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93-480: The H1N1 pandemic of 2009 was the first public health emergency of international concern designated by the World Health Organization. While H1N1/09 was the primary strain of flu seen that year, it was not unusually contagious or lethal. Most cases were mild, although those who had to be hospitalized were often severely ill. In the fall of 2009, between 15-33% of those hospitalized with H1N1 in

186-575: A "call to action" and "last resort" measure. WHO Member States have 24 hours within which to report potential PHEIC events to the WHO. It does not have to be a member state that reports a potential outbreak, hence reports to the WHO may also be received informally, by non-governmental sources. Under the IHR (2005), ways to detect, evaluate, notify, and report events were ascertained by all countries in order to avoid PHEICs. The response to public health risks also

279-765: A PHEIC and do not require an IHR decision to declare them as such. Large scale health emergencies that attract public attention do not necessarily fulfill the criteria to be a PHEIC. ECs were not convened for the cholera outbreak in Haiti , chemical weapons use in Syria , or the Fukushima nuclear disaster in Japan , for example. Further assessment is required for diseases that are prone to becoming pandemics , including, but not limited to cholera , pneumonic plague , yellow fever , and viral hemorrhagic fevers. A declaration of

372-556: A PHEIC at this stage", a notion that is not part of the PHEIC criteria laid down in the IHR. After confirmed cases of Ebola in neighbouring Uganda in June 2019, Tedros Adhanom , the director-general of the WHO, announced that the third meeting of a group of experts would be held on 14 June 2019 to assess whether the Ebola spread had become a PHEIC. The conclusion was that while the outbreak

465-516: A PHEIC may appear as an economic burden to the state facing the epidemic. Incentives to declare an epidemic are lacking and the PHEIC may be seen as placing limitations on trade in countries that already are struggling. In order to declare a PHEIC, the WHO Director-General is required to take into account factors that include the risk to human health and international spread as well as advice from an international committee of experts,

558-710: A PHEIC would be an inappropriate way to raise money for the epidemic. Following a visit to the DRC in July 2019, Rory Stewart , the UK's DfID minister, called for the WHO to declare it an emergency. Acknowledging a high risk of spread to the capital of North Kivu, Goma , a call for a PHEIC declaration was published on 10 July 2019 in The Washington Post by Daniel Lucey and Ron Klain (the former United States Ebola response coordinator ). Their declaration stated that "in

651-441: A PHEIC, as the outbreak was considered over. On 30 January 2020, the WHO declared the outbreak of COVID-19 , centered on Wuhan in central China , a PHEIC. On 5 May 2023, the WHO ended the PHEIC declaration for COVID-19. On the date of the declaration, there were 7,818 cases confirmed globally, affecting 19 countries in five of the six WHO regions. Previously, the WHO had held EC meetings on 22 and 23 January 2020 regarding

744-545: A PHEIC, with six in favor and nine against. On 23 July 2022, the WHO director-general declared the outbreak a PHEIC. On 11 May 2023, the WHO ended the PHEIC declaration for Mpox, six days after doing so for COVID-19. On the date of the declaration, there were 17,186 cases reported globally, affecting 75 countries in all six WHO regions, with five deaths reported outside Africa and 72 deaths in African countries. The WHO had previously held an EC meeting on 23 June 2022 regarding

837-495: A PHEIC. The declaration is publicized by an IHR Emergency Committee (EC) of international experts, which was developed following the 2002–2004 SARS outbreak . Since 2005, there have been eight PHEIC declarations: the 2009–2010 H1N1 (or swine flu) pandemic , the ongoing 2014 polio declaration , the 2013–2016 outbreak of Ebola in Western Africa , the 2015–16 Zika virus epidemic , the 2018–2020 Kivu Ebola epidemic ,

930-452: A case of Ebola was confirmed in Goma, which has an international airport and a highly mobile population. Subsequently, the WHO announced a reconvening of a fourth EC meeting on 17 July 2019, when they officially announced it "a regional emergency, and by no means a global threat" and declared it as a PHEIC, without restrictions on trade or travel. In response to the declaration, the president of

1023-399: A chemical agent or radioactive material. It can be seen as an "alarm system", a "call to action", and "last resort" measure. Multiple surveillance and response systems exist worldwide for the early detection and effective response to contain the spread of disease. Time delays occur for two main reasons. The first is the delay between the first case and the confirmation of the outbreak by

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1116-611: A closely related 'sister virus' has circulated in Asia". However, a subsequent report by researchers at the Mount Sinai School of Medicine in 2016 found that the 2009 H1N1 virus likely originated in central Mexico. In early June 2009, using computational methods developed over the previous ten years, an international team of researchers attempted to reconstruct the origins and timescale of the 2009 flu pandemic. Oliver Pybus of Oxford University's Department of Zoology, and part of

1209-781: A county fair in Ohio. Analysis showed they were infected with the same strain—a H1N1 type containing genes of human, bird and swine origin. A 2004 study found that in Iowa, 20 percent of swine veterinarians and 3   percent of meatpackers, but no university workers, had antibodies in their blood indicating they had been infected with swine flu. Another study, of 804 rural Iowans, found that pig farmers were 50 times more likely, and their spouses about 30 times more likely, than university workers to carry swine flu antibodies. Pigs are also known to have been infected by humans. Humans have been affected since early 2009. The November 27, 2009 worldwide update by

1302-460: A day after their fever subsides (usually 3–4 days after the onset of symptoms) before resuming normal activities, but it has been found that they can continue to shed virus for several more days. The virulence of swine flu virus is mild and the mortality rates are very low. In mid-2009, the U.S. CDC noted that most infections were mild, similar to seasonal flu, and that recovery tended to be fairly quick. The number of deaths as of September 2009

1395-455: A dedicated web site for the swine influenza pandemic. At the time that H1N1 had been declared a PHEIC, it had occurred in only three countries. Therefore, it was argued that the declaration of the H1N1 outbreak as a PHEIC, was fueling public fear. A 2013 study sponsored by the WHO estimated that, although similar in magnitude to seasonal influenza, it cost more life-years than seasonal flu, due to

1488-594: A global emergency. As of 17 August 2024, over 15,600 cases and 537 deaths have been reported in the current outbreak, with approximately 96% of cases occurring in the Democratic Republic of the Congo (DRC). 12 other African countries, some for the first time, have also reported cases. In 2018, an examination of the first four declarations (2009–2016) showed that the WHO was noted to be more effective in responding to international health emergencies, and that

1581-526: A legal duty to respond promptly to a PHEIC. PHEIC is defined as: an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. This definition designates a public health crisis of potentially global reach and implies a situation that is "serious, sudden, unusual, or unexpected", which may necessitate immediate international action. It can be seen as an "alarm system",

1674-459: A mild illness, but the small minority hospitalized were often severely ill. Arand Kumar, an intensive care expert at the University of Manitoba, Winnipeg, Canada, said "this pandemic is like two diseases; either you're off work for a few days or you go to hospital, often to the intensive-care unit (ICU). There's no middle ground." In the southern hemisphere 15 to 33% of hospitalized cases went to

1767-557: A mortality rate of between 60% and 70%. Experts worry about the emergence of a hybrid of the more virulent Asian-lineage HPAI (highly pathogenic avian influenza) A/H5N1 strain (media labeled "bird flu") with more human-transmissible influenza A strains such as this novel 2009 swine-origin A/H1N1 strain (media labeled "swine flu"), especially since the H5N1 strain is endemic among birds in countries like China, Indonesia, Vietnam and Egypt. (See

1860-468: A novel type of virus as new virus particles are being assembled. This new strain appears to be a result of the reassortment of two swine influenza viruses, one from North America and one from Europe. But the North American pig strain was itself the product of previous reassortments, and has carried an avian PB2 gene for at least ten years and a human PB1 gene since 1993. These genes were passed on to

1953-463: A potentially dangerous mutation. Virus experts were concerned that a more dangerous and easily transmitted strain could emerge if H1N1/09 combines again with avian flu, which is far more virulent but much less contagious to humans. By October 2009, another outbreak was identified at a turkey breeder in Ontario, Canada. In October 2009, a ferret exhibiting flu symptoms was confirmed to have contracted

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2046-491: A rural unvaccinated population in China found only a 0.3% cross-reactive antibody reaction to the H1N1 strain, suggesting that previous vaccinations for seasonal flu and not exposure may have resulted in the immunity found in the older U.S. population. Production may be three billion doses per year rather than the earlier estimate of five billion. On May 22, 2009, World Health Organization (WHO) Director-General Margaret Chan said

2139-713: A shift toward mortality among persons less than 65 years of age. The second PHEIC was the 2014 polio declaration , issued on 5 May 2014 with a rise in cases of wild polio and circulating vaccine-derived poliovirus. The status achieved, as global eradication, was deemed to be at risk by air travel and border crossing overland, with small numbers of cases in Afghanistan, Pakistan, and Nigeria. In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia,

2232-693: A sick pet as it might be possible for cats to transmit the virus to humans. This was the third confirmed case of H1N1 in a cat in the U.S.; other cases have occurred in Utah and Iowa. The first case of a dog with H1N1 was reported in December 2009. On July 22, 2011 the Norwegian Veterinary Institute reported the first occurrence of 2009-H1N1 influenza virus in minks. The initial outbreak of a novel swine-origin H1N1 flu pandemic in 2009 and

2325-420: A surface or the hand of a person contaminated with the virus and then touching one's eyes, nose or mouth. In 2009, the WHO reported that H1N1/09 seemed to be more contagious than seasonal flu. However, a New England Journal of Medicine report said the transmissibility of the 2009 H1N1 influenza virus in households was lower than that seen in past pandemics. The U.S. CDC recommended that people should wait at least

2418-481: A swine influenza A (H1N1) virus. The viruses from the two cases were closely related genetically, resistant to amantadine and rimantadine, and contain a unique combination of gene segments that previously had not been reported among swine or human influenza viruses in the United States or elsewhere. After the emergence of the novel virus in the spring of 2009, it spread quickly across the United States, Mexico and

2511-743: Is known for his work on the evolution and epidemiology of viruses and for helping to establish the field of phylodynamics . In recognition of his work, he has received several awards including the Scientific Medal of the Zoological Society of London in 2009, the Daiwa Adrian Prize in 2010, an ERC Consolidator Award in 2014, and the Mary Lyon Medal of the Genetics Society in 2019, and in 2022 he

2604-448: Is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S. So far, little is known about the spread of the virus in any pig population. A preliminary analysis has also shown that several of the proteins involved in the pathophysiology of the virus are most similar to strains that cause mild symptoms in humans. This suggests the virus is unlikely to cause severe infections similar to those caused by

2697-524: Is relatively slow since the structure of the 2009 H1N1 virus is similar to the strain of H1N1 implicated in the 1918 flu pandemic. A study from Hokkaido University found a sequence homology between the Hemagglutinin antigen amino acid residues found in the earlier 1918 strain and the 2009 H1N1 strain. This may have played a role in individuals who had been infected with the 1918 strain and its early descendants in showing stronger specific immunity to

2790-569: Is unsafe for consumption. The CDC began referring to it as "novel influenza A (H1N1)"; "A/H1N1" is sometimes used. The CDC stopped using the nomenclature "novel H1N1" and updated various web pages to reflect the change to "2009 H1N1 Flu". In the Netherlands it was originally called "pig flu" but, later called "Mexican flu" by the National Health Institute and in the media. South Korea and Israel briefly considered calling it

2883-576: The IHR Emergency Committee (EC), one of whom should be an expert nominated by the State within whose region the event arises. Rather than being a standing committee, the EC is created on an ad hoc basis. Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms, now they are. These members are selected according to the disease in question and the nature of

Pandemic H1N1/09 virus - Misplaced Pages Continue

2976-480: The Lancet commission on COVID-19 published a report, calling the response to the pandemic "a massive global failure on multiple levels". The WHO responded by noting "several key omissions and misinterpretations in the report, not least regarding the public health emergency of international concern (PHEIC) and the speed and scope of WHO's actions." They stated that the report "offers the best opportunity to insist that

3069-651: The SARS outbreak of 2002–2003. Between 2009 and 2016, there were four PHEIC declarations. The fifth was the 2018–2020 Kivu Ebola epidemic , declared in July 2019 and ended in June 2020. The sixth was the COVID-19 pandemic , declared in January 2020 and ended in May 2023. The seventh was the 2022–2023 mpox outbreak , declared in July 2022 and ended in May 2023. Under the 2005 International Health Regulations (IHR), states have

3162-408: The proteins of the virus are most similar to strains that cause mild symptoms in humans, leading virologist Wendy Barclay to suggest that the virus was unlikely to cause severe symptoms for most people. Other leading researchers indicated that all segments of the virus were in fact swine in origin, despite it being a multiple reassortment. The first complete genome sequence of the pandemic strain

3255-514: The "Mexican virus". Later the South Korean press used "SI", short for "swine influenza". Taiwan suggested the names "H1N1 flu" or "new flu", which most local media adopted. The World Organization for Animal Health proposed the name "North American influenza". The European Commission adopted the term "novel flu virus". The name A(H1N1)pdm09 later came into widespread use, sometimes qualified as A/California/7/2009(H1N1)pdm, etc. The pdm09 in

3348-567: The 1918 pandemic flu virus or the H5N1 avian influenza . Late on May 6, 2009, Canada's National Microbiology Laboratory first completed the sequencing of Mexican samples of the virus, publishing the result to GenBank as A/Mexico/InDRE4487/2009(H1N1). This was later shown to be nearly identical to A/California/07/2009 (H1N1), the strain from California sequenced and published by the CDC on 27 April. Samples from Mexico, Nova Scotia and Ontario had

3441-471: The 2009 H1N1 virus. This finding provided insight into future monitoring of the H1N1 virus and its evolution within the human population. On November 20, 2013, the Norwegian Institute of Public Health released a statement saying they had discovered a potentially significant mutation in the H1N1 influenza strain that could be responsible for causing the severest symptoms among those infected. In

3534-479: The 2020–2023 declaration for the COVID-19 pandemic , and the 2022–2023 and 2024 mpox outbreaks . The recommendations are temporary and require reviews every three months. Automatically, SARS , smallpox , wild type poliomyelitis , and any new subtype of human influenza are considered as PHEICs and thus do not require an IHR decision to declare them as such. A PHEIC is not only confined to infectious diseases, and may cover an emergency caused by exposure to

3627-413: The DRC, together with an expert committee led by a virologist, took responsibility for directly supervising action, while in protest of the declaration health minister Oly Ilunga Kalenga resigned. A review of the PHEIC had been planned at a fifth meeting of the EC on 10 October 2019 and on 18 October 2019 it remained a PHEIC until 26 June 2020 when it was decided that the situation no longer constituted

3720-539: The H1N1 pandemic virus in the U.S. This is sometimes compared to the 36,000 people per year who die from the "common flu", mostly in winter, although this number is an estimate. The death rate of H1N1 in the U.S. was calculated as less than 0.02% from November 2009 figures from the CDC, and has been explicitly calculated as 0.026% in England. A study at the U.S. Centers for Disease Control and Prevention published in May 2009 found that children had no preexisting immunity to

3813-683: The H1N1 virus from its owner in Oregon. In November 2009, a case of novel H1N1 was confirmed in a household cat. Although the earliest cat fatality from the H1N1 virus in the U.S. occurred in Pennsylvania, the Oregon Veterinary Medical Association was the first to confirm a cat fatality in the U.S. The association recommended that cat owners with flu symptoms avoid touching cat's eyes, nose, and mouth while sick. They recommended thoroughly washing hands after handling

Pandemic H1N1/09 virus - Misplaced Pages Continue

3906-448: The ICU in July and August 2009. Unlike H5N1 avian flu and SARS which provoke a runaway body-wide immune response , H1N1/09 destroys the lungs ' alveoli , often causing acute respiratory distress syndrome , which kills in half of all cases. Preliminary research suggests that severity is linked to a genetic variation in immune systems. From April 2009 to November 2009, 3,900 people died of

3999-494: The International Health Regulations as well as a new legally binding agreement (most likely a treaty) on pandemic prevention, preparedness, and response. Proposals include the possibility of issuing intermediate public health alerts (short of PHEICs) and determining public health emergencies of regional concern. Notably, although COVID-19 is routinely referred to as a pandemic, this word is not used in

4092-424: The International Health Regulations." With the emergency phase of the pandemic being regarded as having ended, more subtle and robust institutional responses and protocols are in the works for further iterations of this pandemic as well as global pandemics of whatever etiology . At the second IHR meeting for the 2022–2023 mpox outbreak on 21 July 2022, members of the emergency committee were divided about issuing

4185-557: The Southern Hemisphere were taken to the ICU. One clinician remarked that the pandemic was "like two diseases" because of the stark difference between mild and severe cases, with few falling in between. The virus is a novel strain of the influenza virus , for which existing vaccines against seasonal flu provided no protection. A study at the U.S. Centers for Disease Control and Prevention (CDC) published in May 2009 found that children had no preexisting immunity to

4278-437: The U.N.'s World Health Organization (WHO) states that "more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 7,820 deaths". The WHO has also tracked more than 622,482 laboratory-confirmed cases of H1N1. The symptoms of this virus are identical to that of seasonal influenza. In late August 2009, the government of Chile discovered that

4371-470: The UK (including Wales) and in North Carolina, occurred in a single ward and involved patients whose immune systems were severely compromised or suppressed. Transmission of resistant virus from one patient to another is suspected in both outbreaks. As of December 2010, the WHO reported 314 samples of 2009 pandemic H1N1 flu tested worldwide have shown resistance to oseltamivir (Tamiflu). This

4464-420: The United States alone, was preceded by a mild "herald" wave of cases in the spring, followed by devastating waves of illness in the autumn. As of late July 2009, U.S. health officials said the swine flu wasn't yet mutating to become more dangerous, but they were closely tracking that as the virus continued to circle the globe. As of October 2009, research done by Taubenberger showed that the evolution of A (H1N1)

4557-453: The United States, in severe as well as in some mild cases. "Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases." On December 2, 2009, the WHO announced that they had been informed of two recent clusters of patients infected with oseltamivir-resistant H1N1 viruses. Both clusters, detected in

4650-523: The WHO declared its fourth PHEIC in response to clusters of microcephaly and Guillain–Barré syndrome in the Americas , which at the time were suspected to be associated with the ongoing 2015–16 Zika virus epidemic . Later research and evidence bore out these concerns; in April, the WHO stated that "there is scientific consensus that Zika virus is a cause of microcephaly and Guillain–Barré syndrome." This

4743-893: The above nomenclature refers to Pandemic Disease Mexico 2009. On April 24, 2009, the U.S. CDC determined that seven samples from suspected cases in Mexico matched the strain that had infected patients in Texas and California with no known linkages to animals or one another; the strain appeared to be spreading from human to human. The CDC determined that the strain contained genes from four different flu viruses—North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe—"an unusually mongrelised mix of genetic sequences". A CDC investigative team arrived in Mexico City on April 25, 2009 to work with Mexican counterparts to study

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4836-480: The absence of a trajectory toward extinguishing the outbreak, the opposite path—severe escalation—remains possible. The risk of the disease moving into nearby Goma, Congo—a city of 1 million residents with an international airport—or crossing into the massive refugee camps in South Sudan is mounting. With a limited number of vaccine doses remaining, either would be a catastrophe". Four days later, on 14 July 2019,

4929-654: The emergence and spread of antimicrobial resistance may constitute a PHEIC. Oliver Pybus Oliver George Pybus is a British biologist. He is professor of evolution and infectious disease at the University of Oxford and professor of infectious diseases at the Royal Veterinary College . He is also editor-in-chief of Virus Evolution and co-Director of the Oxford Martin School Program for Pandemic Genomics. He

5022-729: The emergencies did not coincide with holidays. PHEIC was not invoked with the Middle Eastern Respiratory Syndrome (MERS) outbreak in 2013. Originating in Saudi Arabia, MERS reached more than 24 countries and resulted in 876 deaths by May 2020, although most cases were in hospital settings rather than sustained community spread. As a result, what constitutes a PHEIC has been unclear. PHEIC are not confined to only infectious diseases or biological ones. It may cover events caused by chemical agents or radioactive materials. Debate exists regarding whether

5115-658: The end of November, likely around September 2008. A report by researchers at the Mount Sinai School of Medicine in 2016 found that the 2009 H1N1 virus likely originated from pigs in a very small region of central Mexico. On April 17, 2009, the Centers for Disease Control and Prevention (CDC) determined that two cases of febrile respiratory illness occurring in children who resided in adjacent counties in Southern California were caused by infection with

5208-598: The event. Names are taken from the IHR Experts Roster . The director-general takes the advice of the EC, following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration, the EC then makes recommendations on what actions the director-general and member states should take to address the crisis. The recommendations are temporary and require review every three months while in place. Summary of PHEIC declarations In

5301-475: The failures and lessons from the past 3 years are not wasted but are constructively used to build more resilient health systems and stronger political systems that support the health and wellbeing of people and planet during the 21st century." The formal end of the COVID-19 PHEIC is a matter of much nuance which carries its own risks, and as of March 2023, "WHO member states are negotiating amendments to

5394-413: The healthcare system, allayed by good surveillance via data collection, evaluation, and organisation. The second is when there is a delay between the detection of the outbreak and widespread recognition and declaration of it as an international concern. The declaration is promulgated by an emergency committee (EC) made up of international experts operating under the IHR (2005), which was developed following

5487-414: The human H1N1/09 virus had jumped, unmutated, to birds, "opening a new chapter in the global epidemic". Top flu and animal-health experts with the WHO and the CDC were monitoring the situation closely. They said the infected turkeys had suffered only mild effects, easing concern about a potentially dangerous development. Chile's turkey meat remained safe to eat, they said, and so far there had been no signs of

5580-434: The hypothesis. After reviewing the initial paper, WHO and other organizations concluded the pandemic strain was a naturally-occurring virus and not laboratory-derived. The virus is contagious with an R 0 of 1.4 to 1.6 and spreads from human to human in much the same way as seasonal flu. The most common mechanisms by which it spreads are by droplets from coughs and sneezes of infected people, and also potentially touching

5673-420: The importance of international cooperation to engage in proper surveillance to help monitor changes in the virus's behavior, which will aid in both "vaccine targeting" and interpreting illness patterns in the fall of 2009. Other experts in 2009 were also concerned that the new virus strain could mutate over the coming months. Guan Yi, a leading virologist from the University of Hong Kong, for instance, described

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5766-434: The international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual, or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action". Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to

5859-410: The international system in dealing with these emergencies was "robust". Another review of the first four declarations, with the exception of wild polio, demonstrated that responses were varied. Severe outbreaks, or those that threatened larger numbers of people, did not receive a swift PHEIC declaration, and the study hypothesized that responses were quicker when American citizens were infected and when

5952-471: The lack of systematic swine surveillance allowed for the undetected persistence and evolution of this potentially pandemic strain for many years." According to the researchers, movement of live pigs between Eurasia and North America "seems to have facilitated the mixing of diverse swine influenza viruses, leading to the multiple reassortment events associated with the genesis of the (new H1N1) strain". They also said this new pandemic "provides further evidence of

6045-503: The lungs. Seasonal flu can infect only cells with receptor type a2-6 which are typically located in the nose and throat but H1N1/09 can also infect cells with receptor type a2-3. This may explain why some patients experience severe respiratory symptoms. (The H5N1 virus is also able to infect cells deep in the lungs with receptor type a2-3 but cannot infect cells with receptor type a2-6 making it less contagious than H1N1/09.) As of September 2009, most people infected by this flu suffered

6138-440: The new H1N1 influenza virus as "very unstable", meaning it could mix and swap genetic material (reassortment) when exposed to other viruses. During an interview he said, "Both H1N1 and H5N1 are unstable so the chances of them exchanging genetic material are higher, whereas a stable (seasonal flu) virus is less likely to take on genetic material." The H5N1 virus is mostly limited to birds, but in rare cases when it infects humans it has

6231-405: The new strain but that adults, particularly those older than 60, had some degree of immunity. Children showed no cross-reactive antibody reaction to the new strain, adults aged 18 to 60 had 6–9%, and older adults 33%. While it has been thought that these findings suggest the partial immunity in older adults may be due to previous exposure to similar seasonal influenza viruses, a November 2009 study of

6324-525: The new strain but that adults, particularly those over 60, had some degree of immunity. Children showed no cross-reactive antibody reaction to the then-new strain, while adults aged 18 to 64 had 6–9%, and older adults 34%. Much reporting of early analysis repeated that the strain contained genes from five different flu viruses: North American swine influenza , North American avian influenza, human influenza, and two swine influenza viruses typically found in Asia and Europe. Further analysis showed that several of

6417-411: The new swine flu pandemic arose on factory farms in Mexico", now believe it "most likely emerged in pigs in Asia, but then traveled to North America in a human". They emphasized that there was no way to prove their hypothesis but said there is no evidence this new virus, which combines Eurasian and North American genes, has never circulated in North American pigs, "while there is tantalizing evidence that

6510-639: The new virus. Gene sequences for every viral gene were made available through the Global Initiative on Sharing Avian Influenza Data ( GISAID ). A preliminary analysis found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. While viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, there

6603-415: The occurrence of Ebola in the United States and Europe and with the already intense transmission ongoing in three other countries for months, the WHO declared its third PHEIC in response to the outbreak of Ebola in Western Africa . Later, one review showed that a direct impact of this epidemic on America escalated a PHEIC declaration. It was the first PHEIC in a resource-poor setting. On 1 February 2016,

6696-670: The outbreak, but it was determined at that time that it was too early to declare a PHEIC, given the lack of necessary data and the then-scale of global impact. The WHO recognized the spread of COVID-19 as a pandemic on 11 March 2020. The emergency committee convened its third meeting on 30 April 2020, fourth on 31 July, fifth on 29 October, sixth on 14 January 2021, seventh on 15 April 2021, ninth in October 2021, tenth in January 2022, eleventh in April 2022, twelfth in July 2022, thirteenth in October 2022, fourteenth in January 2023, and fifteenth in May 2023. In September 2022,

6789-505: The outbreak, suggesting a need to increase agricultural surveillance to prevent future outbreaks. Public health emergency of international concern A public health emergency of international concern ( PHEIC / f eɪ k / FAYK ) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through

6882-475: The outbreak, which had more than 2,100 cases in over 42 countries at that point; it did not reach the criteria for a PHEIC alert at the time. It was re-classified a PHEIC in August 2024. After an IHR meeting on 14 August 2024, the WHO declared an mpox outbreak in parts of Africa , of a new variant of the disease, a PHEIC. This marks the second time in three years that the WHO has classified an mpox outbreak as

6975-480: The research team, claims "Our results show that this strain has been circulating among pigs, possibly among multiple continents, for many years prior to its transmission to humans." The research team who worked on this case also believed it was "derived from several viruses circulating in swine", and that the initial transmission to humans occurred several months before recognition of the outbreak. The team concluded that "despite widespread influenza surveillance in humans,

7068-502: The role of domestic pigs in the ecosystem of influenza A". In November 2009, a study was published in Virology Journal in which it was suggested that the virus may be the product of three strains from three continents that swapped genes in a lab or a vaccine-making plant, and subsequently "escaped". The study followed debate among researchers in May 2009, when the authors asked the World Health Organization (WHO) to consider

7161-476: The same sequence, ruling out genetic explanations for the greater severity of the Mexican cases. The genetic divergence of the virus in samples from different cases has been analysed by an international collaboration who found that the virus jumped to humans in 2008, probably after June, and not later than the end of November. The research also indicated the virus had been latent in pigs for several months prior to

7254-488: The situation as "an Ebola gas can sitting in DRC that's just waiting for a match to hit it", while the WHO panel were unanimous in their decision that declaring it a PHEIC would not give any added benefit. The advice against declaring a PHEIC in October 2018 and April 2019, despite the criteria for doing so appearing to be met on both occasions, has led to the transparency of the IHR EC coming into question. The language used in

7347-564: The spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in Mexico , North America . It spread quickly across the United States and the world . On 26 April 2009, more than one month after its first emergence, the initial PHEIC was declared when the H1N1 (or swine flu) pandemic was still in phase three . Within three hours on the same day, the WHO web site received almost two million visits, necessitating

7440-503: The statement they said "The mutation could be affecting the virus' ability to go deeper into the respiratory system, thus causing more serious illness". The World Health Organization said the mutation did not appear to be widespread in Norway and the virus in its mutated form remained sensitive to antivirals and pandemic vaccines. A similar mutation had been detected in H1N1 viruses circulating in several other countries, including China and

7533-464: The statements for the Kivu Ebola epidemic has been noted to be different. In October 2018, the EC stated "a PHEIC should not be declared at this time". In the 13 previously declined proposals for declaring a PHEIC, the resultant statements quoted "the conditions for a PHEIC are not currently met" and "does not constitute a PHEIC". In April 2019, they stated that "there is no added benefit to declaring

7626-401: The suite of H5N1 articles for details.) Other studies concluded that the virus was likely well adapted to humans, had a clear biological advantage over seasonal flu strains and that reassortment was unlikely at that time due to its ease in replication and transmission. However, Federal health officials in the U.S. noted that the horrific 1918 flu epidemic , which killed hundreds of thousands in

7719-402: The virus must be closely monitored in the southern hemisphere, as it could mix with ordinary seasonal influenza and change in unpredictable ways. Experts writing in the July issue of The New England Journal of Medicine noted that historically, pandemic viruses have evolved between seasons, and the current strain may become more severe or transmissible in the coming months. They therefore stressed

7812-410: The virus strain that caused it were called by many names. In July 2009, WHO experts named the virus "pandemic H1N1/09 virus" to distinguish it from both various seasonal H1N1 virus strains and the 1918 flu pandemic H1N1 strain. Some authorities objected to calling the flu outbreak "swine flu". U.S. Agriculture Secretary Tom Vilsack expressed concerns that this would lead to the misconception that pork

7905-506: The virus. Pigs are susceptible to influenza viruses that can also infect both humans and birds, so they may act as a "mixing vessel" in which reassortment can occur between flu viruses of several species. Reassortment is a process that happens if two different types of influenza virus infect a single cell and it can produce a new strain of influenza. This is because the virus genome is split between eight independent pieces of RNA, which allows pieces of RNA from different viruses to mix and form

7998-400: The world. In late April, the World Health Organization (WHO) declared its first ever "public health emergency of international concern", or PHEIC , and in June, the WHO and the U.S. CDC stopped counting cases and declared the outbreak a pandemic . On June 23, 2009, The New York Times reported that U.S. federal agriculture officials believed that, "contrary to the popular assumption that

8091-425: Was a health emergency in the Democratic Republic of the Congo (DRC) and the region, it did not meet all the three criteria for a PHEIC. Despite the number of deaths reaching 1,405 by 11 June 2019 and 1,440 by 17 June 2019, the reason for not declaring a PHEIC was that the overall risk of international spread was deemed to be low, and the risk of damaging the economy of the DRC high. Adhanom also stated that declaring

8184-418: Was decided. The IHR decision algorithm assists WHO Member States in deciding whether a potential PHEIC exists and whether the WHO should be notified. The WHO should be notified if any two of the four following questions are affirmed: The PHEIC criteria include a list of diseases that are always notifiable . SARS , smallpox , wild type poliomyelitis , and any new subtype of human influenza are always

8277-538: Was deposited in public databases on April 27, 2009, by scientists from the U.S. Centers for Disease Control and Prevention in Atlanta. Scientists in Winnipeg later completed the full genetic sequencing of viruses from Mexico and Canada on May 6, 2009. Analysis of the genetic divergence of the virus in samples from different cases indicated that the virus jumped to humans in 2008, probably after June, and not later than

8370-412: Was not totally unexpected as 99.6% of the seasonal H1N1 flu strains tested have developed resistance to amantadine and rimantadine. As of August 2009 no circulating flu had yet shown any resistance to zanamivir (Relenza), the other available anti-viral. Before being transmitted to humans, a H1N1 type virus is known to have circulated in swine. In August 2007, about 25 people and 160 pigs developed flu at

8463-608: Was reviewed and polio continued to be a PHEIC. As of November 2021, taking into account recent events in Afghanistan, a large number of unvaccinated children, increasing mobile people in Pakistan and the risks associated with the COVID-19 pandemic among others, polio remains a PHEIC. Confirmed cases of Ebola were being reported in Guinea in December 2013 and Liberia in March 2014 and Sierra Leone by May 2014. On 8 August 2014, following

8556-443: Was said to be a tiny fraction of the annual number of deaths from seasonal flu. However, comparisons of human fatality figures with seasonal influenza are prone to underestimate impact of the pandemic, and the pandemic H1N1/09 virus was in fact the dominant strain of influenza causing illness in the 2009/10 flu season. Research carried out at Imperial College London has shown that, unlike seasonal flu, H1N1/09 can infect cells deep in

8649-481: Was the first time a PHEIC was declared for a mosquito‐borne disease . This declaration was lifted on 18 November 2016. In October 2018 and then later in April 2019, the WHO did not consider the 2018–2020 Kivu Ebola epidemic to be a PHEIC. The decision was controversial, with Michael Osterholm , director of the Center for Infectious Disease Research and Policy (CIDRAP) responding with disappointment and describing

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