Nicd special communique november 2009.pub

Volume 8, No. 11 Additional Issue (1) Pandemic Influenza A(H1N1) 2009: New case confirmed in a traveller to South Africa Although there has been a decline in local transmis- influenza A(H1N1) activity. Treatment with sion of pandemic influenza A(H1N1) 2009 in recent oseltamivir and broad-spectrum antibiotics was weeks, it remains important for clinicians to continue to suspect pandemic H1N1 infection in patients pre- senting with influenza-like-il ness (ILI), especially in As of 2 November 2009, a total of 12 619 cases and individuals with a recent history of travel. In this 91 deaths have been laboratory-confirmed in South special communiqué we provide an update on the Africa. Fol owing the peak in case frequency during international and South African situations, the August, we have observed a decline in the number vaccine for pandemic influenza A(H1N1) 2009, and of newly confirmed cases (Figure). The last local y advice to travel ers. acquired infections were identified on 5 October 2009; and currently there does not appear to be International situation update local transmission of pandemic H1N1 virus in South Worldwide there have been more than 440 000 Africa. There is, however, ongoing monitoring laboratory confirmed cases of pandemic influenza A through the influenza surveil ance programmes (visit (H1N1) 2009 and over 5 700 deaths reported to www.nicd.ac.za for details on the current situation). WHO from April to 25 October 2009. In the temperate zones of the northern hemisphere, The recent case described here highlights the impor- influenza transmission continues to intensify, mark- tance of sustained vigilance by clinicians to maintain ing an unusual y early start to winter influenza a high index of suspicion for pandemic influenza A season in some countries. In particular, significant (H1N1), especial y in travel ers from the northern numbers of cases are being reported from North hemisphere. Pandemic influenza A(H1N1) must be America, Eastern and Western Europe, the Middle- included in the differential diagnosis of travel ers with East, as wel as Western and Central Asia, where pneumonia, and especial y in patients presenting pandemic A(H1N1) 2009 virus is the predominant with ARDS. Pregnant women, persons with chronic cause of high rates of ILI (visit www.who.int/csr/ cardiac and respiratory conditions, morbid obesity, disease/swineflu/updates/en/index.html for a diabetes, and those with immunosuppressive condi- detailed update). tions (including HIV) remain at increased risk for South Africa situation update: New case identified in a traveller to South Africa Throat and nasal swabs (submitted in viral transport Pandemic influenza A(H1N1) was confirmed on 1 medium and marked for influenza testing) should be November 2009 in a female patient, resident in the col ected from al inbound travel ers from the United Arab Emirates, who travel ed to South Africa northern hemisphere presenting with severe acute on 29 October and presented with an ILI on 31 respiratory il ness (including ARDS), as wel as October 2009. This patient is 33 weeks pregnant those at increased risk for severe disease and has a history of rheumatic heart disease. presenting with ILI. Treatment with oseltamivir must Pandemic influenza was suspected on the basis of be started immediately in such cases if pandemic the clinical presentation with acute respiratory influenza is suspected — do not withhold treatment distress syndrome (ARDS) and a history of inbound while waiting for laboratory results. Antiviral treat- travel from an area with a high level of pandemic (Continued on page 2) Volume 8, Additional issue (Continued from page 1) Advice to travellers ment should continue to be limited to those with Persons travel ing to the Northern Hemisphere moderate to severe disease, and patients at should be made aware of the risk of pandemic increased risk of developing complications (see the influenza A(H1N1) infection. They should be Revised Health Workers Handbook on Pandemic advised to practice hand and cough hygiene, and to Influenza A(H1N1) 2009, version 3, 19 August 2009; seek health care promptly should they develop ILI. available from the NICD website). Travel ers may be able to access the monovalent vaccine against H1N1 pandemic virus at their destination; however, should also be cautioned of Vaccine for pandemic influenza A (H1N1) 2009 is the 10-14 day lag time to the development of not currently available in South Africa. Vaccination protective antibodies, during which they wil be using a monovalent (adjuvanted or non-adjuvanted), susceptible to infection. Antiviral prophylaxis is not one-dose schedule vaccine for pandemic influenza recommended for travel ers; however, individuals at A(H1N1) commenced in a number of northern hemi- high-risk for development of severe disease may be sphere countries in October 2009, where pregnant prescribed an appropriate course of antiviral women and persons with chronic il ness have been medication with instructions to begin taking the drug prioritised. The proposed vaccine for the Southern at the first signs of onset of il ness. Hemisphere wil either be a trivalent vaccine (effective against the H1N1 pandemic virus, the seasonal H3N2 and influenza B viruses), or a bivalent seasonal vaccine with a separate Source: NHLS: Epidemiology and Virology Divisions, NICD; monovalent H1N1 pandemic vaccine. It is currently Tygerberg Hospital; Groote Schuur Hospital; Universitas Hospi- not clear when the vaccine wil be available in South tal; Steve Biko Academic Hospital; Inkosi Albert Luthuli Central Hospital. Private laboratories: Ampath, Lancet, PathCare and Africa, but this is likely to be within the first quarter of Vermaak laboratories. **Data is strictly preliminary. Laboratory-based surveil ance is subject to time delays. Total case counts for the most recent weeks is likely incomplete and wil increase with the reporting of new cases. Week calculated from date of onset or date of specimen col ection if onset is unknown. Figure: Number of laboratory confirmed pandemic influenza A(H1N1) 2009 cases and deaths by week, South Africa, updated 2 November 2009 (n(cases)=12 619, of which 25 with unknown date; n(deaths)=91, of 2 with unknown dates). This communiqué is published by the National Institute for Communicable Diseases (NICD) on a monthly basis for the purpose of providing up-to-date information on communicable diseases in South Africa. Much of the information is therefore preliminary and should not be cited or utilised for publication.

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