The patient is a 19-year-old Singaporean studying in the United States, who returned for the summer holidays. She arrived in Singapore from New York via Tokyo on All Nippon Airways NH901 at 11:40pm local time on May 28. She developed symptoms on Monday morning (June 1), and a 993 ambulance was called to send her to the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital. She was admitted to the CDC on the afternoon of the same day. Laboratory results confirmed her infection at 9pm on Tuesday. Singapore's Health Ministry (MOH) has assessed that no flight passengers needed to be quarantined as the case only developed onset of symptoms more than 24 hours after disembarkation, hence she was assessed to be non-infectious during the flight. MOH added on Wednesday that tracing for the local contacts has been initiated. So far, two close contacts involving the case's family members have been identified. They are currently well and home quarantine orders will be served to them. Tracing for other local contacts is on-going. The Ministry said that so far, all the nine cases are imported and have a travel history. There is currently no evidence of community spread. MOH said it is monitoring the situation closely and will update the public on any new developments. For more information on Influenza A(H1N1), please access MOH's website at www.moh.gov.sg, call the hotline at 1800-333 9999, or visit www.flu.gov.sg. - CNA Source : http://www.channelnewsasia.com/stories/singaporelocalnews/view/433527/1/.html
The World Health Organization reported on Tuesday that Egypt confirmed the first case of H1N1 flu virus. The case involves a 12-year-old girl that arrived to Cairo.
The infected girl is an American from Minnesota that was travelling with her mother to spend holidays in Egypt. She was quarantined as she arrived the Cairo airport.
The case was detected by the thermal detectors placed in the airport as declared by the regional adviser for communicable disease surveillance for the WHO, Hassan al-Bushra.
Hassan al-Bushra also stated that she is in good condition and given treatment. Her mother was given treatment as well.
The Ministry of Health has said in an update on the H1N1 flu that there are two more confirmed cases in Singapore as of 5pm today.
According to the Ministry, both cases have relatively mild symptoms and are in stable condition.
The addition of two new cases brings the total number of H1N1 cases in Singapore to seven.
The 6th case is a 36-year-old Singaporean male who was in Manila on a business trip from 18 - 29 May.
He returned to Singapore from Manila on Friday 29 May on Singapore Airlines SQ917 at 1750 hours. He was seated at row 17.
The 7th case is a 30-year-old Australian male tourist who had travelled to Chicago from 14 - 21 May, Detroit from 21 - 25 May, and New York from 25 - 30 May.
He developed symptoms on 26 May while he was in New York. He arrived in Singapore from New York via Frankfurt on SQ25 at 0618 hours on 1 June.
Laboratory-confirmed cases of new influenza A(H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005)
Country
Cumulative total
Newly confirmed since the last reporting period
Cases
Deaths
Cases
Deaths
Argentina
100
0
63
0
Australia
297
0
150
0
Austria
1
0
0
0
Bahamas
1
0
1
0
Bahrain
1
0
0
0
Belgium
12
0
4
0
Bolivia
3
0
3
0
Brazil
18
0
8
0
Canada
1336
2
218
0
Chile
250
0
85
0
China
52
0
22
0
Colombia
20
0
3
0
Costa Rica
37
1
4
0
Cuba
4
0
0
0
Cyprus
1
0
1
0
Czech Republic
1
0
0
0
Denmark
1
0
0
0
Dominican Republic
2
0
0
0
Ecuador
39
0
7
0
El Salvador
27
0
16
0
Estonia
1
0
1
0
Finland
3
0
0
0
France
24
0
3
0
Germany
28
0
9
0
Greece
4
0
1
0
Guatemala
12
0
7
0
Honduras
2
0
1
0
Hungary
1
0
1
0
Iceland
1
0
0
0
India
1
0
0
0
Ireland
4
0
1
0
Israel
19
0
8
0
Italy
29
0
3
0
Jamaica
2
0
2
0
Japan
370
0
6
0
Korea, Republic of
33
0
0
0
Kuwait
18
0
0
0
Malaysia
2
0
0
0
Mexico
5029
97
119
12
Netherlands
3
0
0
0
New Zealand
9
0
0
0
Norway
4
0
0
0
Panama
107
0
0
0
Paraguay
5
0
5
0
Peru
36
0
5
0
Philippines
16
0
10
0
Poland
4
0
0
0
Portugal
1
0
0
0
Romania
3
0
0
0
Russia
3
0
1
0
Singapore
5
0
1
0
Slovakia
2
0
1
0
Spain
178
0
35
0
Sweden
4
0
0
0
Switzerland
8
0
4
0
Thailand
2
0
0
0
Turkey
4
0
2
0
United Kingdom
229
0
26
0
United States of America
8975
15
1048
4
Uruguay
11
0
9
0
Venezuela
2
0
2
0
Viet Nam
1
0
1
0
Grand Total
17410
115
1900
16
Chinese Taipei has reported 12 confirmed cases of influenza A (H1N1) with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above. Cumulative and new figures are subject to revision Source : http://www.who.int/csr/don/2009_06_01a/en/index.html
A spokesman for the Department of Health (DH) today (May 30) said that the department was investigating three newly confirmed cases of human swine influenza (Influenza A H1N1).
This brings to 23 the total number of human swine influenza cases in Hong Kong. All of them are imported cases.
The first case involved a 21-year-old man. He stayed in the United States from May 15 to 27 and returned to Hong Kong on May 28 from New York by taking a flight of Continental Airlines (flight no. CO009). He wore a face mask during the flight and sat in row 23.
The patient took Airport Express to Tsing Yi where he took a taxi to his home in Cheung Hang Estate, Kwai Tsing.
He had onset of headache in the middle of the flight and developed fever and sore throat after arriving home. He stayed at home during that night.
He consulted a private doctor in the morning of May 29. The doctor referred him to Princess Margaret Hospital (PMH) by ambulance.
His family members are asymptomatic.
The second case involved an eight-year-old boy living in the United States. The boy, accompanied with three family members, arrived in Hong Kong on May 30 from San Francisco by taking a flight of Singapore Airlines (flight no. SQ1).
The boy developed fever, cough, runny nose and malaise during the flight. He sat in row 39 of the flight.
He was intercepted by Port Health Office and was transferred to PMH by ambulance for isolation.
His mother stayed with him in Hong Kong while his father and sister had gone to the Mainland this morning. They were asymptomatic.
The third case involve a 19-year-old woman studying in the United States. She returned to Hong Kong from New York in the evening of May 28.
She and her mother took an airport bus to Wan Tsui Estate in Eastern District.
On May 29, she went to China Travel Agency in Shau Kei Wan and to Immigration Department in Wan Chai to apply for some documents.
She had onset of fever, cough and sore throat in the afternoon. Her mother took her to the Accident and Emergency Department of Pamela Youde Nethersole Eastern Hospital by minibus and was admitted for isolation. She wore a face mask on the journey.
Her family contacts are asymptomatic.
As she had onset of symptoms more than 12 hours after he arrived Hong Kong, CHP would not trace the flight passengers.
Laboratory analysis on respiratory sample taken from the three patients yielded positive results for human swine influenza today.
DH is now tracing passengers sitting in rows 20-26 of CO099 arrived in Hong Kong on May 28 and those sitting in rows 36-42 of SQ1 arrived in Hong Kong on May 30, and crew members of the flights concerned who had served the affected section of the cabin concerned as well as other close contact of the three patients.
Passengers who had travelled on the two concerned flights are urged to call the DH¡¦s Centre for Health Protection hotline 2125 1111.
The spokesman also urged the taxi driver who took the 21-year-old male patient from Tsing Yi to Cheung Hang Estate on May 28 to call the hotline.
Investigations into the three cases are ongoing.
Meanwhile, the spokesman called on members of the public to advise their children, relatives or friends coming to Hong Kong from abroad to defer their trips if they developed symptoms such as fever, cough or sore throat.
"To protect their own health and that of other travellers, they should seek medical attention where they are.
"If they feel unwell on the plane, they should wear a face mask and inform cabin crew immediately," the spokesman said.
End/Saturday, May 30, 2009 Source : http://www.chp.gov.hk/view_content.asp?lang=en&info_id=17311
By Cheryl Lim, Channel NewsAsia | Posted: 31 May 2009 1149 hrs
SINGAPORE: Singapore on Sunday confirmed its fifth case of the H1N1 virus.
The patient is a 22- year-old Singaporean who had travelled to the United States from May 13 to 28.
The Health Ministry (MOH) said she is currently being treated at the Communicable Disease Centre at Tan Tock Seng Hospital and is in a stable condition.
She returned from New York via Tokyo at about 11.30pm on Friday, on All Nippon Airways NH901 flight, seated at Row 36.
She had no fever and passed the thermal scanners at the airport.
She was met by her family who took her home in the family car.
She subsequently developed a fever at around 8am on Saturday.
Her mother drove her to the hospital's emergency department and she was admitted to the Communicable Disease Centre for further testing.
Laboratory results confirmed her infection at 8.05pm on the same day.
The Ministry said her symptoms are mild.
It has initiated tracing of her close contacts, who will be quarantined and provided with antiviral prophylaxis.
Passengers within rows 34 to 38 on All Nippon Airways NH901 on May 29, who have not been contacted by the Ministry, should call the MOH hotline at 1800-333 9999.
BEIRUT, May 30 (Bernama) -- Lebanon on Saturday announced the country's first confirmed three cases of influenza A/H1N1, reports China's Xinhua news agency quoting a local website as saying.
Minister of Public Health Mohammad Jawad Khalifeh said two foreigners and a Lebanese have been found infected with the fatal flu at Beirut international airport, local Naharnet website reported.
Speaking at a press conference, Khalifeh said the Lebanese flu victim remains in quarantine and that the two foreigners -- a Canadian mother and her son -- are fully cured.
29 May 2009 -- As of 06:00 GMT, 29 May 2009, 53 countries have officially reported 15,510 cases of influenza A(H1N1) infection, including 99 deaths.
The breakdown of the number of laboratory-confirmed cases by country is given in the following table.
Laboratory-confirmed cases of new influenza A(H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005)
Country
Cumulative total
Newly confirmed since the last reporting period
Cases
Deaths
Cases
Deaths
Argentina
37
0
18
0
Australia
147
0
81
0
Austria
1
0
0
0
Bahrain
1
0
0
0
Belgium
8
0
0
0
Brazil
10
0
0
0
Canada
1118
2
0
0
Chile
165
0
0
0
China
30
0
3
0
Colombia
17
0
0
0
Costa Rica
33
1
0
0
Cuba
4
0
0
0
Czech Republic
1
0
0
0
Denmark
1
0
0
0
Dominican Republic
2
0
0
0
Ecuador
32
0
0
0
El Salvador
11
0
0
0
Finland
3
0
1
0
France
21
0
1
0
Germany
19
0
1
0
Greece
3
0
0
0
Guatemala
5
0
0
0
Honduras
1
0
0
0
Iceland
1
0
0
0
India
1
0
0
0
Ireland
3
0
0
0
Israel
11
0
0
0
Italy
26
0
1
0
Japan
364
0
0
0
Korea, Republic of
33
0
12
0
Kuwait
18
0
0
0
Malaysia
2
0
0
0
Mexico
4910
85
104
0
Netherlands
3
0
0
0
New Zealand
9
0
0
0
Norway
4
0
0
0
Panama
107
0
31
0
Peru
31
0
4
0
Philippines
6
0
0
0
Poland
4
0
0
0
Portugal
1
0
0
0
Romania
3
0
2
0
Russia
2
0
0
0
Singapore
4
0
3
0
Slovakia
1
0
1
0
Spain
143
0
1
0
Sweden
4
0
1
0
Switzerland
4
0
0
0
Thailand
2
0
0
0
Turkey
2
0
0
0
United Kingdom
203
0
18
0
United States of America
7927
11
0
0
Urguay
2
0
0
0
Grand Total
15510
99
283
0
Chinese Taipei has reported 9 confirmed cases of influenza A (H1N1) with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above. Cumulative and new figures are subject to revision.
Pada Maret, April dan Mei 2009, wabah influenza telah menyebabkan 13.398 kasus dan 95 kematian akibat strain baru dari virus influenza H1N1. Centers for Disease Control (CDC) Amerika Serikat telah memperingatkan kemungkinan perkembangan ke arah pandemi. Pada 27 April 2009, badan kesehatan dunia World Health Organization mendeclare terjadinya PHEIC (Public Health Emergency of International Concern) dan meningkatkan status kewaspadaan dari level 3 ke level 4 (maksimal level 6), karena transmisi virus dari manusia ke manusia secara berkesinambungan telah terbukti terjadi. Selanjutnya pada tanggal 30 April ditingkatkan dari level 4 ke level 5.
Awal mula munculnya strain baru ini tidak diketahui pasti tetapi kasus infeksi pada manusia pertama terjadi di dekat sebuah peternakan babi di La Gloria, Veracruz, Meksiko. Edgar Hernandez, seorang anak berusia 4 tahun, awalnya didiagnosis menderita flu biasa tetapi tes laboratorium membuktikan bahwa Edgar terkena flu babi (swine flu).
Dr. Anne Schuchat, interim Deputi Direktur CDC menyatakan virus flu Meksiko yang diisolasi dari pasien di Amerika Serikat terdiri dari empat elemen genetik virus influenza yang berbeda yaitu virus North American Mexican influenza, North American avian influenza, human influenza, dan swine influenza- "suatu campuran genetik yang tidak umum." Strain baru terbentuk dari proses reassortment virus influenza manusia dan influenza babi pada empat strain berbeda dari subtipe H1N1. Virus influenza mengalami reassortment karena ada perubahan antigenik. Oleh karena pada kasus flu Meksiko ini virus belum diisolasikan dari hewan maka sampai sekarang organisasi kesehatan hewan dunia World Organization for Animal Health (OIE) menamakan virus ini sebagai flu Meksiko.
Pandemi influenza
Ada kekhawatiran bahwa epidemic H1N1 influenza atau flu babi (Swine Flu) di Meksiko akan menjadi pandemi seperti diutarakan CDC. Pandemi influenza adalah epidemi dari virus influenza yang menyebar ke seluruh dunia dan menginfeksi sebagian besar populasi manusia. Berlawanan dengan epidemi flu yang berlangsung reguler, pandemi terjadi dalam waktu yang tidak beraturan. Sekurang-kurangnya terdapat tiga pandemi flu dalam satu abad terakhir yaitu flu Spanyol tahun 1918, flu Asia tahun 1959, dan flu Hong Kong tahun 1968.
Flu Spanyol tahun 1918 adalah pandemi influenza yang menyebar hampir ke seluruh dunia. Kejadian ini disebabkan oleh virus Influenza A subtipe H1N1 yang sangat virulen. Data sejarah dan epidemiologi kurang adekuat untuk dapat mengidentifikasi asal virus ini tetapi Sekutu pada Perang Dunia I menyebutnya sebagai flu Spanyol karena kejadian ini baru mendapat perhatian besar dari pers ketika virus ini mulai menyerang Spanyol pada November 1918. Pandemi terjadi dari bulan Maret 1918 sampai Juni 1920 menyebar dari Arktik sampai pulau Samoa di samudera Pasifik. Diestimasikan terdapat 20 sampai 100 juta orang meninggal di seluruh dunia karena virus ini.
Strain baru influenza
Pandemi influenza terjadi ketika strain baru virus influenza mengalami transmisi dari hewan ke manusia. Hewan yang berperan penting dalam transmisi strain baru virus ke manusia antara lain babi, ayam dan bebek. Strain baru ini tidak terpengaruh oleh sistem imunitas tubuh yang sudah ada sehingga akibatnya dapat menginfeksi banyak populasi manusia secara cepat.
Influenza adalah penyakit infeksi pada burung dan mamalia yang disebabkan oleh virus RNA dari keluarga Orthomyxoviridae. Virus H1N1 adalah subtipe virus influenza A dan penyebab utama influenza pada manusia. Beberapa strain H1N1 endemik pada manusia sementara beberapa strain lainnya endemik pada babi dan burung. Virus influenza memiliki angka mutasi yang tinggi yang merupakan karakteristik virus RNA. Kemampuan strain virus influenza untuk memilih inangnya adalah karena adanya variasi pada gen hemagglutinin. Mutasi pada gen hemaglutinin akan menyebabkan substitusi satu asam amino yang secara signifikan mengubah kemampuan protein hemaglutinin virus untuk mengikat reseptor pada permukaan sel inang. Mutasi inilah yang dapat mengubah virus influenza dari non virulen menjadi sangat virulen ke manusia.
Manifestasi klinis
Menurut CDC, gejala flu Meksiko atau flu babi serupa dengan gejala influenza pada umumnya. Gejalanya meliputi demam, batuk, nyeri tenggorok, nyeri otot, sakit kepala, menggigil, dan rasa lelah. Pada beberapa kasus terdapat gejala diare dan muntah. Pada flu Spanyol tahun 1918 bahkan gejalanya menyerupai penyakit dengue, kolera, dan typhoid sehingga sering sekali terjadi misdiagnosis. Karena gejalanya yang tidak spesifik maka untuk menegakkan diagnosis flu Meksiko diperlukan riwayat kontak dengan penderita flu Meksiko yang sudah terkonfirmasi. CDC Amerika Serikat bahkan menyarankan dokter di wilayah Amerika Serikat untuk mempertimbangkan diagnosis infeksi flu Meksiko atau flu babi pada pasien dengan gejala infeksi saluran nafas atas disertai demam yang mengalami kontak dengan penderita yang sudah dikonfirmasi menderita flu babi atau kontak dengan pasien flu babi di 5 negara bagian di Amerika Serikat atau riwayat bepergian ke Meksiko dalam kurun waktu tujuh hari sebelum muncul gejala flu. Diagnosis harus selalu dikonfirmasikan dengan pemeriksaan laboratorium dari sampel saluran nafas seperti apusan hidung atau tenggorok.
Rute infeksi di manusia
Kesimpulan dari beberapa penelitian menyatakan bahwa angka kematian yang besar pada flu Meksiko terjadi karena adanya badai sitokin di tubuh akibat dari sistem kekebalan tubuh yang sangat bereaksi terhadap virus sehingga malah menghancurkan tubuh. Hal tersebut menjelaskan pertanyaan mengapa infeksi sebagian besar terjadi pada orang usia muda dan sehat. Hal tersebut karena orang usia muda dan sehatlah yang memiliki kekebalan tubuh yang baik sebelum terjadi infeksi sehingga memiliki kecenderungan mengalami reaksi berlebihan terhadap virus. Umumnya, virus influenza ditransmisikan dari manusia yang terinfeksi melalui udara saat batuk atau bersin sehingga droplet berisi virus keluar atau bisa ditransmisikan dari unggas yang terinfeksi melalui fesesnya. Influenza juga ditransmisikan melalu air ludah, ingus, feses, dan darah. Infeksi terjadi ketika hemaglutinin virus influenza menyentuh permukaan epitel tubuh terutama yang mempunyai reseptor virus seperti di hidung, tenggorok, dan saluran nafas. Virus flu dapat tetap infeksius selama satu minggu pada suhu tubuh manusia dan bertahan 30 hari pada suhu 0°C. Beberapa strain virus influenza dapat dengan mudah diinaktivasi oleh disinfektan dan deterjen.
Solusi untuk pencegahan dan terapi
Pencegahan dari flu Meksiko atau flu babi terdiri dari tiga komponen yaitu pencegahan pada hewan, pencegahan transmisi hewan ke manusia, dan pencegahan transmisi antar manusia. Pencegahan pada hewan termasuk pemberian vaksin pada hewan yang terbukti sangat ampuh jika strain virus dalam vaksin cocok dengan strain virus di lingkungan sehingga memiliki efek proteksi silang yang signifikan.
Kasus transmisi virus influenza dari hewan ke manusia yang bekerja di peternakan babi ditemukan pada sebuah penelitian tahun 2004 oleh University of Iowa. Pekerja di peternakan babi dan unggas memiliki risiko tinggi untuk terkena transmisi virus dari hewan dan proses reassortment dapat terjadi. Vaksinasi influenza sering diberikan pada pekerja peternakan di negara maju tapi ternyata vaksin tersebut tidak memiliki efek proteksi karena perbedaan antigen yang besar.
Rekomendasi untuk mencegah penyebaran virus antar manusia termasuk penggunaan protokol standar pengawasan infeksi influenza. Termasuk tindakan mencuci tangan sesering mungkin terutama jika setelah bepergian ke luar rumah. Tindakan mencuci tangan dapat menggunakan sabun, air, atau alkohol. Virus influenza ternyata tidak hanya dapat menyebar melalui droplet tetapi dapat juga ditransmisikan melalui jari tangan ke mulut, hidung, atau mata. Pada kasus pandemi, WHO merekomendasikan empat langkah untuk mengurangi penyebaran virus yaitu isolasi dan terapi segera pada penderita baik yang baru dicurigai maupun sudah terbukti menderita flu babi, karantina bagi rumah tangga yang mengalami kontak dengan penderita, meliburkan sekolah dan merubah jam kerja, serta menunda pertemuan yang bersifat masal.
Obat antivirus terutama inhibitor neuraminidase terbukti efektif dalam mengatasi flu babi. CDC merekomendasikan penggunaan oseltamivir dan zanamivir untuk mencegah resistensi. Amantadine dan rimantadine tidak digunakan karena dari sampel pasien flu Meksiko terbukti bahwa virus pada flu babi resisten terhadap amantadine dan rimantadine. Tetapi, sebagian besar pasien sembuh sempurna tanpa memerlukan obat antivirus.
Belajar dari avian flu
Indonesia memiliki pengalaman menangani avian flu. Pengalaman seperti tidak ada lagi keterlambatan dalam deteksi, pencanangan gerakan nasional, persiapan rumah sakit rujukan, melakukan cegah tangkal terhadap penderita dari negara terinfeksi flu babi, program kampanye kesadaran masyarakat, dan pembuatan peraturan untuk menyokong program pencegahan dapat membuat rakyat Indonesia sadar dan siap untuk menghadapi penyakit ini. Program pencegahan flu babi harus dibuat segera. Fokus program harus pada memaksimalkan cakupan deteksi dini dan pusat pelayanan yang siaga. Mortalitas dapat dicegah jika program pencegahan diletakkan pada pilar pertama. Ini adalah kesempatan besar bagi pemerintah untuk melindungi rakyatnya dari ancaman penyakit mematikan. Bukankah pencegahan selalu lebih baik?
![Map of the spread of Influenza A(H1N1): number of laboratory confirmed cases and deaths [jpg 995kb]](http://www.who.int/entity/csr/don/H1N1map20090601.jpg){kind=link}
