Published 12 May 2009, doi:10.1136/bmj.b1962
Cite this as: BMJ 2009;338:b1962

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Number of confirmed A/H1N1 flu cases doubles over one weekend

¹ London

The number of confirmed swine flu cases worldwide rose by 88% over the weekend of 9 and 10 May, from 2500 to 5251, in 30 countries, the World Health Organization has said.

As the number of cases of A/H1N1 flu rose, the first death linked to it in Canada was announced. A woman from northern Alberta who had chronic pre-existing health problems and who had not travelled to Mexico died on 28 April.

The numbers of deaths had risen to 48 in Mexico, three in the United States, one in Canada, and one in Costa Rica.

The total number of cases in the United Kingdom rose from 39 on Friday 8 May to 65 by the time the BMJ went to press on Tuesday, and laboratory testing is under way in another 336 cases, the Health Protection Agency said.

One of the sharpest rise in cases in the past few days was in the US, which is now the most affected country in the world. It recorded a rise of around 1630 cases since Friday of last week.

England’s health secretary, Alan Johnson, announced after a visit to the Health Protection Agency’s National Institute of Biological Standards and Control that the agency’s researchers had succeeded in working out the full genetic code of the A/H1N1 flu virus, the first step towards producing a European prototype of a vaccine.

Researchers now hope that European manufacturers will be able to take delivery of possible vaccine prototypes in the coming months so that the first steps can be taken in the mass production of vaccine.

Researchers from the US Centers for Disease Control and Prevention had already published genetic information on the virus, but the team from the Health Protection Agency had been working on getting the full genetic fingerprint of the virus that has infected Europeans.

Meanwhile an analysis of the A/H1N1 virus published on Tuesday 12 May said that around one in three people around the world could become infected. The study, led by Neil Ferguson of Imperial College London and published in the journal Science (doi:10.1126/science.1176062), said that the new virus was as dangerous as the one that caused a pandemic in 1957 (killing two million people) but not as dangerous as the virus that caused the 1918 Spanish flu pandemic, which killed between 50 and 100 million people.

Professor Ferguson told BBC Radio 4’s Today programme: "This virus really does have full pandemic potential. It’s likely to spread around the world in the next six to nine months, and when it does so it will infect about a third of the world’s population.

"Normal seasonal flu every year probably infects about 10% of the world’s population, so we are heading for a flu season which is perhaps three times worse than usual."

He said it was uncertain how many people would die from this swine flu, but he estimated that it could be between four in every 1000 infected people and 14 in every 1000.

Professor Ferguson added: "Come the autumn, it’s likely to cause a major epidemic. One of the key decisions that has to be made this week by the world communities is how much do we switch over current vaccine production for seasonal flu to making vaccine against this particular virus."

The UK government has secured supply agreements that will enable it to buy as many as 132 million doses of pandemic specific vaccine, when it becomes available. Mr Johnson said: "A significant step towards protecting the world’s health against swine flu has been taken."

The Department of Health has appointed Ian Dalton, currently chief executive of NHS North East, to be head of flu resilience. He is tasked with ensuring that the health service in England can cope with a swine flu pandemic.

Mr Dalton will be responsible for ensuring that all NHS organisations are ready for a pandemic and are supplied with enough equipment and drugs.

Margaret Chan, director general of the World Health Organization, has warned countries not to "drop the ball" in monitoring the avian flu virus, H5N1.

Dr Chan, addressing a special meeting of health ministers at the end of last week, thanked them for their efforts in tracking and dealing with the effects of the H5N1 virus in humans and animals in recent years.

"For five long years you have kept this avian virus under watch and largely under control," she said.

"As we know today, the virus with the greatest pandemic potential, the H1N1 virus, has sprung up from another source, on another side of the world. But H5N1 taught the world to expect a pandemic and to plan for this event.

"Let me make two requests. First, do not drop the ball on monitoring H5N1. This virus is endemic in poultry in parts of the region. We have no idea how H5N1 will behave under the pressure of a pandemic.

"Second, H5N1 has conditioned the public to equate an influenza pandemic with very severe disease and high mortality. Such a disease pattern is by no means inevitable during a pandemic. We must battle misperceptions with the facts."

Cite this as: BMJ 2009;338:b1962

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