A
semi-logarithmic chart of laboratory-confirmed A(H1N1) influenza cases by date according to
WHO reports.[1] Mexico, USA, and Canada are shown as a breakdown of the total.
Roughly 10% of Canadians had been infected with the virus as of mid-late November[2] with 416 confirmed
deaths as of January 7; there were over 10,000 confirmed cases when
Health Canada stopped counting in July 2009.[3] Canada began its vaccination campaign in October[4][5] and 40% of the populace has since been
immunized against H1N1.[6]
Probable and confirmed Mexican cases by date of illness onset, March 15 – April 26. —CDCMexican soldiers distributing protective masks to citizensOutbreak evolution in Mexico:
Deaths
Confirmed cases
Outbreak evolution in Mexico:
2000+ cases
500+ cases
100+ cases
1+ cases
Outbreak evolution in Mexico:
1+ deaths
5+ deaths
20+ deaths
100+ deaths
Dr.
José Ángel Córdova Villalobos, Mexico's
Secretariat of Health, stated that since March 2009, there have been over 1,995 suspected cases and 149 deaths, with 20 confirmed to be linked to a new
swine influenza strain of Influenza A virus subtype H1N1.[8][9] As of April 26 there had been 1,614 cases, with 103 deaths and about 400 patients in hospital; approximately two-thirds of the sick patients had recovered.[10] "'As many as 23,000 Mexicans were likely infected with the swine flu virus,' Neil Ferguson of Imperial College London and colleagues reported in the journal Science."[11]
Soldiers mobilized by the government have handed out six million
surgical masks to citizens in and around
Mexico City.[12]
On April 24, 2009, schools (from pre-school to university level) as well as libraries, museums, concerts and any public gathering place, were shut down by the government in Mexico City and the neighboring
State of Mexico to prevent the disease from spreading further; the schools in Mexico City, the State of Mexico, and the state of
San Luis Potosí will remain closed until at least May 5.[13]Marcelo Ebrard,
Mexico City's mayor, has also asked all night-life operators to shut down their places of business for ten days to prevent further infections.[14]José Ángel Córdova, federal
Secretary of Health, said on April 24 that schools will probably be suspended for at least the following week then, and that it will take around ten days to see the evolution of the virus' behavior, and to consider other measures after such.[15] On April 25,
PresidentFelipe Calderón declared an emergency which granted him the power to suspend public events and order
quarantines.[16] Hours later, Córdova announced that classes in Mexico City would be officially suspended through May 6.[17] On April 26,
Natividad González Parás, governor of the northeastern State of Nuevo León, announced that statewide schools will remain closed until 6 May, and established a quarantine system in airports, central bus stations and the creation of observation points mainly in the southern part of the state at the nearest highways to the borders with other states, in order to realize tests conducted on people arriving from other states. However, as for April 27, there are no confirmed reported cases of infection in this state.[18]
On April 26, the
World Bank announced
US$ 25 million in immediate aid loans to Mexico, an additional US$180 million for long-term assistance to address the outbreak, and advice on how other nations have responded to similar crises.[12]
On April 28, the Mexico City government closed all restaurants and cinemas. The
National History and Anthropology Institute also closed all its archaeological sites and museums, including the most famous Mayan and Aztec ruins, until further notice.
Initial reports of atypical flu in two individuals in southern California led to the discovery of the novel swine flu virus by the
CDC in mid-April. More than a hundred cases were confirmed in the next two weeks, spread through a dozen states.[20] Outside of California and Texas, initial cases were all tied to recent travel to Mexico or close contact with those who had recently visited Mexico.
St. Francis Preparatory School, a private school in New York, was the center of a large cluster of cases after a Spring Break trip by several students, and perforce one of the first U.S. schools to be closed as a public health measure during the early outbreak.[21] Most of the cases in California and Texas are not linked and may reflect localized outbreaks of this virus in those areas.[22] As of April 30, the disease was not as virulent outside of Mexico as within Mexico, for reasons not fully understood.
The United States of America declared a state of
Public Health Emergency but this was said to be standard procedure in cases as divergent as the recent inauguration and flooding.[23] According to
The New York Times, "the emergency declaration frees resources to be used toward diagnosing or preventing additional cases and releases money for more antiviral drugs," including the transfer of approximately 12 million influenza medications from a federal stockpile to states.[12][24] The U.S. plans followed a guidebook developed over the past five years to fight a pandemic flu such as H5N1. The situation developed rapidly with the White House initially looking into the matter on April 24 according to press releases, but rapidly adopting a serious stance as the WHO and CDC issued stronger recommendations.
On April 29, the US suffered its first confirmed death of swine flu. On April 28, the
Centers for Disease Control and Prevention had officially confirmed through tests that a 23-month-old child was infected with the flu. When the sickness continued to worsen the next day, he was transferred to Texas Children's Hospital in Houston, where he died.[25][26][27]
On May 5, Judy Trunnell, a woman in her 30s suffering from "chronic underlying health conditions" died of swine flu in
Cameron County, near the US-Mexico border. She was the first US citizen to die from the disease.[28] The woman, a special education teacher, had recently given birth to an eight-month-term healthy baby, delivered by caesarian section.[29] She had been in a coma after being admitted to the hospital with breathing problems on April 19.[29] The woman had also suffered from
asthma,
rheumatoid arthritis and a skin condition.
On May 10, a 30-year-old man with underlying health problems died in Washington from H1N1, the first fatality in that state.[30]
On May 17, 55-year-old Mitchell Wiener, an assistant principal at Intermediate School 238 in
Hollis, Queens died from H1N1, making it the first H1N1 related fatality in the state of New York. Wiener suffered from many other underlying health problems, weakening his resistance to the disease.[31]
On May 19, 2009, a St. Louis County man became the first death in Missouri due to the Swine Flu.
As of mid-May 2009 many states had abandoned testing for likely influenza cases unless serious illness and/or hospitalization were present.[32] Because reported numbers represent only confirmed cases, they are a "very great understatement" of the total number of cases of infection, according to the
CDC.[33]
The real number of swine flu cases in the United States could be “upwards of 100,000,” a top public health official estimated on Friday — far higher than the official count of 7,415 cases confirmed by laboratories.[34]
On September 1, 2009, several new virus isolates were tested for neuraminidase inhibitor resistance. These included one seasonal influenza A (H1N1), 13 influenza A (H3N2), 23 Influenza B, and 1, 855 2009 influenza A (H1n1) virus isolates.[35]
Trevor van Gellecum, the Director of the Aruban
Department of Health, announced that all passengers arriving by
airplane or
cruise ship will have to fill out a health
questionnaire beginning on April 27, 2009.[36] Hotels and resorts are required to report to authorities if any tourists are showing flu-like symptoms.[36] The government of Aruba also ordered
antiviral medication and other supplies from the
Netherlands and the
United States.[36] No swine flu cases have been reported.[36]
There are two suspected cases of swine flu currently under investigation in Belize. As a result, all major public events have been cancelled. This includes the National Agriculture and Trade Show. People have been asked to be very careful and use preventative measures.[37]
A 21-year-old woman was confirmed as carrying the swine flu virus on April 28. The woman came back from Mexico by airplane.[38] A second case was confirmed on the same day, a 30-year-old man who traveled to Mexico the week before.[39] On May 2 the Costa Rican Ministry of Health confirmed two more cases.[40] Four more cases were confirmed on May 4.[41]
A 53-year-old man became the first confirmed death from the disease in the country, as reported by the Minister of Health on May 9.[42][43][44] This was the first death outside of a North American country and the fourth country in the world to present a mortal case.[44] The deceased man was suffering other chronic diseases. The Minister of Health informed he had
diabetes and also was suffering from
chronic obstructive pulmonary disease (COPD). She also informed the man was infected inside Costa Rica because he had not traveled to Mexico.[45]
On August 11 was confirmed that Costa Rica's president,
Óscar Arias Sánchez, was infected with the A(H1N1) virus, becoming the first
head of state sick with the A(H1N1) virus[46][47] President Arias returned to his normal activities after one week of isolation at his home.[48]
As of September 8 the Costa Rican Ministry of Health had 1,246 confirmed cases, 1,257 pending cases, 6,337 already discarded, and 33 deaths.[49] The
mortality rate is 0.73 deaths by 100,000 people, and the
fatality rate is 2.96%.[49] From all deceased patients, 48.5% occurred among
San José residents, and only the
Guanacaste Province has not had any deaths related to the virus. The age of the deceased varies between 20 and 79 years, with an average age of 41 years.[49]
Cuba's Health Ministry is adopting precautionary measures to prevent the illness from coming into the country. The government has advised citizens to go to seek medical treatment if experiencing flu-like symptoms.[50] Cuba has also banned flights to and from Mexico for 48 hours.[51]
Cuba has reported its first case of Influenza A H1N1 as a Mexican student who travelled to Cuba on April 25 for study
The ministry statement said that in all of Cuba, authorities have tested 84 possible cases in people of eight nationalities for the virus. Only one case was positive - the Mexican student.[52]
According to the Dominican Republic Government, two people were confirmed to be infected with the AH1N1 flu on May 27.[53] One was a 58-year-old woman from
Santiago de los Caballeros and the other was a 20-year-old woman from
Santo Domingo Province. Each of them had visited the United States (
Orlando and
Seattle, respectively) before being diagnosed.[53] On May 30, nine more cases were confirmed, all from the Carol Morgan school.[54]
On June 5, a 17-year-old pregnant girl infected with the AH1N1 virus died. 44 cases were confirmed to this date.[55]
A 29-year-old, who had recently visited Mexico, was being tested for a suspected case of swine flu.[56]
Guatemala is checking all travelers arriving from Mexico for signs of flu and stopping anyone with symptoms of the virus at border crossings.[56]
On May 5, in a meeting with Health Minister and the Vicepresident, it was announced that an 11-year-old girl was infected with the AH1N1 virus. It was told that the family of the girl came from Mexico a few days ago, but no one else in the family it is infected.[57]
On the same press meeting,
Rafael Espada said: "We've to prepare ourselves for the worst, and just hope for the best".[58]
The government has stated that they're prepared for a first wave of AH1N1. Nevertheless, other institutions have started to help population by giving them masks and information about the virus.
University of San Carlos de Guatemala by the Faculty of Pharmacy and Pharmaceutics has started to prevent the virus among the students population, as the Rector Estuardo Gálvez said: "This people are prepared to counteratack the virus inside and outside this campus".[59]
As of 7 July 2009, there has been 33 confirmed cases of swine flu in Jamaica. On the 6th of July, Jamaica recorded its first human mortality from the virus. Health Minister Ruddy Spencer told Parliament that the country has been placed on high alert. There has been heightened surveillance at health care facilities and port entry's.[60]
As of July 23, 553 confirmed cases had been reported by Panamanian health authorities:[61]
66% of the cases are teens (12–15) and the 34% are adults(20-49). Only one death has been reported. Schools with positive cases are being disinfected and
thermographic cameras have been deployed at
Tocumen International Airport to identify sickness in arriving passengers.
The members of the Under 17 Trinidad and Tobago football team have taken Flu tests after returning from a World Cup qualifying football match in Mexico City.[62]
One female was confirmed as having contracted the H1N1 influenza. Her identity is being withheld. At the moment, people who travelled on the same aircraft as the infected woman are being asked to contact the relevant health authorities.[63]
Timeline
2009
A(H1N1) Outbreak and Pandemic Milestones in North America
17 March
First case in the world of what would later be identified as swine flu.
28 March
First case in the US of what would later be identified as swine flu.
12 April
First known death due to what would later be identified as swine flu.
25 April
Community outbreaks confirmed in United States.
Community outbreaks confirmed in Mexico.
27 April
First case confirmed in Canada.
29 April
First death confirmed in the United States.
2 May
First case confirmed in Costa Rica.
3 May
First cases confirmed of infections in pigs, also first cases of reverse zoonosis.
4 May
First case confirmed in El Salvador.
5 May
First case confirmed in Guatemala.
7 May
First death confirmed in Canada.
First case of zoonosis in Canada, where an infected pig infects a human.
8 May
First case confirmed in Panama.
Community outbreaks confirmed in Canada.
9 May
First death confirmed in Costa Rica.
12 May
First case confirmed in Cuba.
13 May
Community outbreaks confirmed in Costa Rica.
22 May
First case confirmed in Honduras.
26 May
First case confirmed in Puerto Rico.
27 May
First case confirmed in Dominican Republic.
31 May
First case confirmed in Bahamas.
2 June
First case confirmed in Nicaragua.
First case confirmed in Bermuda.
3 June
First case confirmed in Barbados.
First case confirmed in Jamaica.
4 June
First case confirmed in Trinidad and Tobago.
5 June
First death confirmed in Dominican Republic.
First case confirmed in Cayman Islands.
7 June
First case confirmed in Martinique.
8 June
First case confirmed in Dominica.
10 June
First death confirmed in Guatemala.
Community outbreaks confirmed in Guatemala.
11 June
First case confirmed in British Virgin Islands.
17 June
First case confirmed in U.S. Virgin Islands.
First case confirmed in Netherlands Antilles.
19 June
First case confirmed in Antigua and Barbuda.
22 June
First death confirmed in Honduras.
30 June
First case confirmed in Saint Lucia.
2 July
First case confirmed in Saint Vincent and the Grenadines.
3 July
First case confirmed in Aruba.
First death confirmed in El Salvador.
6 July
First case confirmed in Guadeloupe.
First case confirmed in Saint Martin.
First death confirmed in Jamaica.
7 July
First death confirmed in Puerto Rico.
First case confirmed in Belize.
9 July
Community outbreaks confirmed in Panama.
14 July
First case confirmed in Haiti.
First case confirmed in Saint Kitts and Nevis.
19 July
First death confirmed in Panama.
22 July
First case of Oseltamivir (Tamiflu) resistance found in Canada.[64]
23 July
First case confirmed in Turks and Caicos Islands.
24 July
First case confirmed in Grenada.
First death confirmed in Cayman Islands.
25 July
Community outbreaks confirmed in El Salvador.
Community outbreaks confirmed in Nicaragua.
26 July
Community outbreaks confirmed in Cuba.
Community outbreaks confirmed in Honduras.
27 July
First death confirmed in Saint Kitts and Nevis.
5 August
First case confirmed in Anguilla.
12 August
First death confirmed in Nicaragua.
14 August
First case of Oseltamivir (Tamiflu) resistance found in United States.
3 September
First death confirmed in U.S. Virgin Islands.
18 September
First death confirmed in Martinique.
19 September
First death confirmed in Bahamas.
30 September
First death confirmed in Barbados.
1 October
First case confirmed in Saint Barthélemy.
10 October
First death confirmed in Cuba.
14 October
First death confirmed in Trinidad & Tobago.
22 October
First death confirmed in Guadeloupe.
11 November
First case confirmed in Greenland.
24 November
First country to have double case, following by South Korea.
^Thomas H. Maugh II (April 24, 2009). "Eight swine flu cases identified in U.S.: All victims, six of them in California, have recovered. Officials say the new virus is easily passed, but does not appear to be especially virulent. Researchers plan to go to Mexico, where the viruses in 12 cases match six in the U.S.". Los Angeles Times.
^Emma Hitt (9 May 2009).
"CDC: H1N1 Flu Numbers Represent a "Very Great Underestimate"".
Archived from the original on December 8, 2012. Retrieved 7 June 2009.
With limited resources, some states are placing a priority on testing hospitalized patients, which may create a false impression that the virus is becoming more lethal, Richard Besser, MD, the CDC's acting director, said at a media briefing yesterday.
However, he added that scaled-back testing is also in line with how public health officials handle testing for seasonal influenza. Given that the swine flu outbreak seems to resemble seasonal flu, expect the CDC to revise some of its recommendations and change some of its reporting practices, he said.
As the disease becomes more widespread, tallies of individual cases won't be as meaningful, but health authorities will want to know what regions of the country are affected and to what extent, Besser said. For reporting on the swine flu outbreak, the CDC will likely use the surveillance and reporting model it uses for seasonal flu.
Minnesota is among states that have announced a cutback in influenza testing. In a May 4 press release, the Minnesota Department of Health (MDH) said it was asking healthcare providers to submit lab specimens only when a patient has been hospitalized for flu-like symptoms. It will also continue to accept specimens from the state's 29 sentinel influenza surveillance sites and for ill healthcare workers.
May 9, 2009 — The confirmed numbers of influenza A (H1N1) cases reported are likely to fall far short of the actual numbers occurring within the community, according to a US Centers for Disease Control and Prevention (CDC) spokesperson.
"The individual numbers are likely a very great underestimate of how much virus is circulating or how many people are becoming ill from it," said Anne Schuchat, MD, the Director of the CDC's National Center for Immunization and Respiratory Diseases, speaking at a media briefing today.
...
^Donald G. McNeill Jr. (15 May 2009).
"Mild U.S. Flu Cases May Exceed Official Tally". The New York Times.
Archived from the original on 14 March 2017. Retrieved 7 June 2009. The official, Dr. Daniel Jernigan, head of flu epidemiology for the Centers for Disease Control and Prevention, said at a news conference that the official number gave an inaccurate picture of the outbreak because so few mildly sick people were being tested.