Pandemic A(H1N1) 2009 ECDC situation update to EPSCO Council Zsuzsanna Jakab, Director European Centre for Disease Prevention and Control Brussels, 1 December 2009
Pandemic A(H1N1) 2009
ECDC situation update to EPSCO CouncilZsuzsanna Jakab, DirectorEuropean Centre for Disease Prevention and Control
Brussels, 1 December 2009
ECDC key messages (1)
• ECDC is continuously monitoring the pandemic and regularly updates its risk assessment.
• People most at risk from pandemic influenza are people with significant underlying health conditions, pregnant women and young children.
• Most people who catch pandemic influenza will experience only mild illness but a few, including some young healthy individuals, will develop severe disease and die.
• EU citizens can help protect themselves and others by simple measures such as regularly hand washing and good respiratory hygiene.
ECDC key messages (2)
• Given the significant risks to health from the pandemic ECDC would strongly advise all those Europeans who are offered the vaccine to be vaccinated.
• EU citizens rightly require assurance that vaccines are both safe and effective. Rigorous testing and monitoring mechanisms are in place in the EU. So far all vaccines appear to have consistent safety profiles.
What is happening in Europe?Pandemic now a very significant health threat
Number of confirmed deaths among pandemic (H1N1) influenza cases
5
1 1 212
17
2 5 3
1723 21 17 15
2216 15 12
24
4943
84
100
169
188
0
20
40
60
80
100
120
140
160
180
200
25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
Number of deathsCalendar weeks 2009
By week of notification in EU and EFTA countries, week 25 to 48, 2009
Source ECDC Daily Update, 30 November 2009. Available from: http://ecdc.europa.eu/en/healthtopics/Documents/091130_Influenza_AH1N1_Situation_Report_0900hrs.pdf
Reported cumulative number of confirmed fatal cases of influenza A(H1N1)v in EU/EFTA countries, as of 30 November 2009, 09.00 CEST
Week 47: Geographic spread
Weekly influenza surveillance output
=H1 Type A, subtype H1v. Stable clinical activity.
=H1N1 Type A, subtype H1N1v. Stable clinical activity.
Type A, subtype H1v. Increasing/decreasing clinical activity.
Type A, subtype H1N1v. Increasing/decreasing clinical activity. *
* A type/subtype is reported as dominant when > 40 % of all samples are positive for the type/subtype.
No report
No activity No evidence of influenza virus activity; clinical activity remains at baseline levels.
Sporadic Isolated cases of laboratory-confirmed influenza infection.
Localoutbreak Increased influenza activity in
local areas (e.g. a city) within a region, or outbreaks in two or more institutions (e.g. schools) within a region (laboratory confirmed).
Regional activity Influenza activity above baseline
levels in one or more regions with a population comprising less than 50% or more of the country's population (laboratory confirmed).
Widespread Influenza activity above baseline levels in one or more regions with a population comprising 50% or more of the country's population (laboratory confirmed).
=H1 =H1N1
=H1
=H1
=H1N1
H1N1
H1N1
H1N1
Forward look:What is likely to happen over the next two months?
Recommended planning profiles
• Real pandemic waves are not as smooth at this.
• National and local pandemic waves last about 15 weeks.
• They do not occur at the same time in different countries in Europe.
• Nor do they occur at the same time in different parts of the same country.
• Local peaks are higher.
9
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
week
Recommended planning curve
Local planning profile
Less peaked local profile
Source: Department of Health, UK – see www.ecdc.europa.eu
Perc
enta
ge o
f popula
tion
10
Three curves – more hospitalisations and deaths after the peak
Animated slide: Press space bar
Not drawn to scale
Cases
Clinical cases
Hospitalisations
Deaths
Forward look – December to New Year
• Illnesses will peak soon in the first affected countries.
• Hospitalisations and deaths will continue rising in those countries for a while.
• Illness will rise in the eastern, central and south-eastern countries.
• There may be pressures at Christmas and New Year in many countries.
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Meeting the challenge:Key factors to consider in the EU
ECDC advice on meeting the challenge
• Plan to reinforce capacity of intensive care units for peak of pandemic and immediate aftermath.
• Antivirals and pandemic vaccines can help reduce morbidity and mortality.
– Prioritise risk groups and seriously ill for antivirals.
– Prioritise risk groups and health workers and essential services for
vaccine.
• Effectiveness on simple measures such as hand washing and respiratory hygiene should also be emphasised.
• Member States should learn from each others’ experiences.
• Member States and EU should work together to ensure coherence of risk communication.
Acknowledgments
• European Member States
• European Commission
• European Medicines Agency
• ECDC Staff
• Centers for Disease Control and Prevention, USA
• WHO Geneva
• WHO Regional Offices for Europe
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Sources of data and analyses
ECDC Daily Update – every weekday http://www.ecdc.europa.eu/en/healthtopics/Pages/Influenza_A(H1N1)_Outbreak.aspx
ECDC Weekly Influenza Surveillance Output http://www.ecdc.europa.eu/en/activities/surveillance/EISN/Pages/EISN_Bulletin.aspx
Updated ECDC Risk Assessment http://www.ecdc.europa.eu/en/healthtopics/Pages/Influenza_A(H1N1)_Risk_Assessment.aspx
EU Member States
World Health Organization, Geneva and Regional Office for Europe e.g. new WHO Clinical Guidance http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html
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