restrictions on travel and no border closures.

Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection.

We are all in this together, and we will all get through this, together.

Thank you.

Influenza A (H1N1): Is it a pandemic?

Para Espanol vaya a  ISP Salud (http://blogsalud.world-psi.org/)

Almost 40 percent of the world’s nations, including the most populous ones, are now affected. A total of 74 countries report 27,737 confirmed cases and 141 deaths.

Assessment: For several days now, it has been clear that we are facing a new situation. The number of countries reporting confirmed cases continues to increase unabated: 74 countries have officially reported 27,737 cases of influenza A(H1N1) infection, including 141 deaths. Once cases are detected and confirmed, most of those countries continue to report new cases. Most worrisome, however, is the fact that the virus seems to now be seeded outside North America.

While the WHO and government agencies are taking a cautious approach, it is hard to avoid the conclusion that in several countries outside North America, some reported cases are likely to be the result of human to human community transmission. That is, it is likely that reported cases are no longer just travellers returning from North America. What is of greatest concern is that the countries involved are geographically spread. They include the United Kingdom, Spain, Argentina, Chile, Australia and Japan.

The WHO is facing a difficult situation. By reasonable standards, it should have raised the alert level and declared a pandemic. But, as it was evident during the recent World Health Assembly, there were considerable pressures on the WHO not to move “too hastily” in that direction. This was based mostly on considerations of the economic impact. The main basis for the resistance is the low fatality rate. Why, some argue, if seasonal influenza causes between 250,000 and 500,000 deaths annually, and the reported casualty figures from Influenza A is only 139, less than those who died in the recent AF447 flight crash over the Atlantic, should we raise the alert , mobilize resources, and face possible negative economic consequences?

The answer is very simple: if we do not take adequate preventive measures the consequences can be extremely serious.

The one factor working in our favour is the mild negative consequences of infection with the current strain(s). But Influenza A viruses are notorious for undergoing both antigenic drift, which causes gradual evolution of the virus, and antigenic shift, which leads to sudden emergence of new subtypes of the virus. Antigenic shift involves abrupt changes in the hemagglutinin and/or the neuraminidase proteins, which the virus uses to enter human cells and overtake their genetic apparatus, and to exit those cells once it has made multiple copies of itself.

The more people become infected, the more copies of the virus will be produced, and hence the greater the chances that a mutation will emerge that will yield a more lethal strain.

Since we are facing a new strain, there is no immunity against it amongst humans. A vaccine will take about 5 more months to produce and current medications like Tamiflu seem to have limited effectiveness against the virus. This is also a strain with a higher rate of infection and some unusual characteristics.

In a few words, if we face a more dangerous subtype, we would be defenceless. The cost in lives and human suffering would be devastating. The economic impact in terms of health care costs, lost productivity and slowed down economic activities would make the costs of prevention pale in comparison.

What is necessary to understand is that the threat of a lethal subtype is not dependent on a wild chance event, but a matter of statistical probabilities. If the virus continues to spread, and to make copies of itself, it is only a matter of time for a lethal strain to emerge.  Given that it has proven impossible to completely contain its spread, we are engaged in a race against time. If the spread of the virus is slowed down and we are able to develop and distribute a vaccine, and if national health systems have enough time to prepare for a quick response to a sudden increase in the number and seriousness of cases, the current outbreak of Influenza A (H1N1) can take place without serious consequences.

Influenza A (H1N1) latest update

Para Espanol vaya a  ISP Salud (http://blogsalud.world-psi.org/)

The virus has spread to 69 countries. Number of cases grows in the southern hemisphere.

Human infection with the Influenza A (H1N1) virus has now been detected in 66 countries, who collectively report 21,940 confirmed cases and 125 deaths.

Assessment: The preventive measures implemented since the end of April have contained the advance of the outbreak, kept human to human community transmission restricted to North America and the total number of cases relatively low. Thus, in spite of the high mutation rate of the influenza virus, limiting the virus population has resulted in the current strains of the virus continuing to display a low fatality rate. This will allow the WHO and national public health authorities to gain time to develop a vaccine and other tools to better prepare for the threat of a more serious public health emergency.

New tools: The largest number of cases reported are from America and Europe. Thus, the WHO Panamerican and European regional offices have generated interactive maps which show a more detailed geographical distribution of cases in these two areas. The maps can be found at:

America
http://ais.paho.org/flu/sm/en/atlas.html

Europe

For a graphic display of the global advance of the outbreak, use this link to a BBC map that displays the daily advance by moving a  the cursor at the bottom of the map.

For the location and number of confirmed cases in the 69 countries reporting confirmed cases see the:

    * Latest map of the spread of influenza A (H1N1) from the WHO (last update: 5 June)

  
 Daily update (5 June, 2009)

    * Number of countries:     69
    * Confirmed cases:        21,940

Deaths:     Mexico       103 deaths and 5,563 cases
                The US       17 deaths and 11054 cases
                Costa Rica  1 death and 68 cases
                Canada       3 deaths and 1,795 cases           

Tools:

    * Go to PSI's Influenza A information site for current information on the outbreak
    * Go to PSI's influenza resources site for tools for unionists

Summary: The spread continues to be travel-related, but there are increasing concerns that the virus may have seeded itself outside North America. While the lethality rate continues to be low, the continued spread requires caution. As the virus spreads and mutates, without a vaccine available to contain it, there is the danger of Influenza A turning more lethal and the outbreak turning into a pandemic.

The expected delay for the development of a vaccine is 5 or 6 months. In the interim, it is crucial that the spread is contained through contagion prevention measures.

Alertness and surveillance should be maintained, especially in southern hemisphere countries entering the winter months.

Influenza A (H1N1) latest update

Para Espanol vaya al blog ISP Salud

The virus continues to spread: it has now been detected in 48 countries, and there are 13,398 confirmed cases. Japan now reports 360 confirmed cases. In the UK, there are now 137 confirmed cases and in Spain 138. The number of cases in North America continues to grow, as has the number of deaths in the US and Mexico. So far, however, the lethality of the virus is still low.

To see graphically the advance of the outbreak, use this link to a map that displays the daily advance by moving a  the cursor at the bottom of the map.

 
 Daily update (27 may, 2009)

    * Number of countries:     48
    * Confirmed cases:        13,398

For the location and number of confirmed cases in those 48 countries see:

    * Latest map of the spread of influenza A (H1N1) from the WHO

Deaths:     Mexico       83 deaths and 4,541 cases
                The US       10 deaths and 6,764 cases
                Costa Rica  one death and 33 confirmed cases
                Canada       one death and 921 cases           

Tools:

    * Go to PSI's Influenza A information site for current information on the outbreak
    * Go to PSI's influenza resources site for tools for unionists

Summary: The spread continues to be travel-related and the virus appears not to have seeded itself outside North America. While the lethality rate continues to be low, the continued spread requires caution. As the virus spreads and mutates, without a vaccine available to contain it, there is the danger of Influenza A turning more lethal and the outbreak turning into a pandemic.

The expected delay for the development of a vaccine is 5 or 6 months. In the interim, it is crucial that the spread is contained through contagion prevention measures.

Alertness and surveillance should be maintained, especially in southern hemisphere countries entering the winter months.

INFLUENZA A (H1N1): ultimas noticias

Para mantenerse informado, recurra al Blog ISP Salud, completamente en espanol.

La epidemia sigue avanzando. El virus ha sido detectado en 43 paises, 12,022 han sido casos confirmados. El numero de casos en Norteamerica sigue creciendo y aumenta el numero de muertes en Mexico y Estados Unidos. Hasta ahora, sin embargo, el virus sigue teniendo una tasa de mortalidad baja.

Para ver graficamente la rapidez del avance, vea el mapa en este enlace y mueva la flecha inferior para visualizar el avance dia a dia.

Boletin actualizado (24 de Mayo, 2009)

    * Numero de paises:     43
    * Numero de casos:     12,022

La ubicacion y numero exacto de casos confirmados en esos paises esta disponible en:

    *  Mapa actualizado del avance de la influenza A (H1N1) compilado por la OMS

Muertes:     Mexico 75 decesos y 3,892 casos.
                  Estados Unidos 9 muertes y 6,552 casos.
                  Canada un deceso y 719 casos.
                  Costa Rica un fallecimiento y 20 casos.

Herramientas:

    * Ver el Portal de informacion de la ISP sobre Influenza A para obtener informacion actualizada

    * Ver el  Portal de recursos de la ISP for para descargar herramientas para sindicalistas

Resumen: El avance del virus sigue estando ligado a los viajeros y el virus no se ha establecido fuera de Norte America. Aunque el indice de mortalidad sigue siendo bajo, el avance en la extension geografica de la infeccion requiere mantener la alerta. Mientras el virus se expanda y sufra mutaciones, sin que exista una vacuna para contenerle, existe el peligro de que la Influenza A se transforme en mas mortifera y de que estalle una pandemia.

Se espera que tomen 5 a 6 meses generar una vacuna.

Se debe mantener la alerta y vigilancia, especialmente en los paises del hemisferio sur donde el invierno se aproxima.

Influenza A (H1N1) latest update

Para ver esta pagina en Espanol (presione aqui)

The virus has spread to 40 countries, with 8,829 confirmed cases.

To see graphically the advance of the outbreak, use this link to a map that displays the daily advance by moving a  the cursor at the bottom of the map.

 Daily update (18 may, 2009)

• Number of countries:    40
• Confirmed cases:        8,829
  

For the location and number of confirmed cases in those 39 countries see: 

• Latest map of the spread of influenza a (H1N1) from the WHO

Deaths:     Mexico 66 deaths and 2,895 cases

                The United States 4 deaths and 4,714 cases

                Costa Rica one death and 9 confirmed cases

                Canada one death and 496 cases 

               

                

Tools:

• Go to PSI's Influenza A information site for current information on the outbreak

• Go to PSI's influenza resources site for tools for unionists 

Summary: The spread continues to be travel-related and the virus appears not to have seeded itself outside North America. While the lethality rate continues to be low, the continued spread requires caution. As the virus spreads and mutates, without a vaccine available to contain it, there is the danger of Influenza A turning more lethal and the outbreak turning into a pandemic.

The expected delay for the development of a vaccine is 5 or 6 months. In the interim, it is crucial that the spread is contained through contagion prevention measures.

Alertness and surveillance should be maintained, especially in southern hemisphere countries entering the winter months.

INFLUENZA A (H1N1): ultimas noticias

El virus afecta a 40 paises, 8,829 casos confirmados

Para ver graficamente la rapidez del avance, vea el mapa en este enlace y mueva la flecha inferior para visualizar el avance dia a dia.

 

Boletin actualizado (18 de Mayo, 2009)

• Numero de paises:     40
  
• Numero de casos:     8,829
  

La ubicacion y numero exacto de casos confirmados en esos paises esta disponible en: 

•  Mapa actualizado del avance de la influenza A (H1N1) compilado por la OMS
  

Muertes:    Mexico 66 decesos y 2,985 casos. 

                  Estados Unidos 4 muertes y 4,714 casos.

                  Canada un deceso y 496 casos.

                  Costa Rica un fallecimiento y 9 casos.

Herramientas:

• Ver el Portal de informacion de la ISP sobre Influenza A para obtener informacion actualizada

• Ver el  Portal de recursos de la ISP for para descargar herramientas para sindicalistas

Resumen: El avance del virus sigue estando ligado a los viajeros y el virus no se ha establecido fuera de Norte America. Aunque el indice de mortalidad sigue siendo bajo, el avance en la extension geografica de la infeccion requiere mantener la alerta. Mientras el virus se expanda y sufra mutaciones, sin que exista una vacuna para contenerle, existe el peligro de que la Influenza A se transforme en mas mortifera y de que estalle una pandemia.

Se espera que tomen 5 a 6 meses generar una vacuna.

Se debe mantener la alerta y vigilancia, especialmente en los paises del hemisferio sur donde el invierno se aproxima.