Blog Dr. H. Dicky Budiman, S.Ked, M.Sc.PH

Please note that WHO has raised its alert level to 5 and has given its 5th update – including the affected countries and advice, which are attached below.

Current level of influenza pandemic alert raised from phase 4 to 5
29 April 2009 -- Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, WHO's Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

Swine influenza - update 5

29 April 2009 -- The situation continues to evolve rapidly. As of 18:00 GMT, 29 April 2009, nine countries have officially reported 148 cases of swine influenza A/H1N1 infection. The United States Government has reported 91 laboratory confirmed human cases, with one death. Mexico has reported 26 confirmed human cases of infection including seven deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5).
Further information on the situation will be available on the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.


For practical reasons, we should also be aware of the alert status issued as well as the measures implemented including travel advisory (see below) by the Singapore authorities to combat the influenza. The alert system in Singapore is currently at Yellow and the measures are primarily targeted at the control checkpoints e.g. airport and healthcare facilities.
Alert System
The Ministry of Health has come up with a Disease Outbreak Response System. Singapore is now at Alert Yellow. The response plan allows a risk management approach appropriate to the transmissibility and virulence of the virus. Depending on the mutation pattern of the virus, the intermediate colour codes may be skipped.


Alert Yellow

Inefficient human-to-human transmissions of flu caused by a novel virus, requiring close and sustained contact to an index case. Further spread can be prevented through public health measures to isolate cases and quarantine contacts.
Risk of import into Singapore elevated. Isolated imported cases may occur but there is no sustained transmission.

Strategy is to prevent further import of cases, and to ring fence and isolate cases to prevent spread. The focus will be to provide treatment of all cases, and antiviral prophylaxis to contacts including exposed healthcare workers.

Action:

Alert Green action apart, institute home quarantine for close contacts of cases.
Institute temperature screening and impose restriction on hospital and clinic visitors.
Restrict inter-hospital movement, except in emergencies.
Healthcare workers to take temperature twice a day.
Institute temperature screening for passengers arriving from affected countries at border control checkpoints.

Travellers from affected countries given Health Alert Notices (HANs) and advised to monitor their temperature daily for 1 incubation period
Travel AdvisoryMembers of the public are advised to postpone or avoid non-essential travel to Mexico . In the event that travel to Mexico is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times. Upon returning from the affected area (ie Mexico and the state of New York , California , Texas and Kansas of the United States ), members of the public should continue to maintain high standards of personal hygiene and to monitor their own health.

Members of the public who have travelled to affected places and who develop respiratory illness with fever (Temperature > 38°C) within seven days after their return should put on a surgical mask and seek medical consultation immediately. They should also disclose their travel histories to their doctors.