Flashback
- 7 in California
- 2 in Kansas
- 28 in New York City
- 1 in Ohio
- 2 in Texas
28 April 2009:
- 3 cases confirmed in New Zealand (link here)
- WHO alert system raised to level 4, from level 3 (link here)
- Phase 4 is characterized by verified human-to-human transmission or human-animal transmission influenza virus able to cause “community-level outbreaks”.
29 April 2009:
- 10 confirmed cases in Spain, including 1 who was not recently in Mexico.
- 91 confirmed cases in U.S., 1 death in U.S. (23 month old child).
- 1 case confirmed in Austria.
- 5 cases confirmed in Britain.
- Singapore at “Alert Yellow”, from “Alert Green”. (link here)
- 2 cases confirmed in Israel. (link here)
30 April 2009:
- 11 countries have officially reported 257 cases of influenza A (H1N1) infection.
- 1 confirmed case in Netherlands (link here)
- Press Conference chaired by Minister for Health Khaw Boon Wan
- Singapore upgrade the alert from “Yellow” to “Orange” (link here)
- Tripartite Advisory on Workplace Measures to Tackle Mexican Swine Influenza
- 1 confirmed case in Switzerland (link here)
- WHO’s pandemic alert raised from Phase 4 to Phase 5. (link here)
- Update from WHO, confirmed cases:
- 91 in U.S., including 1 death
- 26 in Mexico, including 7 deaths
- 1 in Austria
- 13 in Canada
- 3 in Germany
- 2 in Israel
- 3 in New Zealand
- 4 in Spain
- 5 in United Kingdom
1 May 2009:
- 11 countries have officially reported 331 cases of influenza A(H1N1) infection.
- U.S.: total 141 confirmed cases to date, including 1 death
- Denmark: 1 confirmed case.
- Hong Kong: 1 confirmed case
- Singapore Ministry of Health Update on Influenza A (1 May 2009)
- : As of 19:00 GMT, 1 May 2009, 13 countries have officially reported 365 cases of influenza A(H1N1) infection.
2 May 2009:
- 15 countries have officially reported 615 cases of influenza A(H1N1) infection.
- U.S. : 21 states with total of 160 laboratory confirmed cases, 1 death, as of 2 May 09, 11pm SST (UTC+8)
- Italy: 1 confirmed case
- South Korea: 1 confirmed case
- France: 2 confirmed cases
- As of 18:00 GMT+1, 2 May 2009, 16 countries have officially reported 658 cases of influenza A(H1N1) infection.
3 May 2009:
4 May 2009:
5 May 2009:
- 21 countries have officially reported 1124 cases of influenza A (H1N1) infection.
- Singapore HSA: Risks of Buying Health Products from the Internet
6 May 2009:
- Singapore Ministry of Health Update on Influenza A H1N1 (6 May 2009)
- 22 countries have officially reported 1516 cases of influenza A (H1N1) infection.
7 May 2009:
- Singapore Ministry of Health Update on Influenza A (H1N1-2009) (7 May)
- 23 countries have officially reported 2099 cases of influenza A(H1N1) infection.
8 May 2009:
9 May 2009:
10 May 2009:
- 29 countries have officially reported 4379 cases of influenza A(H1N1) infection.
- Singapore Ministry of Health Update on Influenza A (H1N1-2009) (10 May)
11 May 2009:
On 12 May 2009:
As of 0600 hours, 30 countries have officially reported 5,251 confirmed cases of Influenza A IH1N1) infection.
Two weeks after WHO sounded the alert, the world has learnt a lot more about this A/H1N1 virus. Singapore remains lucky partly because we have low human traffic with Mexico. Now that the virus is endemic in the US, it is a matter of time before we discover cases here, given the high volume of travelers between the US and Singapore.
The US has now the largest number of confirmed cases. A lot of useful scientific information has come out of the US, given their strong medical and scientific research infrastructure. Their data paint the following picture:
- There is easy human-to-human transmission. Vast majority of the cases in the US have no travel history to Mexico. So it is now endemic there. There could have been many more patients not picked up and unreported as their symptoms are mild.Transmission is thought to be via droplets, through respiratory or gastro-intestinal material, e.g. cough, sneeze, tears: hence our strong advice on cough and sneeze etiquette. All Singaporeans should wash their hands thoroughly and frequently.
- The illness pattern ranges from self-limiting to severe pneumonia. Tamiflu and Relenza work for this virus. Most patients were able to recover with prompt treatment.
Of the 5 deaths outside of Mexico, most had some underlying health problems, such as asthma and heart disease. Seasonal flu is also more severe in such patients. However, compared to seasonal flu, the virus appears to have a more severe effect on young people, which is unusual.
We have to wait for more data to see whether this is indeed a true characteristic of the virus. As H1N1 is a new virus, people are less likely to have immunity. So the number of cases may be higher, compared to seasonal flu. (Link here)
13 May 2009:
14 May 2009:
15 May 2009:
16 May 2009:
17 May 2009:
18 May 2009:
19 May 2009:
20 May 2009:
21 May 2009:
22 May 2009:
23 May 2009:
27 May, 2009:
Singapore had reported its first case of H1N1 influenza. She was a 22-year-old local woman who picked up the virus after visiting New York. The Ministry of Health (MOH) said in a statement on Wednesday (27 May 2009) that the woman was in New York from May 14 to 24, and reported developing a cough on her flight back to Singapore earlier this week.
MOH further added that it had quarantined people with whom the woman had been in close contact with and was searching for passengers who were on the same flight from New York to Singapore.
30 May, 2009:
The number of confirmed H1N1 cases in Singapore went up to 4 and 31 people were put under quarantine.
3 June, 2009:
As of 3 June 2009, at least 19,273 cases of infections including 117 deaths have been reported to the World Health Organisation by 64 countries around the world since the virus emerged in the United States and Mexico in April. (See link here ).
In Australia, the Swine Flu has spread more than 1,000-fold in Melbourne over the last three weeks. Melbourne has now become the World’s Number One H1N1 Swine Flu capital, overtaking Mexico and New York. Overall, Australia’s latest confirmed cases have reached at least 1,009, and the Victoria State alone accounts for at least 874 cases, most of which are concentrated in Melbourne.
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A pharmacy assistant at Melbourne Airport. |
“Melbourne is now the swine-flu capital of the world, with the H1N1 virus twice as prevalent in the Victorian population as it is in Mexico, where the pandemic began,” the respected daily reported.
“With the state’s comparatively small population, swine flu occurs in about one in 9,139 Victorians – more than double the one in 21,860 Mexicans with the virus and triple the one in 27,295 people with swine flu in the US,” it added.
Australian H1N1 flu cases now represent about 4.5 per cent of the 21,940 confirmed cases in 69 countries reported to the World Health Organisation.
Health Minister Nicola Roxon said late Friday that H1N1 flu would remain on the rise here for some time.
“I would have thought we are not at the halfway point, given that we still don’t have an extensive spread in Australia,” she told reporters.
She said a vaccine was not yet available and all efforts were being directed at containing the disease.
“The reason it is a marathon is we will potentially have this disease with us not just through this flu season but a risk of it again in the following year,” she said.
The UN health agency said on Friday it was maintaining the pandemic alert level at five out of six, signalling that a pandemic is “imminent”.
Several Australian states and territories this week implemented voluntary quarantine measures for children returning from Victoria or the greater Melbourne area to prevent the spread of the disease.
On 4 June, 2009:
Another 3 confirmed H1N1 cases were reported by the Ministry of Health. This brings the total number of infected people in Singapore to 12.
The 9th patient was a 19-year-old Singaporean student returning from the US for the summer holidays. She arrived from New York via Tokyo on All Nippon Airways NH901 at 23:40 hours on 28 May 2009.
As reported on Channel NewsAsia, MOH said no one else needed to be quarantined as the case developed more than 24 hours after disembarkation, hence she was assessed to be non-infectious during the flight.
The 10th and 11th patients were on the same flight as the 7th confirmed case, a 30—year—old Australian male tourist who was seated at row 54 on Singapore Airlines SQ25, which arrived in Singapore from New York via Frankfurt at 06:18 hours on June 1.
The 10th patient is a 33—year—old Singaporean woman who took a taxi to Tan Tock Seng Hospital after developing symptoms. She was in New York from May 23—30 and was seated at row 19 on SQ25. She was admitted to the Communicable Disease Centre 2 (CDC2) at Tan Tock Seng Hospital (TTSH) before midnight on June 2.
The 11th patient is an 18—year—old American woman. She was seated at row 57 on SQ25. She developed symptoms in the afternoon of June 2, took a taxi with her relative to seek medical attention at Raffles Hospital’s Emergency Department in the evening and was sent to CDC, TTSH via a 993 ambulance. She was admitted to CDC2 in the early hours of June 3.
The ministry has expanded the list of “affected areas” to include Melbourne and the State of Victoria in Australia, Kobe and Osaka in Japan, and Chile, besides USA, Canada and Mexico.
For Japan, more than 90 per cent of its cases are found in the two cities of Kobe and Osaka.
For Chile, the government has announced that H1N1 is entrenched in the community and mitigation measures have replaced containment efforts. Indications are that there is widespread infection throughout Chile, although a large majority of cases are found in the capital city, Santiago.
On 5 June 2009:
A 17-year-old pregnant Dominican Republic national has died of the H1N1 virus or swine flu.
The unidentified girl, who was seven months pregnant and suffering with tuberculosis at the time, has become the Caribbean’s first swine flu-related death, according to a report issued by the Latin American Herald Tribune.
Latest Update
On 6 MAY 2009:
SINGAPORE: According to Channel NewsAsia TV broadcast, the Health Minister Khaw Boon Wan has lowered Singapore’s alert level for Influenza A/H1N1 from “Orange” to “Yellow.” Mr Khaw was quoted to have said in a news conference that “the downgrading will be done progressively over the next five days, but adding that Singapore will remain vigilant and act nimbly!” He also said that precautionary measures such as temperature screening at border checkpoints and hospitals will continue, but the one visitor per patient rule at hospitals will be lifted.
It is rather surprising that while WHO has raised the alert level one notch higher but Singapore has instead lowered its alert level one notch lower, from Orange to Yellow. Perhaps, our Health Ministry is very confident that it can deal with any outbreak of such pandemic, because it has already got some experiences from the 2003 SARS outbreak?
On 6 June 2009:
AUSTRALIA: The city of Melbourne has become the world’s H1N1 Flu Capital, as the country’s confirmed tally of the disease soared to 1,009.
Some 874 of the infections have been detected in the southern state of Victoria, with most of those cases concentrated in the north and west of the state capital Melbourne, the Australian Health Department said on Saturday.
The disease has spread more than 1,000-fold in the past three weeks, hitting schools in the Melbourne area hard and making Victoria the worst affected area on earth per head of population, The Australian newspaper said.
“Melbourne is now the swine-flu capital of the world, with the H1N1 virus twice as prevalent in the Victorian population as it is in Mexico, where the pandemic began,” the respected daily reported.
“With the state’s comparatively small population, swine flu occurs in about one in 9,139 Victorians – more than double the one in 21,860 Mexicans with the virus and triple the one in 27,295 people with swine flu in the US,” it added.
Australian H1N1 flu cases now represent about 4.5 per cent of the 21,940 confirmed cases in 69 countries reported to the World Health Organisation.
Health Minister Nicola Roxon said late Friday that H1N1 flu would remain on the rise here for some time.
“I would have thought we are not at the halfway point, given that we still don’t have an extensive spread in Australia,” she told reporters.
She said a vaccine was not yet available and all efforts were being directed at containing the disease.
“The reason it is a marathon is we will potentially have this disease with us not just through this flu season but a risk of it again in the following year,” she said.
The UN health agency said on Friday it was maintaining the pandemic alert level at five out of six, signaling that a pandemic is “imminent”.
Several Australian states and territories this week implemented voluntary quarantine measures for children returning from Victoria or the greater Melbourne area to prevent the spread of the disease.
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SINGAPORE: In Singapore, the Health Ministry in a statement late Saturday night reported the first local case of infection by the H1N1 Influenza A virus.
The patient is a 39-year-old Indonesian woman, who had not been abroad recently, but is in close contact with her niece, one of the 14 patients confirmed to have the H1N1 Influenza while travelling abroad. Her niece is the 11th confirmed swine flu case in Singapore. She is an 18-year-old girl who has gone to New York and returned to Singapore on 1 June 2009. The Indonesian woman had fetched her niece home from the Changi Airport and then fetched her to the hospital two days late when she developed symptoms of influenza.
The 39-year-old woman was the aunt of the 11th confirmed swine flu case in Singapore, an 18-year-old woman from the United States who arrived from New York on June 1. The aunt fetched her niece at Singapore’s Changi airport and later accompanied her to a hospital when the young woman developed symptoms of influenza.
This brings the officially reported figure to a total of 15 confirmed cases. However, we do not really know if there are other cases that have gone unreported or unnoticed.
- It’s been six weeks since the World Health Organization (WHO) sounded the alert on the Influenza A (H1N1) outbreak and there’s been no evidence of communal spread of the virus in Singapore yet. Health Minister Khaw Boon Wan said this is an achievement.
- As the number of infected individuals remain small, he said the Health Ministry will go all out to track every person who has been in contact with the patients.
- However, contrary to what the Health Minister has said, the Health Ministry has refused to track contacts of people who developed the H1N1 infection symptoms 24 hours after they have arrived in Singapore. So, what does “going all out to track every person who has been in contact with the patients” actually mean?
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On 9 June 2009:
Singapore’s Health Ministry has confirmed two more cases of swine flu, bringing our tiny island’s national total of infected cases to 17.
A ministry statement says a 40-year-old Indian man working in Singapore and a 25-year-old Malaysian female flight attendant for Singapore Airlines arrived from Melbourne last week and tested positive late Monday. They are in stable condition in the CDC at Tan Tock Seng Hospital.
The statement issued on 8 June 2009 advises Singaporeans to avoid nonessential travel to Melbourne and the State of Victoria (Australia), the Japanese cities of Kobe and Osaka, the United States of America, Canada, Mexico and Chile.
The World Health Organisation says the disease has now spread to 73 countries and infected more than 25,000 people, including at least 139 deaths so far.
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CONCLUSION
The world is “getting closer” to a swine flu pandemic as the virus shows early signs of spreading locally in countries outside the Americas.
“Globally we believe that we are at Phase 5 but are getting closer to Phase 6,” said Keiji Fukuda, WHO Assistant Director-General, referring to the agency’s six-level pandemic alert system.
Phase 5 signals that a pandemic is imminent. The world would be in an official pandemic, marking global spread, at Phase 6.
“It is clear that the virus continues to spread internationally. We know there are a number of countries that appear to be in transition moving from travel-related cases to established, more established, community-type spread,” said Fukuda.
He noted in particular that countries like Britain, Spain Japan, Chile and Australia are showing larger numbers of Influenza A (H1N1) infections, “with some early spread into communities.”
In Singapore, the Health Minister Khaw Boon Wan told Singaporeans to be mentally prepared for the likely spread of H1N1 influenza throughout the community.
My conclusion is that Singaporeans should expect the worst case scenario to take place any time!
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P/S:
1. The number of infected cases has risen to 18 after this article has been written. (See link)
2. Travel restrictions lifted by Singapore (see link):
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The visa requirement for all Mexican nationals who wish to enter Singapore was lifted with effect from 12 May 2009.
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The Home Quarantine Order (HQO) for travellers to Singapore with a recent Mexican travel history has been lifted with effect from 16 May 09.
3. As reported in the Ministry of Health’s daily updates, most of the infected persons took a taxi from the Changi Airport to either go home or to their hotels. So, it is likely that some of our taxi drivers may have already been infected. If so, they could be the carriers of the H1N1 viruses to facilitate a speedier spread of the disease.
