Community outbreaks, June 2009Confirmed cases by U.S. state, June 3, 2009
This article covers the chronology of the 2009 novel influenza A (H1N1) pandemic.[1] Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths (and other major events such as their first intergenerational cases, cases of zoonosis, and the start of national vaccination campaigns), and relevant sessions and announcements of the World Health Organization (WHO), the European Union (and its agency the European Centre for Disease Prevention and Control),
and the U.S. Centers for Disease Control (CDC).
Unless otherwise noted, references to terms like S-OIV, H1N1 and such, all refer to this new A(H1N1) strain and not to sundry other strains of H1N1 which are endemic in humans, birds and pigs.
Timeline
Take note that the date of the first confirmations of the disease or any event in a country may be before or after the date of the events in local time because of the International Dateline.
Probable and confirmed Mexican cases by date of illness onset, March 15 – April 26. —CDC
March 2009
Mexico
In La Gloria, Veracruz 60% of the town's population is sickened by a respiratory illness of unknown provenance. The government of Mexico believes it to be caused by H3N2 influenza, though at least one patient in La Gloria tested positive for A/H1N1. Two babies died in the outbreak but both were buried without testing.[2]
March 7
United States In the ninth week of its routine influenza surveillance, the CDC reports on FluView that thirty-five states have reported widespread influenza activity, and 14 states have reported regional activity, but that although the rate of activity was high, that the proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.[3]
March 14
United States The CDC reports on the 10th week of FluView that thirty states reported widespread influenza activity and 18 states reported regional activity.[4]
March 17
Mexico
Earliest known onset of a case that is later to be confirmed as Swine-Origin Influenza A (H1N1) Virus Infection.[5][6]
March 21
United States CDC FluView, Week 11: Widespread influenza activity in twenty-four states; regional activity in 19. Influenza activity continues to decrease.[7]
March 28
Confirmed USA cases with known dates of illness onset (April 27, 2009). —CDC
United States
Earliest known onset of a USA case later confirmed as swine flu, that of a nine-year-old girl residing in Imperial County, California.[8][9] Thirteen states reported widespread influenza activity and 19 reported regional activity on the CDC's FluView, Week 12.[10]
March 30
United States
A sample is collected from a nine-year-old female patient which is later confirmed to contain the novel virus strain (genetically sequenced as A/California/05/2009(H1N1)).[11][12]
United States
Onset of illness for a ten-year-old boy residing in San Diego County, California; his case is eventually the first to be confirmed as swine flu in the US.[9]
April 2009
April 1
United States
A nasopharyngeal swab is collected from a ten-year-old male patient in San Diego County, later confirmed as containing the novel virus and the first organism of that strain to be completely sequenced (A/California/04/2009(H1N1)).[9][11][13]
April 2
Mexico
In La Gloria, Veracruz, a four-year-old boy falls ill at the end of the outbreak. Only his sample, which was eventually sent abroad, tested positive for A(H1N1). Veracruz officials state that there were no plans to exhume the bodies of two infants who died in the outbreak.[2]
April 4
United States CDC FluView, Week 13: Widespread influenza activity in four states, regional activity in 18.[14]
April 5
European Union
The media monitoring website MedISys reports on a Mexican article about the epidemiological alert.[15][16]
April 6
Mexico
Public health authorities begin investigating unusual cases of pneumonia.[17] 400 people had reportedly sought treatment for pneumonia/influenza-like illness (ILI) in La Gloria the preceding week.[17]
United States
Biosurveillance firm Veratect reports the unusual respiratory illness in Mexico.[18][19] Veratect publishes the alert "La Gloria: 'Strange' Respiratory Affects 60% of Local Population; Three Pediatric Deaths May be Associated with the Outbreak."[17][18]
April 11
United States CDC FluView, Week 14: Widespread influenza activity in one state; regional activity in 14.[20]
Mexico
First death in Oaxaca due to what would later be identified as swine flu.[23]
United States
The U.S. Centers for Disease Control (CDC) is advised of a ten-year-old boy with a respiratory illness in San Diego County, California. Test results revealed an Influenza A virus but were negative for standard human strains. The San Diego County Health Department is notified.[9]
April 14
United States
The CDC receives its first sample from California (from the ten-year-old boy in San Diego County), and identifies the virus as a strain of swine influenza A(H1N1).[9]
United States
Veratect publishes the alert "Atypical Pneumonia Cases Reported at Hospital" regarding the Oaxaca cases.[17][18]
April 17
Mexico
A case of atypical pneumonia in Oaxaca prompts enhanced national surveillance. A field investigation is started.[5]
Mexico contacts Canada to request more specialized testing.[24]
United States
The CDC receives a second sample from Southern California (taken from the nine-year-old girl in Imperial County), and again identifies the virus as a strain of swine influenza A(H1N1). The California Department of Public Health is notified.[9]
April 18
Mexico
Mexico sends 14 mucus samples to the CDC and dispatches health teams hospitals to look for patients showing severe influenza- or pneumonia-like symptoms.[25]
United States CDC FluView, Week 15: "Nine states reported regional activity; 17 states reported local influenza activity; the District of Columbia and 22 states reported sporadic influenza activity; and two states reported no influenza activity. Seven human infections with swine influenza A (H1N1) virus have been confirmed." This is the first mention of A(H1N1) in FluView.[26]
April 20
United States
Veratect advises the CDC of the Mexican events.[17][18]
The CDC is already investigating the California and Texas cases.[17][18][27]
April 21
United States
The CDC alerts physicians to a similar novel strain of swine influenza A(H1N1) in two cases from Southern California in a Morbidity and Mortality Weekly Report Early Release on its website.[28] Local investigations, including investigations in Texas, are already underway, and overall surveillance is enhanced.[9][29]The Associated Press covers the alert, the first mention of the A(H1N1) outbreak in English-language news media.[27][30][31]
April 22
Canada
Canada receives the samples from Mexico for testing.[24]
April 23
Mexico
The Public Health Agency of Canada confirms Mexico cases of swine-origin influenza A (H1N1) virus (S-OIV) infection.[5]
Genetic sequence analysis reveals that the Mexican patients were infected with the same S-OIV strain detected in two California children.[5]
The PAHO is informed that a cluster in Mexico of severe respiratory illnesses has been laboratory-confirmed as S-OIV infection.[5]
April 24
The WHO issues its first Disease Outbreak Notice on the matter, confirming the infection of a number of people in Mexico and the United States by "Swine Influenza A/H1N1 viruses... not... previously detected in pigs or humans".[32]
Mexico
The Minister of Health confirms the Mexican cases of human infection by swine influenza and states that it believes that some of these cases had resulted in death.[33]
Health authorities implement public health measures for all airport passengers and the vaccination of health care workers with seasonalinfluenza vaccine.[5]
President Obama is briefed in the Situation Room about the H1N1 outbreak.
United States
The CDC tells a press conference that seven of the 14 Mexican samples contained the same virus strain as the known in California and Texas, and that indications suggested that containment in the USA was "not very likely".[33]
The novel strain had already been reported on the CDC's Morbidity and Mortality Weekly Report website.[28]
United States First closure of an entire school district, the Schertz-Cibolo-Universal City Independent School District outside San Antonio, Texas.[39][40]
April 26
United States United States declares a Public Health Emergency.[41]
WHO The Emergency Committee meets for the second time. The WHO Director-General issues a statement that containment of the outbreak is not feasible, and elevates the pandemic alert from Phase 3 to Phase 4.[42]
European Union (EU) Health Commissioner advises Europeans not to travel to the United States or Mexico unless the need is urgent. This follows the first confirmed case in Spain.[43]
Canada
First six cases confirmed, four in Nova Scotia and two in British Columbia.[44]
Spain
First confirmed case of swine flu, in Almansa, and thus the first case in Europe; A(H1N1) has spread from the WHO Region of the Americas to the WHO European Region.[46]
( ) United Kingdom
First two confirmed cases, in Scotland.[47]
April 28
WHO Confirmed cases are now extant in four of six WHO regions (see map). As of 19:15 GMT seven countries have officially reported cases of swine influenza A(H1N1) infection.[48]
Canada
Confirmed: two cases and another four in Alberta and Ontario, respectively.[49]
Israel
First confirmed case in Israel and thus the WHO Eastern Mediterranean Region (color-coded yellow), the third region to be affected.[50]
New Zealand
First three confirmed cases in New Zealand and thus the WHO Western Pacific Region (color-coded red), the fourth region to be affected.[51]
WHO
The Emergency Committee meets for the third time,[54]
and the WHO raises its pandemic alert level from Phase 4 to Phase 5, its second highest.[55] As of 1800 GMT, nine countries have officially reported 148 cases of swine influenza A(H1N1) infection.[56]
ASEAN ASEAN officials are looking at coordinating measures to address the potential pandemic.[57]
EU Foreign Relations Commissioner Benita Ferrero-Waldner announces that the halt of all travel to Mexico and disinfecting all airports due to the global flu outbreak is being considered.[58]
Germany
First three confirmed cases, two in Bavaria and one in Hamburg.[59]
Spain
Eight more cases raises the total in Spain to 10, including the first human-to-human intergenerational transmission[60] (in which the patient had not recently been to Mexico but was infected by another patient who had just visited Mexico, namely his girlfriend).[61] This is the first intergenerational transmission to be documented in Europe.
United States
First death outside Mexico, a 23-month-old Mexican child hospitalized in Texas.[62] Ninety-one confirmed cases in the US to date.[63]
South Africa
First two cases reported within South Africa, by two women that travelled in Mexico weeks earlier. The cases were confirmed on 18 June 2009.
April 30
Canada
Confirmed: One more case in Toronto, and eight more cases in Nova Scotia, and Alberta bringing total to 28.[64]
Netherlands
First confirmed case, a three-year-old child.[66] The child returned from Mexico to the Netherlands on April 27, 2009. The parents test negative for A(H1N1).
United States
Four cases are confirmed in an outbreak at the University of Delaware; another 12 cases are deemed "probable". One of the confirmed cases is a baseball player, which results in the university cancelling sporting events, a concert by rapper Young Jeezy, and other school activities.[68]
United Kingdom
Three further confirmed cases of swine flu, giving a total of eight confirmed cases.[69]
May 2009
May 1
WHO As of 0600 GMT, 11 countries have officially reported 331 cases of influenza A(H1N1) infection.[70]
United States
There are more than 430 school closures in 18 states.[84] CDC FluView Week 17: Widespread activity in seven states, regional activity in 12.[85]
May 3
WHO As of 0600 GMT, 17 countries have officially reported 787 cases of (A)H1N1.[80]
Arab League Health Ministers meet in Riyadh, to discuss human and technical support to be deployed in any Arab affected place.[86]
WHO As of 06:00 GMT, 20 countries have officially reported 985 cases of influenza A (H1N1) infection.[88][89]
Canada A girl from Edmonton, Alberta was diagnosed with a severe case of the H1N1 virus.[90]
May 5
WHO
As of 06:00 GMT, 21 countries have officially reported 1,124 cases of influenza A (H1N1) infection.[91]
United States
Second confirmed death, the first of a U.S. resident, a pregnant special education teacher in Texas: Judy Trunnell. The 33-year-old gives birth to her second child via Caesarian section during her eighth month of pregnancy, in a coma whilst on life support.[92][93] Judy Trunnell had several underlying medical conditions, most notably asthma.[94][95][96]
Several sailors in San Diego, California fall ill (including a sailor on the USS Dubuque, which results in the cancellation of its deployment). These are the first cases in the U.S. Navy.[97]
As the low level of virulence of novel A(H1N1) in the U.S. becomes established, the CDC issues revised criteria for school closures, effectively ending widespread shutdowns.[98]
May 6
WHO
As of 06:00 GMT, 22 countries have officially reported 1,516 cases of influenza A (H1N1) infection.[99]
ASEAN A special regional summit to fight possible swine flu pandemic was held in Bangkok and was attended by senior ASEAN health officials along with those from China, Japan and South Korea.[100]
Guatemala First confirmed case, and the first in Central America.[101][102]
Canada
Reports suggest that an elderly woman who had swine flu has died in northern Alberta, marking the first death in Canada related to swine flu.[109] Furthermore, an unusual case of zoonosis occurred when a swine flu inspector in improper gear caught the virus from an infected pig.[110]
Netherlands
Second case confirmed, a 53-year-old woman who had recently travelled to Mexico.[111]
Brazil Two cases confirmed, one of which is thought to be the first case of human-to-human infection in Brazil.[120]
Costa Rica First confirmed death, and also the first death outside of North America.[121][122] Three other confirmed cases, all children, were contaminated by the patient who died.[123]
Japan 4th confirmed case, a schoolmate of the first three cases.[124]
United States Third confirmed death, a Washington man with underlying heart disease.[126] Also, the USA passes Mexico in the number of confirmed cases of infection, 1693 to 1364, thus becoming the nation-state with the most laboratory-confirmed cases of infection; Canada is third with 242 cases.[127] CDC FluView Week 18: Widespread influenza activity in eight states, regional activity in 14.[128]
May 10
WHO
As of 07:30 GMT, 29 countries have officially reported 4,379 cases of influenza A(H1N1) infection.[129]
Colombia First domestic infections with three cases confirmed. Total: 10.[140]
May 15
WHO As of 06:00 GMT, 34 countries have officially reported 7,520 cases of influenza A(H1N1) infection.[141]
USA Fourth and fifth deaths confirmed, that of an Arizona woman suffering from a lung condition[142][143] and a Texas man in Corpus Christi, respectively.[144][145]
Malaysia First confirmed case.[146] Malaysia is the 37th country to be affected by the virus.
Panama Four new cases confirmed today. Total: 43, 23 of whom are male and 20 of whom are female. 20 of the cases are under 15 years old.[147]
May 16
WHO As of 06:00 GMT 36 countries have officially reported 8,451 cases of influenza A(H1N1) infection.
India First case confirmed, in Hyderabad.[148] This marks the arrival of A(H1N1) in the fifth of the WHO's six regions, the South-East Asia Region.
Japan First domestic infection confirmed, in Kobe, a male high school student with no history of travel abroad.[149] The Kobe Festival, planned for May 16 and 17, is cancelled.[150]
Malaysia Second confirmed case.[151] The first patient is now showing significant improvement from the treatment.
Turkey First confirmed case, that of an American tourist flying from the United States via Amsterdam, discovered at Istanbul's Atatürk International Airport.[153]
United States CDC FluView Week 19: Widespread influenza activity in five states, regional activity in 13.[154]
May 17
WHO As of 06:00 GMT 37 countries have officially reported 8,480 cases of influenza A(H1N1) infection.
Panama With 54 confirmed cases, Panama occupies second place, along with Canada, for the number of cases per country.
May 18
WHO
As of 06:00 GMT, 40 countries have officially reported 8,829 cases of influenza A(H1N1) infection, including 74 deaths.[155]
Japan reports 96 confirmed cases;[157] it now ranks fourth in the world in the number of infections. Thousands of schools in 21 cities in the Hyogo and Osaka prefectures are temporarily closed.[158][159]
USA The sixth death in the US, and the first in New York—that of an assistant principal.[160][161]
May 19
WHO As of 06:00 GMT, 40 countries have officially reported 9,830 cases of influenza A(H1N1) infection, including 79 deaths.[162]
United States Seventh confirmed death, that of a 44-year-old Missouri man.[163]
Norway One more case confirmed today. Total: three.[165]
Paraguay confirmed its first case and became the 43rd affected country.[166]
Taiwan confirmed its first case and becomes the 44th affected country.[167]
May 20
WHO As of 06:00 GMT, 40 countries have officially reported 10,243 cases of influenza A(H1N1) infection, including 80 deaths.[168]
United States A patient dies in Arizona,[169] and a 22-year-old man dies in Utah,[170] the nation's eighth and ninth H1N1 fatalities. Roughly half of the influenza viruses detected by the CDC's routine influenza surveillance systems are now that of novel A(H1N1).[1] An unusual number of outbreaks in schools is reported.[171]
Norway 1 more case confirmed today. Total: 4.[165]
May 21
WHO As of 06:00 GMT, 41 countries have officially reported 11,034 cases of influenza A(H1N1) infection, including 85 deaths.[175]
Japan 279 confirmed cases; more than 4,800 schools are closed in the Kobe region.[176]
May 22
WHO As of 06:00 GMT, 42 countries have officially reported 11,168 cases of influenza A(H1N1) infection, including 86 deaths.[177]
Japan 317 confirmed, including first confirmed in Saitama Prefecture.[178]
Third confirmed in Tokyo, a 25-year-old man who visited Osaka from May 14-20th.[179]
WHO As of 06:00 GMT, 43 countries have officially reported 12,022 cases of influenza A(H1N1) infection, including 86 deaths.[181]
Iceland First confirmed case. 4 more cases suspected.[182][183]United States CDC FluView Week 20: Widespread influenza activity in four states; regional activity in 11.[184]
May 24
Australia Two more confirmed cases, which now brings the national toll to 16.[185]
Kuwait First confirmed cases, that of 18 U.S. soldiers.[186]
May 25
WHO As of 06:00 GMT, 46 countries have officially reported 12,515 cases of influenza A(H1N1) infection, including 91 deaths.[187]
Malaysia Three more cases confirmed. One of the patients is a 23-year-old student returned from the United States. Another two patients are German tourists who arrived in Singapore after having gone to Malaysia for holiday. Total: 5.[226]
United States CDC FluView Week 22: Widespread influenza activity in eight states, regional activity in nine. "Approximately 89% of all influenza viruses being reported to CDC were novel influenza A (H1N1) viruses."[233]
United States Widespread influenza activity in eleven states, regional activity in six. "Over 98% of all subtyped influenza A viruses being reported to CDC were pandemic influenza A (H1N1) viruses."[253]
June 15
Malaysia Five more cases of H1N1 confirmed. Total: 17.[254]
United States CDC FluView Week 24: Widespread influenza activity in twelve states, regional activity in seven. "Over 99% of all subtyped influenza A viruses being reported to CDC were pandemic influenza A (H1N1) viruses."[266]
June 27
United States CDC FluView Week 25: Widespread influenza activity in ten states, regional in 11 states.[267]
South Africa South Africa National Health Department confirm community outbreak, with 7 new confirmed cases. The total of confirmed cases grew to 12640 within South Africa over the next few months.[citation needed]
Australia First confirmed death in NSW. National total: 10.[274]
Japan Second case found with mutation resulting in Oseltamivir (Tamiflu) resistance.[275]
July 4
United States CDC FluView Week 26: Widespread influenza activity in nine states, regional influenza activity in 12. "Over 97% of all subtyped influenza A viruses being reported to CDC were novel influenza A (H1N1) viruses."[276]
Portugal First human-to-human transmission. Total: 38.[277]
United States CDC FluView Week 27: Widespread influenza activity in nine states, regional activity in 12. "Over 99% of all subtyped influenza A viruses being reported to CDC were novel influenza A (H1N1) viruses."[282]
July 12
Colombia 6th death case confirmed out of 165 infected[283]
Malaysia 39 more cases confirmed. Total: 710.
United Kingdom Another 2 deaths confirmed. Total Deaths: 17.
July 13
Brazil One more death confirmed. Total Deaths: 3.[284]
Ecuador Third death confirmed. Total deaths: 3.[285]
July 14
Brazil Fourth death confirmed.
Malaysia 32 more cases confirmed. Total: 804
New Zealand Two more deaths confirmed. Total deaths 9. Total confirmed cases: 1,984.
July 16
Singapore First flu-related death confirmed, that of a 49-year-old man with heart problems.[286]
Sudan First two confirmed cases of H1N1 detected, from flights which had arrived from the U.K.[287]
July 17
Hawaii First death, that of a sexagenarian with underlying health problems.[288]
July 18
United States CDC FluView Week 28: Widespread influenza activity in seven states, regional activity in 13. "Over 99% of all subtyped influenza A viruses being reported to CDC were novel influenza A (H1N1) viruses."[289]
Venezuela First death confirmed, that of an 11-year-old girl.[290]
Singapore First death with H1N1 involvement confirmed, that of a 49-year-old
male who also suffered from diabetes, hypertension and high cholesterol, from a heart attack caused by severe pneumonia.[291]
The WHO ceases the tracking of cumulative individual cases.[302]
Arab League Health Ministers hold a summit after the death of a pilgrim who had returned from the Hajj. New regulations were promulgated for the Hajj: anyone younger than 12 or older than 65 or who have "chronic health problems" shall not be allowed to undertake the pilgrimage to Mecca.[303]
Malaysia First flu-related death confirmed, that of an obese 30-year-old male.[305]
July 24
Canada Nova Scotia reports its first H1N1 death.[306]
Cayman Islands First death reported, that of a man with underlying medical conditions.[307]
July 25
Indonesia First H1N1 death confirmed, that of a 6-year-old girl suffering from severe pneumonia.[308]
United States It is reported that thousands of Americans are being recruited for H1N1 vaccine testing at several research centers across the country.[309] CDC FluView Week 29: Widespread influenza activity in four states, regional activity in eight. "Over 98% of all subtyped influenza A viruses being reported to CDC were novel influenza A (H1N1) viruses."[310]
July 26
Norway An international 4H youth camp with 1,700 participants from fifteen nations is
shut down after fifty Norwegian participants catch H1N1.[311]
Germany Germany's federal infectious disease center, the Robert Koch Institute, states there were 3,810 confirmed cases of H1N1 in the country; nearly all of the cases are mild.[313]
Israel First death confirmed, that of a 35-year-old man from Eilat.[314]
United Kingdom The NHS is not ready for a second wave of swine flu cases expected this autumn, a House of Lords committee has stated. It warned hospitals do not have enough intensive care beds to cope, and furthermore predicted that the recently established A(H1N1) flu helpline could be overwhelmed with calls.[321]
United States The U.S. military wants to establish regional teams of military personnel to assist civilian authorities in the event of a significant outbreak of the H1N1 virus this fall, according to Defense Department officials.[322]
July 30
Azerbaijan First two cases of A(H1N1) confirmed, those of people who had been on holiday in France and the U.K., respectively.[323]
Belgium First death confirmed, that of a 34-year-old woman.[324]
France First death confirmed, a 14-year-old girl in Brest.[325]
France The cruise ship Voyager of the Seas, which had reported dozens of cases of H1N1 flu amongst its 5,000 passengers and crew, docks in France.[332]
August 2009
August 1
Australia First case of reverse zoonosis confirmed in a piggery in Dunedoo.[333]
United States CDC FluView Week 30: Widespread influenza activity in four states, regional activity in 11. "Over 98% of all subtyped influenza A viruses being reported to CDC were novel influenza A (H1N1) viruses."[334]
August 3
South Africa
First confirmed death in South Africa. Total number of deaths at end of epidemic 93.[citation needed]
Malaysia One more death confirmed. Total: 68 deaths.[348] The unusually high reported death rate, four times the global average,[349] is investigated by the WHO.[350]
Netherlands Second death confirmed, that of a 58-year-old male.[336]
August 21
Chile H1N1 is found in turkeys on farms in Chile near the port city of Valparaiso in a unique zoonosis cluster.[351]
United States CDC FluView Week 33: Widespread influenza activity in two states, regional activity in 13. Activity appears to be increasing in the Southeast.[357]
August 23
WHO At least 2,185 deaths worldwide are reported.[358]
UN;Chile The United Nations issues a warning regarding the discovery of H1N1-infected turkeys on farms in Chile, an unusual case of zoonosis which raises concerns about possible increased genetic reassortment of the virus.[368]
August 28
WHO Most countries in the Southern Hemisphere (represented by Chile, Argentina, New Zealand, and Australia) appear to have passed their peak of influenza activity and returned to baseline activity.[358]
ECDC Based partially on data from the Southern Hemisphere, the ECDC forecasts a
first wave of infections in autumn and winter which stresses hospitals in particular; it is noted, however, that
"the overall interruption of essential services in (well-prepared) countries has been manageable".[369]
Brazil 602 H1N1 deaths confirmed, the highest number of any nation-state to date.[372]
United States CDC FluView Week 34: Influenza activity, which had been largely stable or decreasing in prior weeks, increases in the U.S. "Six states and Puerto Rico reported geographically widespread influenza activity, 13 states reported regional influenza activity, 10 states and the District of Columbia reported local influenza activity, 19 states reported sporadic influenza activity, two states reported no influenza activity, and Guam and the U.S. Virgin Islands did not report." Furthermore, Region IV, i.e. the Southeast, reports increased out-patient ILI above its regional baseline.[373]
August 30
WHO At least 2,837 deaths worldwide are reported.[374]
Colombia President Álvaro Uribe is confirmed to have swine flu, the second Head of state known to have been infected.[375]
United States The CDC in its Morbidity and Mortality Weekly Report[384] notes that 67% of thirty-six children who have died from H1N1 early in the epidemic had at least one serious chronic medical condition, with neurodevelopmental conditions such as developmental delay, epilepsy, and cerebral palsy being especially prominent.[385] Roughly one in thirteen deaths have been of school-age children. More than 80% of the children who died were five or older, in contrast with the seasonal flu baseline of half or more of the influenza fatalities being four or younger.[386]
United States CDC FluView Week 35: Influenza increases in the U.S. with widespread influenza activity in 11 states and regional activity in 13; the proportion of outpatient visits for influenza-like illness (ILI) is above the national baseline, with four out of ten HHS Surveillance Regions reporting ILI above region-specific baselines. "97% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses."[388]
September 6
WHO At least 3,205 deaths worldwide are reported.[389]
September 7
Ecuador Ecuador's chief of presidential security, Col. John Merino,
dies of H1N1 flu[390]
after twenty-eight days at Quito Military Hospital.[391]
Australia First case of Oseltamivir (Tamiflu) resistance found.[401]
September 12
United States CDC FluView Week 36: Influenza activity continues to increase with widespread influenza activity in twenty-one states, regional influenza activity in nine. Seven of ten HHS Surveillance Regions report ILI activity above region-specific baselines. "99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses."[402]
September 13
WHO At least 3,486 deaths worldwide are reported.[403]
September 14
Mozambique First death confirmed, that of a 29-year-old female with an unspecified chronic illness.[404]
Netherlands The third and fourth deaths are confirmed, that of a 52-year-old man and an 85-year-old woman, respectively, both of whom had underlying medical conditions.[406]
United Kingdom Health Minister Andy Burnham states that the second peak of swine flu has started as 5,000 people contracted the virus this week, compared to 3,000 the week before.[405]
September 18
Martinique First death confirmed, that of an 18-month-old girl.[407]
September 19
Malaysia One more death confirmed. Total: 77 deaths.[408]
United States CDC FluView Week 37: Widespread influenza activity in twenty-six states, regional activity in 11. All of the HHS ILI regions report elevated levels of influenza activity above their region-specific baselines except for Region I (New England).[409]
September 20
WHO Over 3,917 deaths worldwide are reported.[410]
September 21
China A national vaccination campaign begins in China, making it the first country to issue the H1N1 vaccine.[411]
United States The U.S. government orders a total of 251 million doses of H1N1 vaccine from manufacturers, up from the long-planned total of 195 million.[412]
September 23
Portugal The first death confirmed, that of a Portuguese man living in France.[413]
September 25
Germany First death confirmed, that of a 36-year-old woman who died of a so-called
superinfection which included H1N1.[414]
United States Forty-two schools are closed in eight states as the second wave of the pandemic
begins in early autumn.[415]
September 26
United States CDC FluView Week 38: Widespread influenza activity in twenty-seven states, regional activity in 18.[416]
September 27
WHO At least 4,108 deaths worldwide are reported.[417]
United States The second wave of the H1N1 pandemic begins to stress hospitals in the U.S. and prompts some school closures.[415][418]
September 28
Cambodia First death confirmed, in Phnom Penh.[419]
September 29
Ireland First case of reverse zoonosis in pigs.[420]
September 30
Australia Mass vaccination drive begins, the second in the world.[421]
China Sinovac Biotech Ltd., the first company worldwide to complete clinical trials for a vaccine, receives an order for an additional 3 million doses of H1N1 vaccine from the PRC government, making for a total of 6.3 million doses.[422][423]
United States 46 states and Washington, D.C. begin ordering what becomes by the next day a cumulative total of 1,378,200 doses of the nasal-spray Live Attenuated Influenza Vaccine (LAIV)[424] for H1N1.
October 2009
October 3
United States CDC FluView Week 39: The proportion of deaths attributed to pneumonia and influenza (P&I) reaches the epidemic threshold with eight out of ten HHS ILI regions reporting region-specific ILI activity above region-specific baseline levels. Widespread influenza activity in thirty-seven states, regional activity in 11.[425]
October 4
WHO At least 4,525 deaths worldwide are reported.[426]
United States The CDC's 2009–10 influenza season officially begins.[416][427]
October 5
United Nations Rich countries should make more vaccines available to poorer nations where the H1N1 virus is starting to hit, United Nations health officials said. They said increased readiness for swine flu was needed in developing countries with weaker medical systems and with large, young populations, who are most vulnerable to the disease. Some countries, such as the United States, Brazil and France, have agreed to make 10 percent of their national vaccine stockpile available to developing countries. Manufacturers have also donated about 150 million doses of vaccine.[428]
Cuba First deaths confirmed, that of three pregnant women.[430]
United States CDC FluView Week 40: The proportion of deaths attributed to pneumonia and influenza (P&I) is officially above the epidemic threshold. Moreover, for the first time all 10 HHS ILI regions reported ILI above region-specific baseline levels. Widespread influenza activity in forty-one states, and regional activity in eight, with only one state—Hawaii—reporting local influenza activity.[431]
October 11
WHO At least 4,735 deaths worldwide are reported.[432]
Vietnam Three cases of Tamiflu resistance (which developed during hospital treatment) are confirmed. The resistant strains were apparently not transmitted, and all three patients survived.[436]
United Kingdom The death toll passes 100. Total confirmed deaths: 106. The NHS confirms that second wave of swine flu has begun, with cases in Wales and Northern Ireland being especially high. The Minister of Health confirms that there were 27,000 cases in the last week in England alone, up from 14,000 the week before. The Minister of Health also announced that 415,000 H1N1 vaccinations shall take place on the week beginning 21 October, then 5,000,000 more vaccinations the week after. 20% of all hospitalized cases are now critical, up from 12% the week before. The government believes it can get 50,000,000 Britons vaccinated before Christmas.[440]
October 16
United States An initial shortfall of swine flu vaccine is predicted shortly after the proportion of deaths attributed to pneumonia and influenza goes above the epidemic threshold[441] in some states,[442] with flu activity widespread in 41 states.[443] It is also announced that the number cases, hospitalizations and deaths are unprecedented for this time of year, with flu-like illnesses accounting for 6.1% of all doctor visits, itself an unusually high number.[444]
October 17
WHO At least 4,999 deaths worldwide are reported.[445]
China Second death confirmed, in the northwestern province of Qinghai.[446]
United States CDC FluView Week 41: All 10 HHS ILI regions reported ILI above region-specific baseline levels. Widespread influenza activity in forty-six states, regional activity in three.[447]
October 19
United States H1N1 is confirmed in a nasal mucus sample taken from a show hog at the Minnesota State Fair in the first case of zoonosis in the country.[448][449][450]
India Two more deaths confirmed. Total: 415 deaths.[451]
United States
In a unique case of zoonosis, a pet ferret in Oregon is confirmed to be infected with H1N1.[455]
October 21
Canada A turkey farm in Ontario province has been confirmed infected with A/H1N1 flu, making Canada the second country to report such infection after Chile, health officials confirmed[456]
Japan Ten H1N1-infected pigs are discovered in a swine herd in Osaka Prefecture, the first reported case of zoonosis in Asia.[457][458]
UK H1N1 vaccinations begin nationwide, with 14,000,000 high-priority people with conditions such as asthma to be vaccinated initially, then eventually up to 51,000,000 other Britons.[459][460]
Netherlands
Two new deaths reported, that of a 14-year-old girl and 40-year-old man. Total deaths: 6.[406]
United States President Barack Obama declares a national emergency, stating "The potential exists for the pandemic to overburden health care resources in some localities."[466]
October 24
High-risk groups line up at a defunct Kmart for the first H1N1 vaccines publicly available in Boise, Idaho.
United States Various public health departments across the country run out of the H1N1 vaccine,[467] due to the shortfall of 10 million doses as the national vaccination campaign gets underway in earnest; 40 million doses had initially been projected.[468][469] According to the CDC's FluView Week 42, influenza activity is widespread in 48 states, with regional activity in just two: Hawaii and South Carolina.[470]
October 25
WHO At least 5,712 deaths worldwide are reported.[471]
October 26
China Another death confirmed, in the northwestern province of Xinjiang.[472]
ECDC The European Centre for Disease Control reports a total of 302 fatal cases in Europe to date; all of the 27 EU and the four EFTA countries are reporting cases of pandemic (H1N1) 2009 influenza.[484]
Ukraine First death confirmed. Meanwhile, Ukrainian Prime MinisterYulia Tymoshenko ordered a massive and for Ukraine unprecedented disease-control programme to go into effect immediately in an attempt to prevent the spread of the disease. A 'full quarantine' will be imposed in seven provinces of Western Ukraine, with police monitoring the entrance and exit of all persons. It will block those lacking justification for travel[485]
United States According to the CDC's FluView Week 43, influenza activity is widespread in 48 states, with regional activity in two: Hawaii and Mississippi.[487]
November 2009
November 1
Afghanistan Schools are closed for three weeks after the first H1N1 death is recorded.[488]
United States CDC FluView Week 44: Widespread influenza activity in forty-six state, regional activity in four. "The proportion of outpatient visits for influenza-like illness (ILI) was 6.7% which is above the national baseline of 2.3%. All 10 regions reported ILI above region-specific baseline levels."[500]
WHO In its 74th update, the WHO reports early signs that the early flu season has peaked in North America, even as the pandemic intensifies across much of Europe and Central and Eastern Asia.[507]
Bulgaria Health authorities confirm more than 12 people have died from H1N1 within a week; the latest victim is a 28-year-old man who died from respiratory failure.[508]
United States CDC FluView Week 45: Widespread influenza activity in forty-three states, regional activity in seven.
"The proportion of outpatient visits for influenza-like illness (ILI) was 5.5% which is above the national baseline of 2.3%. All 10 regions reported ILI above region-specific baseline levels."[512]
Norway A potentially significant mutation is found in specimens taken of the H1N1 virus taken from two fatalities; a third victim was seriously ill.[523][524]
UK The first person-to-person transmission of Tamiflu-resistant H1N1 in the world is confirmed at the University Hospital of Wales in Cardiff. Five patients are so infected, with three apparently having been infected in hospital in a case of iatrogenic transmission.[525]
US An iatrogenic Tamiflu-resistant cluster is reported at Duke University Medical Center in North Carolina, with four severely ill cancer patients infected, the largest cluster in the U.S. More than fifty resistant cases have been reported in the world since April.[526]
November 21
United States CDC FluView Week 46: Widespread influenza activity in thirty-two states, regional activity in 17. "The proportion of outpatient visits for influenza-like illness (ILI) was 4.3% which is above the national baseline of 2.3%. All 10 regions reported ILI above region-specific baseline levels.[527]
November 23
Romania First death confirmed, that of a 43-year-old man with obesity, high blood pressure, and diabetes.[528]
November 24
United States First double infection case confirmed, in a pediatrician in West Virginia.[citation needed]
WHO H1N1 mutations have led to roughly 75 people worldwide developing Tamiflu resistance. Furthermore, the separate D222G or D225G mutation which helps the virus to reach deep into the lungs has been reported in cases both severe and mild in Norway, Ukraine, Brazil, China, Japan, Mexico and the United States.[530][531][532]
France The H1N1 mutation first detected in Norway causes two deaths in separate French cities.[533][534][535]
South Korea First double infection case confirmed, in a two-year-old girl.[536]
November 28
China Two cases in dogs are confirmed, the first instance of canine zoonosis in the world.[537]
Indonesia First case in pigs is confirmed, in southwest Sulawesi.[538]
United States CDC FluView Week 47: Widespread influenza activity, in Twenty-five states, regional influenza activity in 17.
"The proportion of outpatient visits for influenza-like illness (ILI) was 3.7% which is above the national baseline of 2.3%. Eight of the 10 regions reported ILI at or above region-specific baseline levels. Regions 6 and 10 reported ILI below their region specific baselines."[539]
November 30
United States The CDC states that H1N1 may have peaked as the number of states reporting widespread influenza dropped from 43 the previous week to 32 this week. Furthermore, influenza-like illness now account for 4.3% of doctor visits, down from 8% four weeks ago (on average, influenza accounts for 2.5% of doctor visits). The proportion of deaths attributed to pneumonia and influenza continues to be higher than expected for this time of year, however. This proportion has remained elevated for eight weeks now.[540]
Finland First case of reverse zoonosis in pigs.[420]
Saudi Arabia Only five deaths and 73 cases are reported from the hajj.[542]
December 2
United Kingdom First case of reverse zoonosis in pigs is discovered, in Norfolk.[543]
December 5
US CDC FluView Week 48: Widespread flu activity in 14 states, regional activity in 25. "The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the tenth consecutive week. The proportion of outpatient visits for influenza-like illness (ILI) was 2.7% which is above the national baseline of 2.3%."[544]
December 6
Gaza Strip First five cases are confirmed in the blockaded Gaza Strip.[545]
United States
With one in six Americans infected, or 15% of the country, nearly 10,000 have died to date, including 1,100 children and 7,500 younger adults. More than 200,000 Americans had been hospitalized to date — roughly the same number who are so affected by the regular seasonal flu variant in an entire year. Furthermore, with 12 million additional doses of H1N1 vaccine being released this week, several states begin to distribute the vaccine to the general public.[547]
December 7
North Korea First deaths are confirmed, according to newsletters released by the Seoul-based aid group Good Friends.[548][549]
United States A sophisticated Bayesian analysis of public health data from April to the end of June from New York City and Milwaukee[550] indicates that the pandemic's symptomatic case-fatality ratio has been far lower than the previous three pandemics of 1968, 1957, and 1918, making it to date the mildest pandemic on record.[551][552]
December 12
Afghanistan The 17th H1N1 fatality is reported.[553]
Gaza The eighth fatality is reported, that of a child with underlying kidney failure, within a week of the first H1N1 case in the Gaza Strip.[554]
United States CDC FluView Week 49: Widespread influenza activity in 11 states, regional activity in twenty. "The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the eleventh consecutive week... The proportion of outpatient visits for influenza-like illness (ILI) was 2.6% which is above the national baseline of 2.3%. Five of the 10 regions reported ILI at or above region-specific baseline levels."[555]
December 13
Georgia First fatality confirmed, that of a 27-year-old man.[citation needed]
United States Roughly 100 million H1N1 vaccines[557] become widely available to the general public in pharmacies in several American states as the supply increases and restrictions to high-risk groups are lifted.[558][559]
December 17
Thailand First confirmed case of H1N1 in a pig, in a case of reverse zoonosis in Saraburi Province. The pig recovered.[560]
December 19
United States CDC FluView Week 50: The CDC reports that levels of influenza are declining steadily, with only seven states reporting widespread influenza activity and 18 reporting regional activity; furthermore, the proportion of deaths attributed to pneumonia and influenza (P&I) is below the epidemic threshold. The CDC also notes that almost all isolates of H1N1 remain sensitive to oseltamivir.[441][561] "The proportion of outpatient visits for influenza-like illness (ILI) was 2.3% which is at the national baseline of 2.3%."[562]
December 21
US First case of canine zoonosis confirmed. The 13-year-old dog from New York state was believed to have contracted the virus from his owner.[563]
December 23
US H1N1 is discovered at two North Carolina pig farms, making it the 10th state to identify the virus in animals. The swine caught the disease from infected workers and recovered after becoming moderately ill.[564]
Argentina An Argentine study published in the New England Journal of Medicine shows that "Pediatric 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza than in previous years,"[565] and that the elevated risk for pregnant women extends for as long as two weeks after they give birth.[566][567]
December 26
US CDC FluView Week 51: Influenza activity decreases slightly, although the proportion of deaths attributed to P&I remained above the epidemic threshold. "Four states reported geographically widespread influenza activity, 13 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 19 states reported local influenza activity, Guam and 13 states reported sporadic influenza activity, and one state reported no influenza activity, the U.S. Virgin Islands did not report."[568]
December 27
WHO At least 12,220 deaths globally are formally confirmed. (By contrast, the WHO estimates that the seasonal flu kills from 250,000 to 300,000 people around the world each year.) Overall, the activity of the H1N1 pandemic has peaked.[569]
Nepal First death confirmed, that of a woman who suffered major organ failure.[570]
December 29
WHO In Geneva Dr. Margaret Chan, Director-General of the WHO, remarks in the context of the H5N1 bird flu virus that "The fact that the long overdue influenza pandemic is so moderate in its impact is probably the best health news of the decade" but that "No, the world is not ready for a pandemic to be caused by H5N1." Given that H1N1 could still mutate, however, the WHO shall continue to monitor the pandemic for six months to a year. She also said that it would take at least two years before a true death total is established. (Approximately 11,500 people are believed to have died in more than 200 countries.)[571]
December 30
A study published in the New England Journal of Medicine finds that "household contacts less than 18 years of age were twice as susceptible to an acute respiratory illness as were those 19 to 50 years of age, whereas contacts older than 50 years were less susceptible".[572][573]
December 31
A joint US-UK study shows that children are twice as likely as adults to catch H1N1.[574]
2010
January 2010
January 2
United States CDC FluView Week 52: The proportion of deaths attributed to P&I falls below the epidemic threshold. No influenza activity is reported in Nebraska. "One state reported geographically widespread influenza activity, 12 states reported regional influenza activity, Puerto Rico, the District of Columbia, and 17 states reported local influenza activity, the U.S. Virgin Islands, Guam, 19 states reported sporadic influenza activity, and one state reported no influenza activity."[575]
January 8
United States The CDC reports that only Alabama reports widespread influenza activity.[576]
United States The weekly report released by the CDC states that H1N1 activity has either remained stable or decreased over the past week in nine out of the ten regions of the United States. Furthermore, the proportion of deaths attributed to pneumonia and influenza, which technically remains above the epidemic threshold, has declined over the past week.[582]
United States According to the CDC, only four states have reported regional influenza activity: Mississippi, Alabama, Georgia, and South Carolina.[585]
March 12
United States According to the CDC, five states have reported regional influenza activity: Mississippi, Alabama, Georgia, South Carolina, and Maine.[586]
March 19
United States According to the CDC, only three states have reported regional influenza activity: Mississippi, Alabama, and Georgia.[587]
March 26
United States According to the CDC, only three states have reported regional influenza activity: Alabama, Georgia, and South Carolina.[588]
United States The CDC Morbidity and Mortality Weekly Report states that inoculation rates varied, with the highest rates in New England and the lowest in the South. (E.g., roughly 39% of the population of Rhode Island is immunized vis-à-vis 13% that of Mississippi.) Among children Georgia had the lowest vaccination rate, with 21%; the state currently has the highest level of H1N1 flu activity.[590]
April 2010
April 2
US According to the CDC, only three states have reported regional influenza activity: Alabama, Georgia, and South Carolina.[591]
WHO An external panel advises against winding down the pandemic alert level until experts have tracked the southern hemisphere's traditional autumn and winter flu season. Accusations of undue influence from the pharmaceutical industry were also addressed.[595]
April 17
US According to the CDC, no states have reported either widespread or regional influenza activity, and four have reported local activity: Hawaii, Alabama, Georgia, and South Carolina.[596]
April 19
WHO Director-General Dr. Margaret Chan states that "It is still premature and too early for us to say we have come to an end of the pandemic influenza worldwide. It would be prudent and appropriate... to continue to monitor the evolution of this pandemic for the next six to 12 months," i.e. possibly into 2011. She also remarked that although the United States, Britain and Canada have passed through a second wave of H1N1, outbreaks in India, Egypt and elsewhere are intensifying, and reiterates that countries remain ill-prepared for a bird flu (H5N1) pandemic. More than 200 countries have now been affected by H1N1 with almost 12,000 confirmed deaths worldwide, although the vast majority of those infected recovered without special treatment.[597]
WHO Director-General Dr. Margaret Chan states at the U.N.'s World Health Assembly that "We are just plain lucky ... This has been the case with the A/ H1N1 influenza pandemic... The virus did not mutate to a more lethal form. Cases of resistance to oseltamivir remained few and isolated. The vaccine closely matched circulating viruses and showed an excellent safety record," Chan said. "Emergency wards and intensive care units were often strained, few health systems were overwhelmed ... Schools closed, but borders remained open, and disruptions to travel and trade were far less severe than feared," she told delegates from the agency's 193 member states. "Had things gone wrong in any of these areas, we would have a very different agenda before us today," she added."[599]
August 2010
August 6
US Researchers discover the mutation which had enabled the pandemic.[600][601]
August 10
WHO Director-GeneralMargaret Chan officially declares the H1N1 pandemic over as countries are now seeing a mix of H1N1, H3N2, and B viruses, with some populaces displaying community-level immunity to H1N1 of 20% to 40%.[602] Nevertheless, Angus Nicoll of the European Centre for Disease Prevention and Control urged health officials worldwide to "prepare for a new type of seasonal flu to appear in the near future that will combine elements of the pandemic A(H1N1) strain, and older A(H3N2) strain and several lesser strains".[603] "Pandemics are unpredictable and prone to deliver surprises," Director-General Chan noted.[603]
^Brown, David (2009-04-26). "U.S. Slow to Learn of Mexico Flu: Canadian Officials Knew of Rare Strain Before Americans Did". The Washington Post. Archived from the original on 2019-01-18. Retrieved 2 August 2010. The earliest case found in Mexico was a 39-year-old woman who died April 12 of severe viral pneumonia in San Luis Potosi, a city of about 700,000 in central Mexico. "That attracted the attention of the epidemiologist there," said Mauricio Hernández, deputy minister for disease prevention and health promotion in Mexico's Federal Department of Health
^"Sri Lanka detects first H1N1 flu case". Reuters. 2009-06-16. Archived from the original on 2009-06-26. COLOMBO, June 16 (Reuters) - Sri Lanka has identified its first case of the H1N1 flu virus in a young patient who arrived from Australia over the weekend, the government said on Tuesday."We...
