Pandemic Update – September 6, 2009

There have been over 3,300 deaths due to the new H1N1 virus.

Brazil has reported the most deaths, at least 657. Although the WHO has suggested that the number of infections in the South America is declining, the number of deaths continues to increase. For example, Ecuador now reports 44 deaths, many of them recent.

In the United States, 593 deaths have been reported. A noticeable increase in deaths among children whose schools started a few weeks ago has occurred. As most schools have just opened or will open this week in the US, there may be a large wave of deaths among children starting within the next few weeks. In Mexico, there has been a recent increase in the number of cases reported on a daily basis. There have been at least 207 officially confirmed deaths in this country.

In Australia and New Zealand, the number of new cases have been reported to be in decline, although the number of deaths continue to increase. There have been reports of a large numbers of deaths in Papua New Guinea. The reported causes of death have included cholera, dysentery and influenza. How many people have been killed by flu and what subtype is causing the deaths is not clear. The infections and deaths continue to increase. The WHO is investigating.

In Europe, Germany continues to report large numbers of new infections, but no deaths. The UK has reported many fewer cases of infections than Germany, but has reported at least 70 deaths. Spain has reported 25 deaths.

In Asia, India has reported at least 140 deaths, now the most in the region. Thailand has reported 130 deaths. Malaysia has reported 73 deaths. Vietnam has only reported 3 deaths, but news stories indicate a sudden increase in cases among children. Hospitals are now overcrowded with children who must share mats on the floor. In China, there are 12 reported deaths, none on the mainland. The disproportionate number of cases in Hong Kong and Macao as compared to the mainland is not credible. This raises concern of a cover-up within mainland China as to their true situation, as occurred with SARS and early H5N1 cases.

The situation in Africa is unclear. South Africa has now reported 27 deaths. Mauritius has reported 8 deaths and Ghana 1 death. However, given the state of the public health infrastructure in many countries in Africa, it is likely that there have been many cases that have not been reported.

There are increasing numbers of deaths in the Middle East. 26 deaths have been reported in Saudi Arabia. 21 deaths have occurred in Israel. 5 deaths have been reported in Kuwait and 4 in the United Arab Emirates.

There are an increasing number of  reports of Tamiflu-resistant strains of the new H1N1. There are anecdotal reports of patients being treated with Relenza, in some cases in combination with Tamiflu. Efforts are underway to identify alternative therapies to treat patients if Tamiflu- and Relenza-resistant strains become dominant.

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