Update on the Influenza A(H1N1) Situation From Ministry of Health, Ghana Update15 2009-05-30 The reported outbreaks of influenza A(H1N1) in humans continue to evolve rapidly. WHO has recommended that the new virus be officially called influenza A(H1N1), instead of swine influenza. This is to reflect an important fact: though this new virus originated in pigs, it is a human virus now and current concerns are with person to person transmission. Transmission of this virus from pigs to humans is not a major public health concern at this point.
The outbreak which initially affected Mexico, United States of America, and Canada has spread to other countries. As at 08:00 hours GMT, 26 May 2009, 46 countries have reported a total of 12,954 laboratory confirmed cases with 92 deaths.
The table below shows the number of confirmed cases reported to the World Health Organization (WHO).
Cumulative Reported Laboratory Confirmed Cases of
Influenza A(H1N1) as at 08:00 GMT on 26 May 2009
Country Cumulative Total as at 26 May 2009 Newly confirmed since 25 May 2009
Cases Deaths Cases Deaths
Argentina 5 0 3 0
Australia 19 0 3 0
Austria 1 0 0 0
Belgium 7 0 0 0
Brazil 9 0 0 0
Canada 921 1 116 0
Chile 74 0 30 0
China 20 0 5 0
Colombia 16 0 3 0
Costa Rica 33 1 5 0
Cuba 4 0 0 0
Denmark 1 0 0 0
Ecuador 24 0 14 0
El Salvador 6 0 0 0
Finland 2 0 0 0
France 16 0 0 0
Germany 17 0 0 0
Greece 1 0 0 0
Guatemala 4 0 0 0
Honduras 1 0 0 0
Iceland 1 0 0 0
India 1 0 0 0
Ireland 1 0 0 0
Israel 8 0 0 0
Italy 19 0 0 0
Japan 350 0 5 0
Kuwait 18 0 0 0
Malaysia 2 0 0 0
Mexico 4174 80 0 0
Netherlands 3 0 0 0
New Zealand 9 0 0 0
Norway 4 0 0 0
Panama 76 0 0 0
Peru 27 0 2 0
Philipines 2 0 1 0
Poland 3 0 0 0
Russia 2 0 1 0
Portugal 1 0 0 0
Republic of Korea 21 0 18 0
Spain 136 0 3 0
Sweden 3 0 0 0
Switzerland 3 0 0 0
Thailand 2 0 0 0
Turkey 2 0 0 0
United Kingdom 137 0 15 0
USA 6764 10 212 1
Chinese Taipei 4 0 3 0
Total 12954 92 439 1
The level of pandemic alert is currently Phase 5 which suggests that human- to-human transmission of an animal or human-animal influenza reassortant virus that is able to sustain community-level outbreaks has been verified and the same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.
Sustained human to human transmission occurs when three generations are involved - i.e. the virus has passed from person A to person B and then to person C.
Sustained person to person transmission of this flu virus is currently limited to the US and Mexico – for this reason, the pandemic alert phase remains at 5. In other countries, the virus seems to be associated with return travellers.
The disease may present like common cold with cough, sore-throat, fever, catarrh, general weakness, body ache and headache, and sometimes vomiting or diarrhoea. It may lead to severe pneumonia with difficulty in breathing, rapid breathing and chest pain.
When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.
The following measures have been or are being implemented:
• Training on influenza case management for influenza teams from five regional hospitals and selected hospitals in the southern sector of the country took place from 24 – 26 May 2009 in Accra. Similar training will be held for the northern sector teams from 27 – 29 May 2009 in Kumasi
• Four sub-committees of National Technical Coordinating Committee have been formed to support the implementation of pandemic influenza preparedness and response activities. The sub-committees are Communication; Surveillance; Prevention, containment and case management; Resource Mobilization
• A high level National Coordinating Committee (NCC) is to be established to coordinate the overall preparedness and response in the country.
• An alert on the outbreak sent to regions and districts with regular updates
• Enhancement of surveillance for early detection nationwide
• Protocols for specimen collection and transportation have been updated by Noguchi Memorial Institute for Medical Research designated as the lead institution for case confirmation and have been sent to the regions
• Staff of port health, and immigration at the Kotoka International Airport have been given orientation and have set up surveillance and information desks at the airport to educate travellers
• Measures have also been put in place at the airport to refer and transport immediately any arriving passenger who is ill to 37 Military hospital for treatment
• Steps taken to ensure adequate stocks of antiviral drugs, supplies and personal protective equipment that have been prepositioned in the regions for treatment of cases
• Ministry of Health and its Agencies are putting in place systems for prompt and appropriate management of all cases
• All regional hospitals are to establish isolation wards for managing cases of influenza A(H1N1). In the Greater Accra Region, the Korle Bu Teaching Hospital, 37 Military and Police Hospitals have been identified as referral treatment centres.
• All Regions and districts are to activate their Pandemic Influenza response committees and their contingency plans
• Regular press releases from the Ministry of Health to inform and educate the public
• Various channels are being used to educate the general public
• NADMO hotline has been activated for people who want to get information and want to give information. The hotlines are 021 772926 and 020 2019090
In line with current WHO recommendations, it is advised that there should be no restriction of regular travel or closure of borders. It is however considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek immediate medical attention.
The following simple precautions are to be followed by the general public as preventive measures;
• Observe respiratory hygiene/cough etiquette:
- Cover the nose and mouth when coughing or sneezing;
- Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use; do not use a handkerchief that is also used to wipe away sweat;
- Perform hand hygiene after having contact with respiratory secretions and contaminated objects/materials;
• Report any influenza-like illnesses to the nearest health facility
• Avoid close contact with people who appear unwell and have fever and cough;
• Wash your hands with soap and water thoroughly and often;
• Practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.
If you feel unwell, have high fever, cough or sore throat:
• Stay at home and keep away from work, school or crowds
• Rest and take plenty of fluids
• Cover your mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly
• Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing
• Inform family and friends about your illness and try to avoid contact with other people
If you need medical attention:
• Contact your doctor or healthcare provider before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A(H1N1) (if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you.
• If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility.
• Cover your nose and mouth during travel.
Currently, Ghana has not yet reported any confirmed case of A(H1N1) and remains on high alert to investigate and manage any suspected case. To help the Ministry of Health detect and manage cases of Influenza A(H1N1) disease in Ghana we call on the general public to cooperate by reporting all flu-like illnesses to the nearest health facility.
The updates can be found on Ghana Health Service website at www.ghanahealthservice.org