Influenza A (H1N1)

Chronology of Influenza A (H1N1)

April 2009

April 12

A 39-year old woman suffering from an acute respiratory illness and undergoes treatment for five days in a hospital in Oaxaca, Mexico, and subsequently dies.

Subsequently, local health authorities trace people who have been in contact with the woman and find some are displaying mild symptoms of pneumonia. They note that over 5,000 cases of pneumonia occur annually in Oaxaca and the woman's death is declared an isolated incident.

April 16

Mexican health officials contact the Pan-American Health Organization, over the illness.

April 21

Oaxaca health department confirms a second death from the atypical pneumonia. Fearing an outbreak of what they believe could be avian flu, the hospital where the two deaths occurred establishes quarantine in its emergency room.

April 22

The Mexican health ministry issues a nationwide alert and samples are sent to Canada for testing.

April 23

Mexico reports first cases of H1N1 to WHO. In the US, public health officials announce that seven people in California and Texas have been diagnosed with a flu virus known as H1N1, but all seven recovered. At the time it is unclear whether these cases are related to Mexico's outbreak.

Later in the day, Canadian public health authorities announce that the Mexican virus is the H1N1 "swine flu" virus.

April 24

Health authorities around the world go on alert as the World Health Organization announces that several hundred cases of swine flu in humans have been suspected over the past weeks in Mexico. They include what is eventually identified as around 15 fatalities, although many more are initially blamed on the virus, while there are nearly a dozen cases in the United States.

Mexican authorities speak for the first time of an "epidemic." More than 1000 people in the country are placed under observation. Schools, universities, theatres and museums are closed down in Mexico City and in the city centre to prevent the spread of the disease. Neighbouring Latin American countries declare health alerts or announce preventative measures.

April 25

WHO Director-General convenes Emergency Committee in Geneva under International Health Regulations (2005). This is the first such meeting called to advise the

Director-General on a public health emergency. It recommends that a Public Health Emergency of International Concern (PHEIC) be declared.

WHO warns of the "pandemic potential" of the new swine flu virus, which can be transmitted from human to human.

More cases are found in the United States.

Mexico toughens measures against the disease and orders people who are sick or showing symptoms of the disease to be isolated. The South-East Asia Regional Office’s Strategic Health Operation Centre activated.

April 26

The United States declares a health emergency after the confirmation of a total of 20 cases in the country, including eight students in New York. Canada announces its first cases of swine flu.

Countries around the world step up vigilance and precautionary measures as WHO warns that the virus can mutate at any time and become much more dangerous. Public meetings are suspended in Mexico.

April 27

The first confirmed cases in Europe, in Spain and Scotland, in people who have returned from Mexico. WHO raises its alert level from 3 to 4 on a scale of 6, signaling a "significant increase in risk of a pandemic." It warns that no region in the world is safe from the virus.

Communicable Diseases Surveillance and Response Unit presents the first Influenza A (H1N1) update at Monday Morning Meeting in the Regional Office for South-East Asia with specifics on the number of cases and areas affected. Emergency Committee Meeting #2 held to declare Phase 4.

April 28

The epidemic continues to progress, affecting all five continents in the world – from New Zealand to Israel to Costa Rica. A state of emergency is declared in California.

Several countries suspend their pork imports from infected regions. Joint South-East Asia Regional Office IHR Task Force and Crisis Management Team meeting held with the Regional Director.

April 29

The first confirmed death in the United States for H1N1 is a 23-month old Mexican toddler.

The virus spreads in Europe, where first cases are confirmed in Germany and Austria. New cases are declared in Spain, of which one person had not been to Mexico.

WHO raises to five its level of alert on a scale of six calling on countries to prepare for an "imminent" pandemic.

WHO officially refers to this disease as New Influenza A (H1N1).

Video Conference between WHO Director-General and Regional Offices.

Daily International Health Regulations (IHR) taskforce discussion in Regional Office. Four core working groups formed to cover Surveillance/Monitoring & Laboratory, Logistics and Management, Communication and Health Education and Medical & Health Systems.

WHO declares Phase 5.

April 30

Regional Office for South-East Asia holds press conference – 35 journalists attend with live coverage on several TV channels.

The European Union rules out a French idea to suspend flights to Mexico. WHO does not recommend limiting travel but Britain, Canada, France, Italy and the Netherlands advise people against travelling to Mexico.

WHO, the Food and Agriculture Organization and the World Organization for Animal Health (OIE) issue a joint statement stating pork and pork products "will not be a source of infection" if handled in accordance with good hygienic practices.