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11 June 2009
World Health Organization Declares Global Pandemic for H1N1 Flu

By Cheryl Pellerin
Staff Writer

Related:
 • More on the H1N1 Influenza
 • U.S. Centers for Disease Control’s website

Washington — The World Health Organization (WHO) has raised the pandemic alert to the highest level, phase 6, after confirming with virus experts and member countries that the novel H1N1 virus, which causes in most people a mild seasonal-flu-like illness, is spreading from person to person in a sustained way in 74 countries on three continents.

The pandemic declaration — the first since 1968–1969, when an H3N2 flu strain initially detected in Hong Kong caused 700,000 deaths — means the virus has become widespread around the world, not that it has become more severe, and that all countries should begin following their national pandemic plans.

“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,” WHO Secretary-General Dr. Margaret Chan said at a June 11 briefing. “On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met.”

“The world is now at the start of the 2009 influenza pandemic,” Chan said.

On June 11, WHO said 74 countries had officially reported 28,774 cases of the novel H1N1 infection and 144 deaths. Countries with the highest numbers of cases include Australia (1,307), Canada (2,446), Chile (1,694), Mexico (6,241) and the United States (13,217).

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

She added, “Countries should prepare to see cases or the further spread of cases in the near future. Countries where outbreaks seem 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.”

PREPARING COUNTRIES

WHO officials have been working with member nations for weeks to make sure that all are prepared to handle the transition from phase 5, which WHO declared April 29 as a strong signal that a pandemic was imminent and a notice to countries that it was time to organize, communicate and implement mitigation measures.

Preparations under way include making sure countries have critical information and tools for their citizens, working to develop vaccines, increasing the antiviral drug supply, developing clinical guidelines for treatment and providing updates on scientific understanding of the novel and complex H1N1 virus.

“The movement from one phase to another is not simply getting up in front of press cameras or making an announcement,” Keiji Fukuda, WHO assistant director-general for health security and environment, said at a June 9 briefing. “It is a way to prepare the world to deal with the situation.”

Fukuda said WHO aims to “discuss the severity of the situation and provide guidance to countries about how to modify and tailor the response actions to meet the current situation and not to be so locked into pre-existing plans.”

Most national pandemic plans were developed during the 2003 spread of highly pathogenic H5N1 avian flu among birds and people. Unlike H1N1, H5N1 is not easily transmissible among people, but it is much more deadly. Pandemic plans based on that virus may call for actions like border closings and trade embargoes that are more extreme than what is necessary for dealing with H1N1.

Since 2003, some 15 countries have reported 433 cases of human H5N1 flu with 262 deaths. Vietnam and Egypt have reported human H5N1 cases this year; Egypt so far has reported 27 cases and four deaths, Vietnam four cases, all fatal. Both countries also have confirmed cases of H1N1 — 15 in Vietnam and eight in Egypt — causing scientists to worry that the strains could “reassort,” or trade genes, creating a new strain with unpredictable characteristics.

MOST VULNERABLE

At a June 11 briefing, Dr. Thomas Frieden, who assumed leadership of the U.S. Centers for Disease Control and Prevention (CDC) on June 8, said the United States would continue its aggressive action against the novel H1N1 virus.

“Our key goals are to determine where viruses are spreading and to reduce its impact,” he said, “particularly on those who are most vulnerable — people with underlying health conditions, and infants in this case.”

Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases, said the United States continues to see ongoing transmission of this virus, with more than 1,000 hospitalizations and 27 deaths.

CDC, a WHO collaborating center for the surveillance, epidemiology and control of influenza, has taken the first steps to develop a candidate vaccine, providing the virus to several laboratories and manufacturers in other countries, Schuchat said at a June 4 briefing. The virus can be used to produce pilot lots of vaccine for testing to determine whether it produces an immune response and is safe for people to take.

“The decision about whether or not to use a vaccine and how to use it has not been made and won't be made until more information is available about patterns of disease,” she said, “and about how a vaccine performs in clinical testing.”

“WHO has been in close dialogue with influenza vaccine manufacturers,” Chan said. “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.”

“There has been excellent global cooperation with the World Health Organization, with countries around the world,” Frieden said. “This is one of the many conditions that reminds us that we are all connected and many of our decisions in the U.S. will rely on good information from countries in Latin America, in Africa, in Asia, Australia and elsewhere. It’s very important that we confront this jointly.”

More information about the response to the novel H1N1 virus is available at special Web sites of the CDC and WHO.

Learn more about the novel H1N1 flu at America.gov’s “Tracking the H1N1 Flu Outbreak.”

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