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警报!!! 世卫(WHO)宣布:流感大流行到来---1st in 41 years
作者:USMedEdu
发表时间:2009-06-11
更新时间:2009-06-11
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地址:10.
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WHO: Swine flu pandemic has begun, 1st in 41 years


ABC News – Swine Flu to Be Declared Pandemic

GENEVA – The World Health Organization told its member nations it was declaring a swine flu pandemic Thursday — the first global flu epidemic in 41 years — as infections climbed in the United States, Europe, Australia, South America and elsewhere.

In a statement sent to member countries, WHO said it decided to raise the pandemic warning level from phase 5 to 6 — its highest alert — after holding an emergency meeting on swine flu with its experts.

The long-awaited pandemic decision is scientific confirmation that a new flu virus has emerged and is quickly circling the globe. It will trigger drugmakers to speed up production of a swine flu vaccine and prompt governments to devote more money toward efforts to contain the virus.

"At this early stage, the pandemic can be characterized globally as being moderate in severity," WHO said in the statement, urging nations not to close borders or restrict travel and trade. "(We) remain in close dialogue with influenza vaccine manufacturers."

On Wednesday, WHO said 74 countries had reported nearly 27,737 cases of swine flu, including 141 deaths.

The agency has stressed that most cases are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities — especially in poorer countries.

Still, about half of the people who have died from swine flu were previously young and healthy — people who are not usually susceptible to flu.

Swine flu is also continuing to spread during the start of summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but swine flu is proving to be resilient.

The last pandemic — the Hong Kong flu of 1968 — killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year.

Many health experts say WHO's pandemic declaration could have come weeks earlier but the agency became bogged down by politics. In May, several countries urged WHO not to declare a pandemic, fearing it would cause social and economic turmoil.

"This is WHO finally catching up with the facts," said Michael Osterholm, a flu expert at the University of Minnesota who has advised the U.S. government on pandemic preparations.

Despite WHO's hopes, raising the epidemic alert to the highest level will almost certainly spark some panic about spread of swine flu.

Fear has already gripped Argentina, where thousands of people worried about swine flu flooded into hospitals this week, bringing emergency health services in the capital of Buenos Aires to the brink of collapse. Last month, a bus arriving in Argentina from Chile was stoned by people who thought a passenger on it had swine flu. Chile has the most swine flu cases in South America.

In Hong Kong on Thursday, the government ordered all kindergartens and primary schools closed for two weeks after a dozen students tested positive for swine flu — a move that some flu experts would consider an overreaction.

In the United States, where there have been more than 13,000 cases and at least 27 deaths from swine flu, officials at the U.S. Centers for Disease Control and Prevention said the move would not change how the U.S. tackled swine flu.

"Our actions in the past month have been as if there was a pandemic in this country," Glen Nowak, a CDC spokesman, said Thursday.

The U.S. government has already taken steps like increasing availability of flu-fighting medicines and authorizing $1 billion for the development of a new vaccine against the novel virus. In addition, new cases seem to be declining in many parts of the country, U.S. health officials say, as North America moves out of its traditional winter flu season.

Still, Osterholm said the declaration was a wake-up call for the world.

"I think a lot of people think we're done with swine flu, but you can't fall asleep at the wheel," he said. "We don't know what's going to happen in the next 6 to 12 months."

___

Medical Writer Maria Cheng reported from London. Mike Stobbe in Atlanta, Jill Lawless in London, Dikky Sinn in Hong Kong, Vincente L. Panetta in Buenos Aires and Bradley S. Klapper in Geneva also contributed to this report.

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共有4条评论
1   [DrNewbie 于 2010-11-20 02:12:39 提到] [FROM: 98.]


Medi is back to its glory days in the absence of the obnoxious barking from the MadDog!!! Does anyone think there are some indispensable tips he actually learned from his private club? His club is such a joke.

I cant believe this kind of idiot exists in this world. Two words to describe this piece of human trash: shameless and stupid. USMedEdu, aka, MadDog, put the following thread in his blog and bold it in the front page. Yet, clearly, the answers he endorsed are the worst answers. The answer I provided got a nod from an English forum. Does he understand the concept of shame or logic? Not only he speaks/writes shitty English, he cant think straight either. And now he wants to drag everyone down with him. PITY! What kind of dumb ass slaps his own face in public? What a joke!
无极: 住院医生面试碰到的尴尬事( 力刀评注推荐及麦地网友讨论)

Doc has successfully sabotaged a good learning club. At the peak, the pre_resident_english_corner had over 95 members and hundreds of posts. Congratulations! I will jot down a few expressions and new words here and there for myself mostly. Sorry friends. I let you down. You guys are the only losers as the bystanders caught in the cross-fire between the two warring parties. Ironically, both of the two people at war came out as the only two 'winners'. Doc can claim his star power. I can focus on my study.

Clearly, this USMedEd cant think straight anymore at his age. To give his credit where credit is due, he is still good at copying/pasting of the posts written by others. Follow his rubbish advice at your peril. We can write a laundry list of his shitty advice. This is a guy who cant keep his job for long. I am still wondering why he had to side with the losing party in a political struggle at work as he put it in one of his posts. Most people would not get involved. Only confrontational and aggressive douche bags would go for it. They can be burned again and again and are still clueless as it is just bad luck and not their faults whatsoever.

It is not just me saying this. Read this:
[snowfox01 于 2010-11-02 17:25:32 提到] [FROM: 134.74.]
Dr.Newbie:Please be nice to this old man。
难道你没看见你把他生命中唯一的支柱----收集各种贴子,然后大言不惭的copy&post 到自己的网页。给打碎了。同时,他在麦地的“一手遮天” 用那二十年前的狗屁经验来误导新人,也让你给揭穿了。我能理解他的恼羞成怒。他也没几天了,就让他乐呵乐呵吧。

There is no doubt that my English is better than anyone else including Eric and that lumcsomething. I was actually touched by the applications to my club every day during this short time. While I am still trying to figuring out the best way to get people energized and the best way to help, it went kaboom. It is such a pity. Just imagine how much more I can help once I get into residency and finish it.

I am sorry it has gone this far. This dokknife has been attacking me relentlessly on anything I write for no good reason. I have to stand up for myself. He said it himself: He does not care whether I am right or wrong. So he makes it personal. Now, he got it. It is personal between him and me.

Feel free to say hello to me at your leisure. I dont have time to play with this piece of human trash and a sadist who excels in copying/pasting and who cant keep his jobs for long. Let him have his schadenfreude from how the ex-boss who canned him got divorced. Let him brag how successful he is in dismantling a learning place.

Lets watch which comes first: I get into residency or he got fired.

并爱好给人改错的蠢人的发言更充分地反映出其愚蠢和无知,她的所谓良好英语在她的愚蠢脑袋支配下成了砸她自己脚的石头。此人在麦地已经贩卖了无数的垃圾和错误得东西。我实在无法忍受这种蠢人无休无止地误导CMG.
-----Doc.
乌龟总是对眼王八,狼和狈总是为奸。
你和这个混球对上眼很正常。装糊涂装黄花大姑娘真有坐台小姐得姿态嘛。
-----Doc
你这WSN还真是咸吃萝卜蛋操心.
-----Doc
耗子乌龟王八苍蝇和垃圾.
-----Doc
狗屁不懂的蠢货,愚蠢跳粱BSO牛Xer还真是第一次出现。各位可以饱眼福了.
-----Doc
换王八壳子来口水的蠢货的蠢言蠢语愚不可及的暴露,她懂个狗P.
-----Doc
我当我的医生,真也是撑了的,给你这号250上课来了还指望你懂人话呢。俺还真不如去打兔子大雁打网球去了。你这号真是纯粹的生物WSN德性。
-----Doc
向你这号又哭穷和没地方找饭碗,还不愿去换个活法,才真让人烦的WSN德性呢!真该去CT或MRI了!
-----Doc
你丫的又该酸掉几个牙?尔等难怪人家说生物萎缩,真TMD不亏!
-----Doc
说你等装B萎缩吧,你还扭扭捏捏跟坐台的要装黄花大姑娘似的。想来邪的,俺不是
不会更不是没掐过。
-----Doc



You all think this is acceptable and a good presentation of character? What I said back is half what he has said to me. Every time I make an apology to him, I got spit-at-your-face response in return.

It is a pity to see a good club falling apart. At least I have the decency not to use my club as a venting joint. I am sorry that you are put between a rock and a hard place. I will understand if you have to quit the club. You are always welcome to use a majia and check us out. This club is not intended as a base for isolation or a launch pad for personal attacks. It is a place purely devoted to English skills. It is a really a shame that Doc would pull people out of a club just to make people take sides. I dont see how he sabotages an educational club would help his cause. Yes, he has succeeded in pulling 20 people out of my English club and he can claim it is a win-lose-lose situation for himself. But ultimately, it is a lose-lose-lose situation.


1 [DrNewbie 于 2010-11-08 22:03:16 提到][删除][修改] [FROM: 98.119.]
Do you have any traces of honor and integrity left in your body? What a piece of human trash. How hard is it to admit you were wrong? What a stupid, arrogant, crazy bitch. Your bark is worse than your bite. Pathetic loser. You promote a 'clean' medi. Yet, you started a club for the sole purpose of shitting in it.You are a disgrace to the human race.

Read this and you know how it started and what I said is exactly what Doc said to me in English. And he said it a dozen of times to me.

http://www.mitbbs.com/pc/pccon_7773_142905.html

1 [DrNewbie 于 2010-11-08 23:51:41 提到][删除][修改]

What I said is half of what you have said to me. What are you whining about? Be a man. Fight fair and square. Dont just shit in your own compound. You thought you will get sympathy from your followers? What you get is despise from your sympathizers.

2 [DrNewbie 于 2010-11-08 23:05:40 提到][删除][修改]
Clearly you have no comprehension of English. You have a low EQ. You are clueless here. Why dont you shut your mouth? Be a man and make an apology to me. I have apologized to you a dozen of times. What I get is spit-at-my-face every time in return. Do you have any integrity and honor left in u?

3. All said and done. You truly think you gain the upper hand by locking me outside? You truly think I will lose without getting into your club? Seriously, dont flatter yourself. I have connections to match into a good University program already. I personally know a couple of Chinese PDs and American PDs. Give me a break already.

Lexian (蒙古大夫) 于 (Thu Feb 11 12:11:31 2010, 美东) 提到:

I think you are pointing this to me. I can honestly tell you i don't have
any MaJia. never had and never will. I don't hold personal grudge against
anybody, especially this one. it's not worth my time.

However, i think you are biased by assuming people who are against tyranny
and unjust are against anyone specifically. I can only speak for myself
because i really don't know anyone else that got into similar kind of
argument with him. I have no intention of "打击正在做的人", but that doesn't
mean i won't say "WAIT A MINUTE, THIS IS NO RIGHT" when i see posts like
the one i respond to.

As i have stated long long time ago, CMG's history in this country are short
. Our mission goes far beyond getting into residency. A public forum that
attracts examiners, residents and PRACTICING PHYSICIANS is very important in
exchange information and experience. I just can't help laughing when i see
some guy who happen to got into residency wants to "harmonize" the forum. I
can honestly say the game just starts AFTER you graduate. Please refrain
from your "GOD" like euphoria of getting into the residency,

发信人: amanda12 (digest08), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 08:01:00 2010, 美东)

我想说的是,作为一名医生,应该有更高的道德标准,宽容心和同情心,医生是和人打
交道的职业,会碰到各种各样人,首先我们想到的是他是我的病人,不管他是杀人犯还
是某某人大代表,穷人和富人,都要统一对待。不会因为别人过激言语或者什么而去计
较,要这有宽容心,能站在他人的角度去理解对方,这才会得到对方的信任。不要动不
动就对别人丢WSN。。。你只会显出你心胸狭隘,既与你的医生身份不配,也会让人鄙
视!以前看过你在丁香园的帖子,貌似你没完成专科移植是因为2老美因为你手术做得
好排挤你。
别人稍与你意见不同就恶言相向,言辞激烈,这是你说服别人的办法吗?是从一名医生
口里出来的话吗?要得到别人的尊重和赞美,同时需要你在本专业的优秀和个人魅力,
一言一行感动别人,取得别人信任,医生更是如此。尊重别人的同时,别人才会尊重你
也许力刀的初衷是好的,但是从他的言语看来,更让人觉得是个暴发户。。。。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 20:03:42 2010, 美东)

只有250才会在网上显摆自己的薪水,当年这厮也显摆自己在osu的薪水,现在总算得到
头的"亲徕"了

发信人: redasuka (EVA-02), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 03:59:15 2010, 美东)

没啥奇怪的,考版的那些人本身就花了比一般PhD多得多的时间和精力,当然希望能换
来一点优越感。何况不少大陆的MD最后在北美都是在做内科儿科什么的,每天工作也很
压抑,只好靠贬低别人获得一点心理安慰啦。

说实话,我在这边认识的混得好的中国MD还没有Bio/BME的faculty比率高,绝大多数30
-40岁的Attending还是处在天天接待黑哥们的境界,收入税前也就100k多点。真正混得
好、拿大钱的的MD,那是少数,而且基本都是白人。

不是说老中没有MD混得好的,只不过那些混得好的是人家真牛,在哪一行能牛起来。至
于只是为了混碗饭吃的,还是要多掂量几下自己折腾的起不。

发信人: Kiwixi (kiwi), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 04:05:37 2010, 美东)

这斯绝对是凭着CMG来美国弄了一个博后的位子。可想而知,实验室做的一塌糊涂,老
板天天骂,连老婆也看不起,留空就跑到楼外面捡烟屁股抽。
然后就考了版,摇身一变就成了医生。

薪水涨了,心魔却去不了,跟同行比,口音重,年龄大,还是来这里显摆,
打着普渡众生的幌子,年复一年贴几个链接,满足自己的虚荣心。本来考版当医生就是
一个职业,非要搞成一个崇拜一个图腾,入门的教众齐颂文成武德哈里路亚癫狂不已。

你那几个链接还是自己留在记事本里吧。不需要你这样自上而下的伪善。

最后送你几句话,真的是为你好,淡定一些,从容一些,都快半百的人了。

他人骑大马,我独跨驴子,回顾担柴汉,心下较些子。
发信人: snowfox01 (白面狐), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 14:16:58 2010, 美东)


我可以理解许多国人为五斗米折腰,想得到需要的信息。但是十年前的经验今天不一定
适用了。而且他像传销一样给许多老CMG False hope,一些老毕业生像打了鸡血一样跟
随他, 做了不且实际的选择, 也不知害了多少家庭。精神病人很可怕, 若他再领着
一帮人, 这帮人真是可怜。 take a look:

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 10:45:26 2010, 美东)

click the link and go to club site to apply. Once you apply there, your ID
will be in waiting list for approval.

发信人: lostknife (麦地俯卧撑), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 13:03:31 2010, 美东)

I fully support the idea and be happy to join.
But it shows:抱歉, 缺少参数, 加入俱乐部失败!
please advise what I should do to join the club.
Thanks.

发信人: lostknife (麦地俯卧撑), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 13:05:16 2010, 美东)

By the way, I am a good-egg who hate the bad-egg!

【 在 meigui0714 (rose) 的大作中提到: 】
: 谢谢你的(USMedEdu)忠告。"听人劝,吃饱饭"。我会好自为之的。
: 但是,一个好的论坛氛围,需要大家的努力。我们做为老生,应该已实事求是的态度引: 导后生们走好,走稳自己的路。人生只有一次,尤其是毕业时间长,没有经历过美国正: 规教育的老生们,我们已经没有"试验”"尝试"的时间了。三思而后行, 一旦做出了决: 定,就不要犹豫,大刀阔fu, 勇往直前。
: 尊敬的老前辈,这里是公共论坛,不是你个人的博客。老了,不但应该"自尊,自爱",: 更要尊重他人的不同看法,意见,这样才能赢得更多的尊敬。“唯我独尊”“我是老: 大我怕谁”的心态是万万要不得的。这里不是"黑色会”,这里不需要“教父”!: 读者的眼睛是雪亮的,这个论坛的读者们都是受过高等教育的,相信他们清楚,谁更浅薄。


发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 18:22:24 2010, 美东)

不要再“尔等,尔等”的了,让人看了烦。身边考版做医生的太多太多了,也没见几个
这么嚣张的。

我不相信这世界有啥救世主。试图做救世主的,脑袋真的需要MRI啦

发信人: yoyoch (yoyoch), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 23:39:59 2010, 美东)

素质,素质。
风度,风度。

发信人: KeeVan (Kevin), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 23:57:59 2010, 美东)

你说你瞎急啥。就是因为你没说赚多少钱,但是又说生物wsn泛酸,我没看明白人家为什么泛酸。讨论讨论问题不行啊,你这素质也太低贱了,我看还是别行医了

发信人: pigsun (屁哥~~大圣教候补二师兄), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:07:33 2010, 美东)

散了吧,老刀确实不是来劝退的,也不是故意显摆,其实,他就是专门来找抽的...
--
哈,说出来心里舒服多哩

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:25:47 2010, 美东)

我都懒得抽她。这么大年纪了,好好说话会死啊??

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:33:02 2010, 美东)

最后回你一贴吧:
你还是真是个幻想狂人唉。还有吧,就你这口气和心态,现实中能过得舒服还真是见了鬼了。算了,刚才说了,说你也是白说。你还是好好找工作吧,最好找个$1million/yr的,可千万别把自己的高等生活给葬送了呀,走到今天(昨天)也怪不容易的。。。

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:48:19 2010, 美东)

^_^,你这风向转的还真快

靠骂别人或者教训别人是不可能有效传播自己的信息的。就这种性格,他下个工作也
干不久,哪个上下级能受得了这种人啊。好象别人没见过钱没见过医生没见过成功
人士一样,一副高高在上的架势,受不了。

发信人: newlily (lily), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 09:18:43 2010, 美东)

老刀,本来我是挺尊敬您的,想从您的帖子学点东西,结果谩骂满篇,没有一点有用的东西。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 11:19:53 2010, 美东)

这厮两次被fired了,还特喜欢到处指手画脚

标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 14:10:26 2010, 美东)

1.相信大家都有北美工作经验,新chair来了,就辞掉所有的人,可能吗?道是有可能
。。。。,

2.“加拿大拿的工资比美国大学薪水要高一倍可工
: 作量才是美国的1/4(其实俺每天1小时就干完了!)” 这种事情只会发生在社会主义
中国。 加拿大? 你可别弄的跟唐骏似的。
3.你是为了祖国加拿大的医学发展,毅然决然放弃了美国的高薪
工作,回到了加拿大了吧。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 11:31:42 2010, 美东)

正常个p, 被fired了就是被fired, 没见过这么不要脸的


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 窝草! 俺自己在网上说过,还怕你来拾俺的鞋后跟泥巴砸俺不成?
: 被新chair辞了,换朝换臣找新工作在北美不是常事吗?哪个医生老死在一个单位的?
: 俺要再显摆一把告诉你俺现在在加拿大拿的工资比美国大学薪水要高一倍可工
: 作量才是美国的1/4(其实俺每天1小时就干完了!)你丫的又该酸掉几个牙?
: 尔等难怪人家说生物萎缩,真TMD不亏!




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共有2条评论
1 [Viky 于 2010-11-12 09:42:23 提到][删除] [FROM: 152.11.]
劝 lz别跟那个老250浪费时间了。。
 
2   [dokknife 于 2009-06-18 09:08:36 提到] [FROM: 140.]
Influenza A(H1N1) - update 50
Laboratory-confirmed cases of new influenza A(H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005)
Cumulative and new figures are subject to revision
17 June 2009 12:00 GMT


Country, territory and area Cumulative total Newly confirmed since the last reporting period
Cases Deaths Cases Deaths
Argentina 733 1 390 1
Australia 2112 0 289 0
Austria 7 0 0 0
Bahamas 2 0 1 0
Bahrain 12 0 11 0
Barbados 3 0 0 0
Belgium 19 0 2 0
Bermuda, UKOT 1 0 1 0
Bolivia 11 0 4 0
Brazil 79 0 25 0
British Virgin Islands, UKOT 1 0 1 0
Bulgaria 2 0 0 0
Canada 4049 7 1071 3
Cayman Islands, UKOT 4 0 2 0
Chile 2335 2 641 0
China 382 0 64 0
Colombia 53 1 11 0
Costa Rica 149 1 45 0
Cuba 7 0 1 0
Cyprus 1 0 0 0
Czech Republic 4 0 0 0
Denmark 15 0 3 0
Dominica 1 0 0 0
Dominican Republic 93 1 0 0
Ecuador 86 0 6 0
Egypt 26 0 8 0
El Salvador 125 0 30 0
Estonia 4 0 0 0
Finland 12 0 8 0
France 118 0 38 0
France, French Polynesia, FOC 1 0 1 0
France, Martinique, FOC 1 0 1 0
Germany 195 0 25 0
Greece 23 0 4 0
Guatemala 128 1 9 0
Honduras 100 0 11 0
Hungary 4 0 0 0
Iceland 4 0 0 0
India 30 0 14 0
Ireland 12 0 0 0
Israel 152 0 35 0
Italy 72 0 5 0
Jamaica 12 0 1 0
Japan 666 0 61 0
Jordan 2 0 2 0
Korea, Republic of 65 0 0 0
Kuwait 18 0 0 0
Lebanon 11 0 3 0
Luxembourg 2 0 1 0
Malaysia 17 0 12 0
Mexico 6241 108 0 0
Morocco 3 0 2 0
Netherlands 68 0 7 0
Netherlands, Curacao, OT 1 0 1 0
New Zealand 127 0 41 0
Nicaragua 118 0 62 0
Norway 13 0 0 0
Panama 272 0 0 0
Paraguay 25 0 0 0
Peru 112 0 21 0
Philippines 193 0 116 0
Poland 7 0 0 0
Portugal 3 0 0 0
Qatar 3 0 3 0
Romania 16 0 3 0
Russia 3 0 0 0
Samoa 1 0 1 0
Saudi Arabia 17 0 6 0
Singapore 49 0 2 0
Slovakia 3 0 0 0
Spain 499 0 11 0
Sri Lanka 1 0 1 0
Sweden 37 0 5 0
Switzerland 27 0 5 0
Thailand 310 0 281 0
Trinidad and Tobago 5 0 0 0
Turkey 16 0 6 0
Ukraine 1 0 0 0
United Arab Emirates 1 0 0 0
United Kingdom 1461 1 235 1
United Kingdom, Isle of Man, Crown Dependency 1 0 1 0
United Kingdom, Jersey, Crown Dependency 1 0 1 0
United States of America* 17855 44 0 -1
Uruguay 36 0 0 0
Venezuela 45 0 20 0
Viet Nam 27 0 2 0
West Bank and Gaza Strip 2 0 0 0
Yemen 1 0 1 0
Grand Total 39620 167 3692 4

Chinese Taipei has reported 58 confirmed case of influenza A (H1N1) with 0 deaths. Cases from Chinese Taipei are included in the cumulative totals provided in the table above.
*The data has been revised on the basis of further laboratory confirmation

Abbreviations
UKOT: United Kingdom Overseas Territory
FOC: French Overseas Collectivity
OT: Overseas Territory
 
3   [USMedEdu 于 2009-06-16 18:39:06 提到] [FROM: 140.]
What is phase 6?

Updated 11 June 2009

http://www.who.int/csr/disease/swineflu/frequently_asked_questions/levels_pandemic_alert/en/index.html


What is phase 6?

Phase 6 is a pandemic, according to the WHO definition.

WHO pandemic phase descriptions [pdf 456kb]

Pandemic influenza preparedness and response
What about severity?
At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.

The moderate assessment reflects that:

Most people recover from infection without the need for hospitalization or medical care.
Overall, national levels of severe illness from influenza A(H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.
Overall, hospitals and health care systems in most countries have been able to cope with the numbers of people seeking care, although some facilities and systems have been stressed in some localities.
WHO is concerned about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.

Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known.

Assessing the severity of an influenza pandemic

Assessing the severity of an influenza pandemic
11 May 2009
The major determinant of the severity of an influenza pandemic, as measured by the number of cases of severe illness and deaths it causes, is the inherent virulence of the virus. However, many other factors influence the overall severity of a pandemic’s impact.

Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today’s highly mobile and closely interdependent societies. Moreover, the same virus that causes mild illness in one country can result in much higher morbidity and mortality in another. In addition, the inherent virulence of the virus can change over time as the pandemic goes through subsequent waves of national and international spread.

Properties of the virus
An influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. This creates an almost universal vulnerability to infection. While not all people ever become infected during a pandemic, nearly all people are susceptible to infection.

The occurrence of large numbers of people falling ill at or around the same time is one reason why pandemics are socially and economically disruptive, with a potential to temporarily overburden health services.

The contagiousness of the virus also influences the severity of a pandemic’s impact, as it can increase the number of people falling ill and needing care within a short timeframe in a given geographical area. On the positive side, not all parts of the world, or all parts of a country, are affected at the same time.

The contagiousness of the virus will influence the speed of spread, both within countries and internationally. This, too, can influence severity, as very rapid spread can undermine the capacity of governments and health services to cope.

Pandemics usually have a concentrated adverse impact in specific age groups. Concentrated illnesses and deaths in a young, economically productive age group will be more disruptive to societies and economies than when the very young or very old are most severely affected, as seen during epidemics of seasonal influenza.

Population vulnerability
The overall vulnerability of the population can play a major role. For example, people with underlying chronic conditions, such as cardiovascular disease, hypertension, asthma, diabetes, rheumatoid arthritis, and several others, are more likely to experience severe or lethal infections. The prevalence of these conditions, combined with other factors such as nutritional status, can influence the severity of a pandemic in a significant way.

Subsequent waves of spread
The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least two, sometimes three, waves. For many reasons, the severity of subsequent waves can differ dramatically in some or even most countries.

A distinctive feature of influenza viruses is that mutations occur frequently and unpredictably in the eight gene segments, and especially in the haemagglutinin gene. The emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out.

Different patterns of spread can also influence the severity of subsequent waves. For example, if schoolchildren are mainly affected in the first wave, the elderly can bear the brunt of illness during the second wave, with higher mortality seen because of the greater vulnerability of elderly people.

During the previous century, the 1918 pandemic began mild and returned, within six months, in a much more lethal form. The pandemic that began in 1957 started mild, and returned in a somewhat more severe form, though significantly less devastating than seen in 1918. The 1968 pandemic began relatively mild, with sporadic cases prior to the first wave, and remained mild in its second wave in most, but not all, countries.

Capacity to respond
Finally, the quality of health services influences the impact of any pandemic. The same virus that causes only mild symptoms in countries with strong health systems can be devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and under-staffed.

Assessment of the current situation
To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, based on limited data in only a few countries.

The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.

H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimates of the secondary attack rate of H1N1 range from 22% to 33%.

With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.

In the two largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.

In terms of population vulnerability, the tendency of the H1N1 virus to cause more severe and lethal infections in people with underlying conditions is of particular concern.

For several reasons, the prevalence of chronic diseases has risen dramatically since 1968, when the last pandemic of the previous century occurred. The geographical distribution of these diseases, once considered the close companions of affluent societies, has likewise shifted dramatically. Today, WHO estimates that 85% of the burden of chronic diseases is now concentrated in low- and middle-income countries. In these countries, chronic diseases show an earlier average age of onset than seen in more affluent parts of the world.

In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.

Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.

Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.

The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.


Considerations for assessing the severity [pdf 318kb]
Does WHO expect the severity of the pandemic to change over time?
The severity of pandemics can change over time and differ by location or population.

Close monitoring of the disease and timely and regular sharing of information between WHO and its Member States during the pandemic period is essential to determine future severity assessments, if needed.

Future severity assessments would reflect one or a combination of the following factors:

changes in the virus,
underlying vulnerabilities, or
limitations in health system capacities.
The pandemic is early in its evolution and many countries have not yet been substantially affected.

More about the new influenza A(H1N1)
What is WHO doing to respond?
WHO continues to help all countries respond to the situation. The world cannot let down its guard and WHO must help the world remain and become better prepared.

WHO's support to countries takes three main forms: technical guidance, materials support, and training of health care system personnel.

WHO's primary concern is to strengthen and support health systems in countries with less resources. Health systems need to be able to prevent, detect, treat and mitigate cases of illness associated with this virus.

WHO is also working to make stocks of medicines (such as antivirals and antibiotics) and an eventual pandemic vaccine more accessible and affordable to developing countries.

Both antivirals and vaccines have important roles in treatment and prevention respectively. However, existing stocks of antivirals are unlikely to meet the demand. WHO is working closely with manufacturers to expedite the development of a safe and effective vaccine but it will be some months before it is available.

Therefore, rational use of the limited resources will be essential. And medicines are only part of the response. WHO is also deploying diagnostic kits, medicines and masks and gloves for health care settings, teams of scientific experts, and medical technicians so countries in need can respond to local epidemics.

A pandemic sets national authorities in motion to implement preparedness plans, identify cases as efficiently as possible, and minimize serious illness and deaths with proper treatment.

The goal is to reduce the impact of the pandemic on society.

Guidance for national authorities
What do I do now? What actions should I look for in my community?
Stay informed. Go to reliable sources of information, including your Ministry of Health, to learn what you can do to protect yourself and stay updated as the pandemic evolves. Community-specific information is available from local or national health authorities.

You can also continue to visit the WHO web site for simple prevention practices and general advice.

WHO is not recommending travel restrictions nor does WHO have evidence of risk from eating cooked pork.

What can I do?

Guidance for communities


What is the new influenza A(H1N1)?
Updated 11 June 2009

What is the new influenza A(H1N1)?
This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses.

How do people become infected with the virus?
The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.

There are no known instances of people getting infected by exposure to pigs or other animals.

The place of origin of the virus is unknown.

What are the signs and symptoms of infection?
Signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

Why are we so worried about this flu when hundreds of thousands die every year from seasonal epidemics?
Seasonal influenza occurs every year and the viruses change each year - but many people have some immunity to the circulating virus which helps limit infections. Some countries also use seasonal influenza vaccines to reduce illness and deaths.

But influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu. WHO is working closely with manufacturers to expedite the development of a safe and effective vaccine but it will be some months before it is available.

The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast particularly among young people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death. The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems.

Most people experience mild illness and recover at home. When should someone seek medical care?
A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

197
Considerations for assessing
the severity of an infl uenza
pandemic
The WHO pandemic phases1 are based on
the geographical spread of a pandemic
virus and are intended as a global call to
countries to increase their alertness and
readiness. However, within each phase,
countries may fi nd it useful to assess the
specifi c severity parameters of a pandemic
at the national or regional level, as such
assessments can be used to effi ciently
target and scale the use of limited
resources and interventions2 aimed at
lowering pandemic-associated morbidity
and mortality.
Assessment of the severity of a pandemic
is complex. Experience has shown that
past infl uenza pandemics have varied in
terms of severity, and that the associated
health impacts may vary signifi cantly
based on a variety of factors.
First, severity may vary from country to
country and among different population
groups or geographical locales. Therefore,
a single assessment of severity at the
global level may not be relevant or helpful
to countries. Second, severity will likely
change as an event unfolds over time. As
a result, monitoring is essential to detect
changes in disease patterns, disease complications,
transmissibility, virulence and
other such factors. Third, the robustness
of a severity assessment will refl ect the
quality and availability of information
about the virus and the people who are
susceptible to infection. Such information
is most limited at the beginning of a pandemic.
Furthermore, some parameters of
severity, such as the case-fatality ratio, require
information on the number of
1 WHO Global Infl uenza Programme. Aide-memoire: WHO pandemic
phase descriptions and main actions by phase (available
at http://www.who.int/csr/disease/infl uenza/GIPA3AideMemoire.
pdf; accessed May 2009).
2 Pandemic infl uenza prevention and mitigation in low resource
communities. Geneva, World Health Organization, 2009
(available at http://www.who.int/csr/resources/publications/
swinefl u/PI_summary_low_resource_02_05_2009.pdf; Accessed
May 2009)
Considérations à prendre en
compte pour évaluer la gravité
d’une pandémie de grippe
Les phases OMS de pandémie1 reposent sur la
propagation géographique d’un virus pandémique
et ont pour but d’appeler les pays du
monde entier à intensifi er leur état d’alerte et
de préparation. A chaque phase cependant,
l’évaluation des paramètres spécifi ques de
gravité d’une pandémie au niveau national ou
régional pourra s’avérer utile dans tous les
pays, en leur permettant de cibler et d’étendre
effi cacement l’utilisation des ressources limitées
et les interventions2 visant à réduire la
morbidité et la mortalité associées à la pandémie.
L’évaluation de la gravité d’une pandémie est
complexe. L’expérience a montré que les
pandémies grippales du passé ont été variables
en gravité, avec des conséquences sanitaires
qui peuvent être très différentes en fonction
de divers facteurs.
Premièrement, la gravité peut varier d’un pays
à l’autre et, au sein d’un même pays, en fonction
des groupes de population et des localisations
géographiques. Une évaluation unique
de la gravité à l’échelle mondiale pourrait
donc s’avérer ni pertinente, ni utile pour les
pays. Deuxièmement, il est probable que les
pandémies évoluent au fur et à mesure de leur
déroulement dans le temps. En conséquence,
le suivi est essentiel pour détecter les changements
au niveau du tableau de morbidité, des
complications, de la transmissibilité, de la
virulence et d’autres facteurs. Troisièmement,
la qualité et la disponibilité des données sur
le virus et les sujets sensibles à l’infection
conditionnent la validité de l’évaluation. Hors,
les informations de ce type sont très limitées
en début de pandémie. En outre, certains paramètres,
comme le taux de létalité, nécessitent
1 OMS, Programme mondial de lutte contre la grippe. Aide-memoire:
WHO pandemic phase descriptions and main actions by phase (disponible
sur : http://www.who.int/csr/disease/infl uenza/GIPA3AideMemoire.
pdf; consulté en mai 2009).
2 Pandemic infl uenza prevention and mitigation in low resource communities.
Genève, Organisation mondiale de la Santé, 2009 (disponible
sur http://www.who.int/csr/resources/publications/swinefl u/PI_
summary_low_resource_02_05_2009.pdf; consulté en mai 2009).
Weekly epidemiological record
Relevé épidémiologique hebdomadaire
29 MAY 2009, 84th YEAR / 29 MAI 2009, 84e ANNÉE
No. 22, 2009, 84, 197–212
http://www.who.int/wer
2009, 84, 197–212 No. 22
WORLD HEALTH
ORGANIZATION
Geneva
ORGANISATION MONDIALE
DE LA SANTÉ
Genève
Annual subscription / Abonnement annuel
Sw. fr. / Fr. s. 334.–
05.2009
ISSN 0049-8114
Printed in Switzerland
Contents
197 Considerations for assessing
the severity of an infl uenza
pandemic
203 Estimating the global burden
of foodborne diseases:
a collaborative effort
212 Monthly report
on dracunculiasis cases,
January–April 2009
Sommaire
197 Considérations à prendre en
compte pour évaluer la gravité
d’une pandémie de grippe
203 Evaluation de la charge
mondiale des maladies
d’origine alimentaire:
une action concertée
212 Rapport mensuel des cas
de dracunculose, janvier-avril
2009
198 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
deaths and of the number of people who have been
infected; this understanding takes time to develop.
Determinants of severity
Pandemic severity has many dimensions, including economic
and social consequences. However, WHO’s guidance
on assessment of pandemic severity is based on
effects on human health.3 The guidance is focused principally
at the population level rather than at the individual
level.
Given these considerations, the “impact” of a pandemic
on a population is a function of 3 determinants: (i) the
pandemic virus and its virological characteristics, as
well as the epidemiological and clinical manifestations;
(ii) the vulnerability of the population; and (iii) the capacity
of the population for response.
An assessment of these 3 determinants will provide the
most complete estimate of pandemic severity at national
and subnational levels. Each of these aspects is
described in more detail in the sections below.
The pandemic virus
WHO has advised countries to perform a national comprehensive
assessment of the epidemiological, clinical
and virological characteristics of the pandemic virus.
Some of these characteristics will vary as a result of
climate, time of year, population density and the further
evolution of the pandemic virus over time. Therefore,
comprehensive assessments should be made by the fi rst
affected countries and also by as many other countries
as possible as the situation evolves. Interpretation of
these data will require additional information about the
context in which they were collected, the methods for
case-fi nding and how the assessments were carried out.
Key data for such assessments include:
Epidemiological characteristics
 total number of suspected and confi rmed cases, and
deaths;
 distribution of cases and deaths by age and sex;
 distribution of cases by health status (that is, people
at risk for complications of seasonal infl uenza compared
with healthy people);
 clinical attack rate;
 case-fatality ratio; and
 estimates of the incubation period, reproduction
number (R0) and other transmission characteristics.
Clinical characteristics
 signs and symptoms of illness;
 clinical course and outcome;
 number and proportion of hospitalized cases, cases
in intensive care, cases requiring mechanical ventilation;
and
 proportion of cases with sub-clinical infection, typical
infl uenza-like illness, and severe illness.
3 See http://www.who.int/csr/disease/swinefl u/assess/disease_swinefl u_assess_
20090511/en/ and http://www.who.int/csr/resources/publications/swinefl u/technical_
consultation_2009_05_06/en/
de connaître le nombre des morts et des personnes infectées,
et il faut du temps pour obtenir ces informations.
Déterminants de la gravité
La gravité d’une pandémie comporte de nombreuses dimensions,
parmi lesquelles ses conséquences économiques et sociales.
Pourtant, les orientations de l’OMS pour l’évaluer se basent
seulement sur les effets sanitaires3 et sont principalement axées
sur la population plutôt que sur l’individu.
Compte tenu de ce qui précède, «l’impact» d’une pandémie sur
une population dépend de 3 déterminants: (i) les caractéristiques
du virus, avec ses manifestations épidémiologiques et
cliniques; (ii) la vulnérabilité de la population; et (iii) la capacité
d’action de la population.
L’évaluation de ces 3 déterminants permet d’aboutir à l’estimation
la plus complète de la gravité d’une pandémie au niveau
national et infranational. Nous allons décrire chacun de ces
aspects plus en détails dans les sections suivantes.
Le virus pandémique
L’OMS a conseillé aux pays de procéder à une évaluation nationale
complète des caractéristiques épidémiologiques, cliniques
et virologiques du virus pandémique. Certaines d’entre elles
peuvent varier en fonction du climat, de l’époque de l’année,
de la densité démographique et de l’évolution du virus dans le
temps. Les évaluations complètes ne doivent donc pas être faites
seulement par les premiers pays touchés mais par le plus grand
nombre de pays possible, à mesure que la situation évolue. L’interprétation
de ces données imposera d’obtenir des informations
complémentaires sur le contexte dans lequel elles ont été
recueillies, sur les méthodes de dépistage des cas et sur les
modalités des évaluations. Les données essentielles pour ces
évaluations sont les suivantes:
Caractéristiques épidémiologiques
 nombre total de cas suspects, de cas confi rmés et de
décès;
 répartition des cas et des décès selon l’âge et le sexe;
 répartition des cas en fonction de leur état de santé (c’està-
dire les sujets exposés au risque de complications d’une
grippe saisonnière, par rapport à ceux en bonne santé);
 taux d’atteinte;
 taux de mortalité;
 estimations de la durée d’incubation, du taux de reproduction
(R0) et d’autres caractéristiques de la transmission.
Caractéristiques cliniques
 signes et symptômes;
 évolution clinique et issue;
 nombre et proportion de cas hospitalisés, en soins intensifs,
nécessitant la ventilation mécanique;
 proportion de cas présentant une infection infraclinique, un
syndrome de type grippal classique et une atteinte grave.
3 Voir http://www.who.int/csr/disease/swinefl u/assess/disease_swinefl u_assess_20090511/fr/index.
html et http://www.who.int/csr/resources/publications/swinefl u/technical_consultation_
2009_05_06/en/
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 199
Virological characteristics
 sensitivity to antiviral agents;
 molecular markers of severity; and
 antigenicity.
Although countries will differ in their capacity to carry
out assessments, WHO encourages all countries to collect
and report information.4 All data gathered on early
cases, even if limited, will still be useful for determining
subsequent control, management and mitigation activities.
Table 1 summarizes epidemiological, clinical and virological
data available to WHO to date, including data
provided by countries, results of modelling analyses,
results of special studies and other, global analyses.
WHO will provide such updated summary information
on a regular basis to allow countries to tailor their
response measures as needed.
Vulnerability of populations
The vulnerability of a population to a pandemic virus
is related in part to the level of pre-existing immunity
to the virus in the population and the proportion of
people who have medical or other conditions that may
increase the risk for serious or fatal illness.
Pre-existing immunity
Depending on the pandemic virus, certain segments of
the population (for example, the elderly) might already
be partially immune because of previous infection. Descriptive
data on age-specifi c attack rates, hospitalization
rates and mortality rates and comparing them with
corresponding data for typical seasonal infl uenza will
be essential to confi rm laboratory fi ndings. Additional
information on possible cross-protection may be derived
from serological studies.
People at increased risk
Typically, infants and young children, the elderly, pregnant
women, people with chronic underlying diseases
such as cardiovascular, respiratory and liver disease,
diabetics and people with immunosuppression related
to malignancy, HIV infection or other diseases are at
increased risk for complications of seasonal infl uenza.
In developed countries, most fatal infections by seasonal
infl uenza occur in the elderly.
In many under-resourced countries, the burden of seasonal
infl uenza, as well as the segments of the population
that may be disproportionately affected, have not
been well documented. Additional factors, such as malnutrition,
infection with other infectious diseases (for
example, malaria, tuberculosis and bacterial pneumonia)
may also be present. In addition, such countries
often have a higher proportion of younger rather than
older people, and high pregnancy rates, both of which
may increase the impact of pandemic infl uenza.
4 For the most current version of WHO’s recommendations on case-based reporting
for new infl uenza A (H1N1) virus infection, see http://www.who.int/csr/resources/
publications/swinefl u/interim_guidance/en/index.html
Caractéristiques virologiques
 sensibilité aux antiviraux;
 marqueurs moléculaires de la gravité;
 antigénicité.
Bien que les pays aient des moyens variables pour faire ces
évaluations, l’OMS invite chacun d’eux à collecter et à transmettre
ses informations.4 Même limitées, toutes les données
réunies sur les cas précoces seront utiles pour déterminer ultérieurement
les mesures à prendre pour la lutte, la prise en
charge des cas et l’atténuation des effets.
Le tableau 1 dresse une synthèse des données épidémiologiques,
cliniques et virologiques dont l’OMS dispose aujourd’hui. Elles
ont été transmises par les pays ou résultent d’analyses de modélisation,
d’études spéciales et d’analyses à l’échelle mondiale.
L’Organisation mettra régulièrement à jour ces informations
récapitulatives et les tiendra à la disposition des pays pour leur
permettre d’ajuster en fonction des besoins les mesures qu’ils
prennent.
Vulnérabilité des populations
La vulnérabilité d’une population à un virus pandémique
dépend en partie du niveau d’immunité préexistant et de la
proportion de sujets présentant des états pathologiques ou
autres susceptibles d’accroître le risque d’une atteinte grave ou
mortelle.
Immunité préexistante
En fonction du virus de la pandémie, certains segments de la
population (par exemple les personnes âgées) peuvent être déjà
partiellement immunisés en raison d’infections antérieures. Les
données descriptives sur les taux d’atteinte en fonction de l’âge,
les taux d’hospitalisation, les taux de mortalité et les comparaisons
avec les chiffres correspondants pour la grippe saisonnière
classique seront essentielles pour confi rmer les résultats des laboratoires.
Les études sérologiques peuvent donner des informations
complémentaires sur une éventuelle protection croisée.
Personnes exposées à un risque accru
Classiquement, les nourrissons, les jeunes enfants, les personnes
âgées, les femmes enceintes, les sujets présentant des maladies
chroniques sous-jacentes, cardiovasculaires, respiratoires ou
hépatiques par exemple, les diabétiques et ceux qui ont une
immunosuppression liée à une affection cancéreuse, au VIH ou
à d’autres maladies, sont exposés à un risque accru de complications
de la grippe saisonnière ou d’atteinte mortelle. Dans les
pays développés, la plupart des infections mortelles dues à la
grippe saisonnière surviennent chez les personnes âgées.
Dans de nombreux pays manquant de ressources, on n’a pas
d’informations précises sur le poids de la grippe saisonnière,
ni sur les segments de la population susceptibles de payer un
tribut disproportionné. D’autres facteurs, comme la malnutrition,
la présence d’autres maladies infectieuses (paludisme,
tuberculose, pneumonies bactériennes par exemple) peuvent
aussi exister. De plus, la proportion de jeunes et le nombre de
femmes enceintes sont souvent élevés dans ces pays ce qui, dans
les deux cas, peut accroître l’impact d’une pandémie grippale.
4 Pour obtenir la version la plus actuelle des recommandations de l’OMS sur la notifi cation des cas
pour l’infection par le nouveau virus grippal A(H1N1), consulter http://www.who.int/csr/resources/
publications/swinefl u/interim_guidance/en/index.html
200 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
Table 1 Characteristics of reported cases of new infl uenza A (H1N1) virus infections in humans
Tableau 1 Caractéristiques des cas notifi és d’infection humaine par le nouveau virus grippal A (H1N1)
Note. When assessing severity, responding agencies and organizations must consider that the situation is continuously evolving and investigations are ongoing.
Therefore, the numbers below may not be the latest available. – NB: Au moment d’évaluer la gravité, les agences et organisations actives doivent garder à l’esprit que
la situation est en évolution constante et que les investigations se poursuivent. Les chiffres ci-dessous ne sont donc pas forcément les derniers dont on dispose.
Characteristic –
Caractéristiques
Measurement(a) – Chiffres et informations(a)
Epidemiological aspects – Aspects épidémiologiques
Total number of cases and
deaths – Nombre total de cas
et de décès
10 of 6764 confi rmed cases have died in the United States, 80 of 4174 cases have died in Mexico, 1 of 921 cases have died in Canada
and 1 of 33 cases have died in Costa Rica.(f) No deaths were reported by the remaining 42 affected countries or by Chinese Taipei.(i) –
Dix cas sur 6764 cas confi rmés sont morts aux Etats-Unis, 80 sur 4174 sont morts au Mexique, 1 sur 921 est mort au Canada et 1 sur
33 est mort au Costa Rica.(f) Aucun décès n’a été notifi é dans les 42 autres pays touchés ou au Taipei chinois.(i)
Age – &Acirc;ge Predominantly younger age groups (<30 years) are affected.(c) Range of age medians: 16–25 years,(b, c, d) (data reported directly to
WHO). Overall age range: 3 months to 81 years.(b) – Prédominance des tranches d’&acirc;ge jeunes (< 30 ans). (c) Médianes: 16–25 ans(b, c, d)
(données transmises directement à l’OMS). Fourchette globale: 3 mois à 81 ans.(b)
Sex (male:female ratio) –
Sexe (rapport hommes/femmes)
Approximately 50:50.(b, d) – Environ 50:50.(b, d)
Clinical attack rate – Taux
d’atteinte
High clinical attack rates estimated from selected groups (such as 33% of 1996 schoolchildren in one outbreak).(c) – &Eacute;levé selon les
estimations dans certains groupes (33% par exemple chez 1996 écoliers dans une fl ambée).(c)
Incubation period – Durée
d’incubation
Median 3–4 days (data reported directly to WHO). Range: 1–7 days.(c, d) – Mediane: 3–4 jours (données transmises directement à
l’OMS). Entre 1 et 7 jours.(c, d)
Reproduction number (R0) –
Taux de reproduction (R0)
1.4–1.6 estimated based on modelling of preliminary data from a closed community in Mexico.(j) – 1,4-1,6 d’après une estimation sur
la base d’une modélisation des données préliminaires provenant d’une communauté fermée du Mexique.(j)
Community-level spread(k)
– Propagation au niveau
communautaire (k)
Confi rmed in Mexico and the United States.(c, d) – Confi rmée au Mexique et aux Etats-Unis.(c, d)
Human exposure to swine –
Exposition de l’homme au porc
None reported.(b, d) – Aucun cas signalé.(b, d)
Clinical aspects – Aspects cliniques
Overall clinical features –
Tableau clinique général
Primarily infl uenza-like illness (ILI) in affected people.(b, c, d, e) Gastrointestinal symptoms have been reported in some countries,(c, d)
including in 38% of outpatients in the United States.(e) Some countries have reported cases of mild or sub-clinical illness without
fever.(c) – Principalement syndrome de type grippal (STG).(b, c, d, e) On a signalé des sympt&ocirc;mes digestifs dans certains pays,(c, d) notamment
chez 38% des patients ambulatoires aux Etats-Unis.(e) Certains pays ont notifi é des cas d’atteinte bénigne ou infraclinique,
sans fi èvre.(c)
Clinical features of severe
cases – Tableau clinique des
cas graves
No reports of severe disease in most affected countries.(c, d) Limited severe disease reported in patients aged >65 years (data reported
directly to WHO). Severe illness generally characterized by pneumonia and respiratory failure.(e) Coinfection and secondary bacterial
infection in hospitalized patients are rare to date (data reported directly to WHO). – Pas de notifi cations de cas graves dans la plupart
des pays affectés.(c, d) Atteintes sévères limitées signalées chez des patients > 65 ans (données transmises directement à l’OMS). Les
atteintes graves se caractérisent généralement par une pneumonie et une insuffi sance respiratoire.(e) Les co-infections et les surinfections
bactériennes chez les patients hospitalisés sont rares jusqu’à présent (données transmises directement à l’OMS).
Hospitalization –
Hospitalisation
No hospitalizations for illness in many affected countries.(c, d) Approximately 2–5% of confi rmed cases in Canada and the United
States and 6% in Mexico have been hospitalized.(f) Few cases hospitalized for illness are adults aged >60 years.(c) – Aucune hospitalisation
dans de nombreux pays touchés.(c, d) Environ 2 à 5% des cas confi rmés au Canada et aux Etats-Unis et 6% au Mexique ont été
hospitalisés.(f) Peu de cas hospitalisés sont des adultes &acirc;gés de >60 ans.(c)
Predisposing risk factors to
severe illness – Facteurs de
prédisposition à une atteinte
sévère
A moderate proportion of severe cases were considered to be at increased risk.(g) 64% of 30 hospitalized cases in California (USA)(h)
and 46% of 45 fatal cases in Mexico(e) had underlying medical conditions. Predisposing factors were absent in about half of cases in
some reports.(b) Severe disease has been noted in some pregnant women. Of 30 hospitalized cases in California (USA), 17% were pregnant.(
h) – On considère qu’une proportion modérée des cas graves étaient exposés à un risque accru.(g) 64% de 30 cas hospitalisés
en Californie (USA)(h) et 46% de 45 cas mortels au Mexique(e) présentaient des états pathologiques sous-jacents. Absence de facteurs
de prédisposition dans environ la moitié des cas pour certains rapports. (b) On a observé des atteintes sévères chez certaines femmes
enceintes. Sur 30 cas hospitalisés en Californie (Etats-Unis), 17% étaient des femmes enceintes.(h)
Virological aspects – Aspects virologiques
Sensitivity to antivirals –
Sensibilité aux antiviraux
Neuraminidase inhibitors (oseltamivir, zanamivir): yes.(b) – Inhibiteurs de la neuraminidase (oseltamivir, zanamivir): oui.(b)
Adamantanes (amantadine, rimantadine): no.(b) – Adamantanes (amantadine, rimantadine): non.(b)
Rate of evolution – Vitesse
d’évolution
No faster than other infl uenza viruses.(l) As of 4 May 2009, only 5 amino acid differences were found among new infl uenza (H1N1)
viruses evaluated by the WHO Collaborating Centre in Atlanta, GA, USA, (CDC).(l) – Pas plus grande que pour les autres virus
viraux.(l) Au 4 mai 2009, on n’avait trouvé que 5 différences d’acides aminés dans les nouveaux virus grippaux (H1N1) analysés par le
centre collaborateur de l’OMS à Atlanta (Géorgie – Etats-Unis), (CDC).(l)
Molecular markers of severity
– Marqueurs moléculaires de
la gravité
No known molecular transmissibility/pathogenicity markers or motifs, nor any further reassortments.(l) – Pas de marqueurs moléculaires
ou de motifs connus de transmissibilité/pathogénie, pas de nouveaux réassortiments.(l)
Circulation in animals –
Circulation chez l’animal
Mostly unknown; 1 swine farm in Alberta reported an outbreak.(m) – Inconnue pour la plus grande part; une fl ambée signalée dans un
élevage de porcs en Alberta.(m)
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 201
Each country should regularly assess its own level of
vulnerability to guide their mitigation measures. WHO
is currently developing tools to assist countries in performing
such vulnerability assessments.
Capacity for response
The capacity of a country to respond will also determine
the vulnerability of a population. Key capacities
include:
&#61591; access to health care;
&#61591; communication and social mobilization; and
&#61591; advance preparedness and planning.
Countries can use information about both the pandemic
virus and their own vulnerability to determine
possible options and resources needed to increase their
national capacity to respond.
Health care
The level of access and quality of health services affect
the impact of any pandemic. The same virus that has
only a modest impact on morbidity and mortality in
countries with strong health systems can be severe in
countries where health systems are weak, supplies of
medicines (including antibiotics) are limited, and hospitals
are crowded, poorly equipped and understaffed.
During a pandemic, health systems may need to provide
the usual health-care services while attending to an infl
ux of patients with infl uenza. In order to limit morbid-
Tous les pays devraient régulièrement évaluer leur niveau de
vulnérabilité pour pouvoir orienter leurs mesures d’atténuation.
L’OMS élabore actuellement des outils pour les aider dans cette
t&acirc;che.
Capacité d’action
La vulnérabilité d’une population dépend aussi de la capacité
d’action du pays en question. Les moyens essentiels pour agir
sont les suivants:
&#61591; l’accès aux soins de santé;
&#61591; la communication et la mobilisation sociale;
&#61591; la préparation et la planifi cation.
Les pays peuvent se servir des informations sur le virus pandémique
et sur leur vulnérabilité pour déterminer les options à
leur disposition et les ressources nécessaires pour développer
leur capacité nationale d’action.
Soins de santé
L’accès aux services de santé et leur qualité modulent l’impact
de toute pandémie. Le même virus, qui aura seulement des
effets modestes sur la morbidité et la mortalité dans des pays
dotés de puissants systèmes de santé, peut avoir des conséquences
graves dans d’autres pays qui ont des systèmes de santé
fragiles, des stocks limités de médicaments (y compris pour les
antibiotiques) et où les h&ocirc;pitaux sont bondés, mal équipés et
manquent de personnel.
Durant une pandémie, il arrive que les systèmes de santé
doivent à la fois assurer les services habituels, et s’occuper d’un
affl ux de patients atteints par la grippe. Afi n de limiter la morbia
References given in parentheses. When no reference is given, data were reported directly to WHO. – Références entre parenthèses. En l’absence de références, les données ont été transmises
directement à l’OMS.
b Novel Swine-Origin Infl uenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin infl uenza A (H1N1) virus in humans. New England Journal of Medicine, 7 May 2009
(E-pub ahead of print) (10.1056/nejmoa0903810) (http://content.nejm.org/cgi/content/full/NEJMoa0903810?query=TOC). – Novel Swine-Origin Infl uenza A (H1N1) Virus Investigation Team.
Emergence of a novel swine-origin infl uenza A (H1N1) virus in humans. New England Journal of Medicine, 7 May 2009 (E-pub ahead of print) (10.1056/nejmoa0903810) (http://content.nejm.
org/cgi/content/full/NEJMoa0903810?query=TOC).
c New infl uenza A (H1N1) virus infections: global surveillance summary, May 2009. Weekly Epidemiological Record, 2009; 80:173–178 (http://www.who.int/wer/2009/wer8420/en/index.html).
– Situation mondiale de la nouvelle infection à virus grippal A (H1N1), mai 2009. Relevé épidémiologique hebdomadaire, 2009; 80:173–178 (http://www.who.int/wer/2009/wer8420/fr/index.
html).
d WHO technical consultation on the severity of disease caused by the new infl uenza A (H1N1) virus infections (http://www.who.int/csr/resources/publications/swinefl u/technical_consultation_
2009_05_06/en/index.html). – WHO technical consultation on the severity of disease caused by the new infl uenza A (H1N1) virus infections (http://www.who.int/csr/resources/publications/
swinefl u/technical_consultation_2009_05_06/en/index.html).
e Human infection with new infl uenza A (H1N1) virus: clinical observations from Mexico and other affected countries, May 2009. Weekly Epidemiological Record, 2009; 84, 185–196 (http://
www.who.int/wer/2009/wer8421/en/index.html). – Infections humaines par le nouveau virus grippal A (H1N1): observations cliniques en provenance du Mexique et d’autres pays touchés,
mai 2009. Relevé épidémiologique hebdomadaire, 2009; 84, 185–196 (http://www.who.int/wer/2009/wer8421/fr/index.html)
f As these numbers represent only confi rmed cases, case-fatality ratios cannot be calculated from these data. – Ces chiffres ne représentant que des cas confi rmés, il est impossible de calculer
les taux de mortalité à partir de ces données.
g People who are at risk for complications of seasonal infl uenza, such as the very young, pregnant women and those with underlying medical conditions. – Sujets exposés à des risques de
complications de la grippe saisonnière, comme les très jeunes, les femmes enceintes et ceux présentants des états pathologiques sous-jacents.
h MMWR, Hospitalized Patients with Novel Infl uenza A (H1N1) Virus Infection — California, April — May, 2009, 22 May 2009/58(19); 536-541 (http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5819a6.htm?s_cid=mm5819a6_e). – MMWR, Hospitalized Patients with Novel Infl uenza A (H1N1) Virus Infection — California, April — May, 2009, 22 May 2009/58(19); 536-541 (http://
www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a6.htm?s_cid=mm5819a6_e).
i WHO. Infl uenza A (H1N1) update 39, 26 May 2009 (http://www.who.int/csr/don/2009_05_26/en/index.html). – OMS. Infl uenza A (H1N1) update 39, 26 May 2009 (http://www.who.int/csr/
don/2009_05_26/en/index.html).
j Fraser C et al. Pandemic potential of a strain of infl uenza A (H1N1): early fi ndings. Science, 11 May 2009, 10.1126/science.1176062. – Fraser C et al. Pandemic potential of a strain of infl uenza A
(H1N1): early fi ndings. Science, 11 May 2009, 10.1126/science.1176062.
k Community-level spread: occurrence of cases without a link to known cases. – Propagation au niveau communautaire: survenue de cas sans lien avec des cas connus.
l WHO. Joint WHO–OFFLU technical teleconference to discuss human–animal interface aspects of the current infl uenza A (H1N1) situation. 4 May 2009 (http://www.who.int/csr/resources/
publications/swinefl u/who_offl lu_technical/en/index.html). – OMS. Joint WHO–OFFLU technical teleconference to discuss human–animal interface aspects of the current infl uenza A (H1N1)
situation. 4 May 2009 (http://www.who.int/csr/resources/publications/swinefl u/who_offl lu_technical/en/index.html).
m World Organisation for Animal Health. OIE immediate notifi cation, 02/05/2009: A/H1N1 infl uenza, Canada. WAHID Interface; 22 (http://www.oie.int/wahis/public.php?page=weekly_
report_index&admin=0). – Organisation mondiale de la Santé animale. OIE immediate notifi cation, 02/05/2009: A/H1N1 infl uenza, Canada. WAHID Interface; 22 (http://www.oie.int/wahis/
public.php?page=weekly_report_index&admin=0).
Table 1 (continued)
Tableau 1 (suite)
202 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
ity and mortality, health-care facilities and resources
should:
&#61591; treat people who have severe pandemic-related illness;
&#61591; give priority for treatment of people at increased
risk for complications of pandemic infl uenza;
&#61591; use adequate triage and infection control measures;
and
&#61591; provide the necessary care and treatment for other
life-threatening medical conditions in the population.
WHO will continue to provide guidance5 on treatment
measures, with particular emphasis on health care in
lower-resourced countries.
Communication and social mobilization
Communication and social mobilization are critical for
an effective national response to a pandemic.6 Countries
are in the best position to determine the most
effective means of providing regularly updated information
to health-care and other essential workers, the public
and other national stakeholders. Information that
should be communicated includes what is known and
not known about the pandemic virus and the disease
it causes; appropriate home-based care; when to seek
medical help; who might be increased risk for complications
and more severe disease; sources of medical care
and treatment; and measures people can take to reduce
their risk of infection.
Communication and social mobilization should encourages
the people in the community to become partners
in the response and recognize that all have an important
role to play.
Advance planning and preparedness to increase
resilience
Advance planning and preparedness can help countries
to make and implement the necessary decisions to reduce
the impact of a pandemic. In some cases, underresourced
countries may be able to apply experiences
such as mass campaigns to distribute vaccines and
medications, management of chaotic events (such as
famines or outbreaks of infectious diseases) that have
required delivery of health care to large numbers of
people in improvised settings. Country capacity might,
as necessary, be supplemented by assistance from nongovernmental
organizations, United Nations agencies
and other internal and external organizations and social
networks.
Each country should regularly assess its capacity to respond
in view of the epidemiological, clinical and virological
characteristics of the pandemic virus and its
own vulnerabilities. WHO is currently developing tools
to assist countries in performing such assessments. 
dité et la mortalité, il faut consacrer les établissements de santé
et les ressources aux t&acirc;ches suivantes:
&#61591; traiter les sujets atteints d’une forme grave de la grippe
pandémique;
&#61591; donner la priorité au traitement des sujets exposés à un
risque accru de complications de la grippe pandémique;
&#61591; prendre les mesures adaptées pour le triage des patients et
la lutte anti-infectieuse;
&#61591; prodiguer à la population les soins et traitements nécessaires
pour les autres états pathologiques engageant le pronostic
vital.
L’OMS continuera de donner des orientations5 sur les mesures
thérapeutiques, en mettant particulièrement l’accent sur les
soins de santé dans les pays qui ont peu de ressources.
Communication et mobilisation sociale
Elles sont indispensables pour l’effi cacité de l’action nationale
face à une pandémie.6 Les pays sont le mieux à même de déterminer
les moyens les plus effi caces de fournir régulièrement
des informations actualisées aux agents de santé et aux autres
personnels indispensables, ainsi qu’aux parties prenantes publiques
et nationales. Les informations à communiquer sont les
suivantes: ce que l’on sait et ce que l’on ignore du virus pandémique
et de la maladie qu’il provoque; les soins à domicile; le
moment où il faut consulter; les sujets exposés à un risque
accru d’atteintes graves; les endroits où trouver les soins médicaux
et les traitements; les mesures qui peuvent être prises par
la population pour atténuer le risque d’infection.
La communication et la mobilisation sociale doivent être faites
de manière à inciter les individus dans les communautés à
devenir des partenaires de l’action et à reconna&icirc;tre que tous
ont un r&ocirc;le important à jouer.
Planifi cation et préparation à l’avance pour augmenter
la résilience
La planifi cation et la préparation à l’avance peuvent aider les
pays à atténuer l’impact d’une pandémie. Dans certains cas, il
arrive que des pays manquant de ressources puissent tirer parti
de leurs expériences antérieures, comme des campagnes de
distribution massive de vaccins ou de médicaments, la gestion
de situations chaotiques (famines ou de maladies infectieuses
par exemple) qui les ont obligés à prodiguer des soins à des
populations nombreuses dans des circonstances improvisées. Si
nécessaire, les organisations non gouvernementales, les institutions
des Nations Unies et d’autres organisations internes ou
externes et des réseaux sociaux, peuvent venir en aide aux pays
pour renforcer leurs capacités.
Chaque pays devrait évaluer régulièrement ses moyens d’action
par rapport à ses propres vulnérabilités et aux caractéristiques
épidémiologiques, cliniques et virologiques du virus pandémique.
L’OMS met actuellement au point des outils pour aider les
pays à procéder à ce type d’évaluations. 
5 http://www.who.int/csr/resources/publications/swinefl u/clinical_management/en/index.html
6 http://www.who.int/csr/resources/publications/WHO_CDS_2005_32/en/index.html
5 See http://www.who.int/csr/resources/publications/swinefl u/clinical_management/
en/index.html
6 See http://www.who.int/csr/resources/publications/WHO_CDS_2005_32/en/index.
html
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 203
Estimating the global burden
of foodborne diseases:
a collaborative effort
This article was previously published in Eurosurveillance.*
Illness and death from diseases caused by unsafe food
are a constant threat to the security of public health as
well as to socioeconomic development throughout the
world.1 The full extent of the burden and cost of foodborne
diseases associated with pathogenic bacterial,
viral and parasitic microorganisms, and food contaminated
by chemicals, is unknown but is thought to be
substantial. WHO’s Initiative to Estimate the Global Burden
of Foodborne Diseases aims to fi ll the data gap and
respond to increasing global interest in health information.
Collaborative efforts are required to achieve the
ambitious task of assessing the burden of foodborne
diseases from all causes worldwide. Recognizing the
need to join forces, WHO has assembled an alliance of
stakeholders that share and support the initiative’s vision
as well as its intended objectives and outcomes.
One important collaborator is the European Centre for
Disease Prevention and Control, which has embarked
on a study of disease burden that covers >18 foodborne
diseases in nearly 30 countries.
Burden of foodborne diseases
All countries have limited resources with which to address
the health needs of their populations. Therefore,
decision-makers need to have access to high-quality
scientifi c evidence to help them prioritize the allocation
of resources and improve public health in the most effi
cient and effective manner.2
Surveillance data are often considered one of the main
evidence bases underpinning decisions about public
health policy. However, traditional surveillance systems
tend to capture merely a fraction of the existing disease
burden. For data on foodborne diseases to be included,
people who have been affected need to seek medical
care, provide a specimen and have that specimen test
positive in the laboratory. Moreover, the results must be
reported to the relevant health authorities.3 The spec-
Evaluation de la charge mondiale
des maladies d’origine alimentaire:
une action concertée
Cet article a précédemment été publié dans Eurosurveillance.*
Les cas de maladie et les décès dus à des pathologies associées
à la consommation d’aliments insalubres font peser dans le
monde entier une menace constante pour la sécurité de la santé
publique et pour le développement socio-économique.1 On ne
conna&icirc;t pas exactement la charge et le co&ucirc;t que représentent
les maladies d’origine alimentaire provoquées par des bactéries,
des virus et des parasites pathogènes ainsi que des aliments
contaminés par des substances chimiques, mais on pense que
le problème n’est pas négligeable. L’initiative lancée par l’OMS
pour l’évaluation de la charge mondiale des maladies d’origine
alimentaire a pour but de livrer les données manquantes et de
répondre à la demande croissante d’information sanitaire au
niveau mondial. Il faudra des efforts concertés pour arriver à
évaluer la charge que représentent dans le monde entier les
maladies d’origine alimentaire toutes étiologies confondues.
Consciente de la nécessité d’une action concertée, l’OMS a
constitué une alliance de partenaires qui approuvent tous et
appuient l’idée de l’initiative ainsi que les objectifs et les résultats
visés. L’une des principales institutions collaboratrices est
le Centre européen pour la prévention et le contr&ocirc;le des maladies,
qui a entrepris une étude de la charge de morbidité portant
sur >18 maladies d’origine alimentaire dans une trentaine de
pays.
Charge des maladies d’origine alimentaire
Les ressources disponibles pour répondre aux besoins sanitaires
de la population sont limitées, et ce dans tous les pays. C’est
pourquoi les décideurs doivent avoir accès à des données scientifi
ques de qualité pour allouer les ressources en fonction des
priorités et améliorer la santé publique avec un maximum
d’effi cience et d’effi cacité.2
Les données de la surveillance sont souvent considérées comme
l’une des principales bases factuelles sur lesquelles fonder les décisions
quant aux politiques de santé publique. Cependant, les systèmes
classiques de surveillance ne saisissent généralement qu’une
partie de la charge de morbidité existante. Pour pouvoir inclure
des données sur les maladies d’origine alimentaire, il faut que les
patients s’adressent à un médecin et fournissent un échantillon
qui se révèlera positif au laboratoire. De plus, il faut que les résultats
soient communiqués aux autorités sanitaires compétentes.3 Il
* This article is a secondary publication of the original paper by Kuchenmüller T et al.
Estimating the Global Burden of Foodborne Diseases - a collaborative effort. Eurosurveillance,
2009;14(18):pii=19195 (available at http://www.eurosurveillance.org/
ViewArticle.aspx?ArticleId=19195; accessed April 2009)
1 This article was made possible by contributions from the European Centre for Disease
Prevention and Control, Stockholm, Sweden; the Laboratory for Zoonoses and
Environmental Microbiology, National Institute for Public Health and the Environment
(RIVM), Bilthoven, the Netherlands; and WHO’s Department of Food Safety,
Zoonoses and Foodborne Diseases, Geneva, Switzerland.
2 Evidence-informed policy network. EVIPNet for better decision making. Geneva,
WHO, 2009 (http://evipnet.bvsalud.org/php/index.php?lang=en; accessed April
2009)
3 Initiative to estimate the global burden of foodborne diseases. Geneva, WHO, 2009
(http://www.who.int/foodsafety/foodborne_disease/ferg/en/index1.html; accessed
April 2009).
* Cet article est la seconde publication d’un article origine rédigé par Kuchenmüller T et al. Estimating
the Global Burden of Foodborne Diseases – a collaborative effort. Eurosurveillance,
2009; 14(18):pii=19195 (disponible sur http://www.eurosurveillance.org/ViewArticle.
aspx?ArticleId=19195; consulté en avril 2009).
1 La présente analyse a été possible gr&acirc;ce au concours du Centre européen de lutte contre les
maladies, Stockholm (Suède), du Laboratoire pour les zoonoses et la microbiologie de l’environnement,
Institut national pour la Santé publique et l’Environnement (RIVM), Bilthoven (Pays-
Bas) et du Département OMS Sécurité sanitaire des aliments, zoonoses et maladies d’origine
alimentaire, Genève (Suisse).
2 Réseau de politiques fondées sur des faits. EVIPNet for better decision making. Genève, OMS,
2009 (http://evipnet.bvsalud.org/php/index.php?lang=en; consulté en avril 2009).
3 Initiative to estimate the global burden of foodborne diseases. Genève, OMS, 2009 (http://www.
who.int/foodsafety/foodborne_disease/ferg/en/index1.html; consulté en avril 2009).
204 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
trum of pathogens causing infectious diseases is vast,
and the diversity of these diseases makes it diffi cult to
use surveillance data to set priorities to enable the best
use of resources.4 In addition, there are few surveillance
systems that capture and attribute human illnesses
caused by infection following ingestion of specifi c foods
or sequelae that may be associated with foodborne infections
– for example, Guillain–Barré syndrome arising
after campylobacteriosis or epilepsy associated with
neurocysticercosis following infection with the parasite
Taenia solium.
Using burden-of-disease methodology enables public
health offi cials to circumvent some of the problems
posed by diffi culties in reporting the incidence of foodborne
diseases. The “burden of disease” has been defi
ned as the incidence or prevalence, or both, of morbidity,
disability and mortality associated with acute and
chronic manifestations of disease.5 The overall burden
of disease is estimated using various composite measures
of the population’s health status, such as the disability-
adjusted life year (DALY), which is a time-based
measure that combines the years of life lost due to premature
mortality and the years of life lost due to time
lived with disability or in states of less than full
health.6
The burden-of-disease metric has been used extensively
by WHO and others to describe the global, regional and
national burden of diseases.6 Although some countries
have quantifi ed the national burden of foodborne diseases,
7, 8 the overall burden of these diseases has not
been fully described.
Why estimate the global burden of foodborne
diseases?
Through the globalization of food marketing and distribution,
food products that have been either accidentally
or deliberately contaminated may affect the health
of people in numerous countries at the same time. This
was demonstrated by the contamination of food with
melamine.9 Moreover, foodborne diseases appear to be
emerging more frequently than before, and the capacity
existe de très nombreux agents pathogènes responsables de maladies
infectieuses et, de ce fait, il est diffi cile d’utiliser les données
livrées par la surveillance pour fi xer des priorités afi n d’utiliser
au mieux les ressources.4 En outre, rares sont les systèmes de
surveillance qui permettent de repérer et d’attribuer des maladies
provoquées chez l’être humain par une infection due à l’ingestion
de certains aliments ou les séquelles de ces maladies à des infections
d’origine alimentaire – par exemple, le syndrome de Guillain-
Barré consécutif à une campylobactériose ou l’épilepsie associée
à la neurocysticercose à la suite d’une infection par le parasite
Taenia solium.
Le recours méthodologique à la charge de morbidité permet
aux responsables de la santé publique d’éviter certains des
problèmes liés à la notifi cation de l’incidence des maladies
d’origine alimentaire. La &laquo;charge de morbidité&raquo; a été défi nie
comme l’incidence et/ou la prévalence de la morbidité, des incapacités
et de la mortalité associées aux manifestations aigu&euml;s
et chroniques des maladies.5 Pour procéder à l’évaluation de la
charge globale de morbidité, on utilise diverses mesures composites
de l’état de santé de la population, comme les années de
vie ajustées sur l’incapacité (DALY), une mesure portant sur la
durée qui associe les années de vie perdues en raison de la
mortalité prématurée et les années de vie perdues en raison du
temps passé avec une incapacité ou une santé défi ciente.6
La mesure de la charge de morbidité a été largement utilisée
par l’OMS et d’autres pour décrire la charge que font peser les
maladies aux niveaux national, régional et mondial.6 Même si
certains pays ont calculé la charge des maladies d’origine
alimentaire au niveau national,7, 8 la charge globale qu’elles
représentent n’a pas été décrite de fa&ccedil;on très détaillée.
Pourquoi évaluer la charge mondiale des maladies
d’origine alimentaire?
En raison du caractère mondialisé de la commercialisation et
de la distribution des aliments, il peut arriver que des produits
alimentaires contaminés accidentellement ou délibérément
mettent en danger la santé des gens dans plusieurs pays à la
fois. On l’a vu par exemple lors de la contamination de denrées
alimentaires par la mélamine.9 De plus, les maladies d’origine
alimentaire sont apparemment plus fréquentes qu’auparavant
4 Krause G. Prioritisation of infectious diseases in public health – call for comments.
Eurosurveillance, 2008, 13(40):1–6 (available at http://www.eurosurveillance.org/
images/dynamic/EE/V13N40/art18996.pdf accessed April 2009).
5 WHO consultation to develop a strategy to estimate the global burden of foodborne
diseases: taking stock and charting the way forward. Geneva, World Health Organization,
2006: vii. (available at http://www.who.int/foodsafety/publications/foodborne_
disease/fbd_2006.pdf; accessed April 2009).
6 Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment
of mortality and disability from diseases, injuries, and risk factors in 1990 and
projected to 2020. Cambridge, Harvard University Press, 1996.
7 van Kreijl CF, Knaap AGAC, van Raaij JMA, eds. Our food, our health: healthy diet
and safe food in the Netherlands. Bilthoven, National Institute for Public health and
the Environment (RIVM), 2006 (available at http://www.rivm.nl/bibliotheek/rapporten/
270555009.pdf; accessed April 2009).
8 WHO consultation to develop a strategy to estimate the global burden of foodborne
diseases: taking stock and charting the way forward. Geneva, World Health Organization,
2006:16–17 (available at http://www.who.int/foodsafety/publications/foodborne_
disease/fbd_2006.pdf; accessed April 2009).
9 Expert meeting to review toxicological aspects of melamine and cyanuric acid,
1-4 December 2008. Geneva, World Health Organization, 2008 (http://www.who.
int/foodsafety/fs_management/infosan_events/en/index.html, accessed April
2009).
4 Krause G. Prioritisation of infectious diseases in public health – call for comments. Eurosurveillance,
2008, 13(40):1–6 (disponible http://www.eurosurveillance.org/images/dynamic/EE/
V13N40/art18996.pdf, consulté en avril 2009).
5 Consultation OMS pour élaborer une stratégie visant à estimer la charge mondiale des maladies
d’origine alimentaire. OMS, Genève, 2006: vii (disponible sur http://www.who.int/foodsafety/
publications/foodborne_disease/fbd_2006.pdf; consulté en avril 2009).
6 Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortalité
and disability from diseases, injuries, and risk factors in 1990 and projected to 2020.
Cambridge, Harvard University Press, 1996.
7 van Kreijl CF, Knaap AGAC, van Raaij JMA, eds. Our food, our health: healthy diet and safe food
in the Netherlands. Bilthoven, National Institute for Public Health and the Environment (RIVM),
2006 (disponible sur http://www.rivm.nl/bibliotheek/rapporten/270555009.pdf; consulté en
avril 2009).
8 WHO consultation to develop a strategy to estimate the global burden of foodborne diseases:
taking stock and charting the way forward. Genève, Organisation mondiale de la Santé, 2006:
16 17 (disponible sur http://www.who.int/foodsafety/publications/foodborne_disease/fbd_2006.
pdf; consulté en avril 2009).
9 Réunion d’experts chargés d’examiner les aspects toxicologiques de la mélamine et de l’acide
cyanurique, 1er-4 décembre 2008: Genève, Organisation mondiale de la Santé, 2008 (http://
www.who.int/foodsafety/fs_management/infosan_events/en/index.html; consulté en avril
2009).
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 205
of public health authorities to apply conventional control
measures does not seem to be developing at the
same speed.10 A recent article showed that approximately
30% of all emerging infections occurring during
the past 60 years were caused by pathogens commonly
transmitted through food.11 This trend is compounded
by the growing industrialization of food and feed production,
as well as intensive farming, which catalyses
the appearance and spread of pathogens (for example,
prions associated with bovine spongiform encephalopathy
led to new variant Creutzfeldt–Jakob disease
(vCJD) in humans during the 1990s; the emergence of
vCJD was caused by the use of meat and bone meal in
the production of animal feed).12
Diarrhoeal diseases alone – a considerable proportion
of which are foodborne – kill 2.2 million people globally
every year,13 but the burden arising from all foodborne
diseases is clearly larger. The heaviest share of the disease
burden occurs in poor countries and jeopardizes
international development efforts, including the achievement
of Millennium Development Goals (MDGs) (the
MDGs are 8 specifi c development goals that aim to combat
extreme poverty around the world and are to be
met by 2015). The MDGs were endorsed at the United
Nations Millennium Summit in 2000.14 Indeed, several
analyses have shown that to attain MDG 4, which focuses
on reducing the mortality rate among children
aged <5 years by two thirds between 1990 and 2015,
renewed efforts are needed to prevent and control diarrhoea,
among other diseases.13
In order to generate data on the full extent and cost of
foodborne diseases, WHO’s Department of Food Safety,
Zoonoses and Foodborne Diseases launched the initiative
during an international consultation in 2006.5 The
initiative aims to provide the fi rst-ever quantitative description
of the burden of foodborne diseases by 2011,
when worldwide estimates will be generated and stratifi
ed by age, sex and WHO region for a defi ned list of
causative agents of microbial, parasitic and chemical
origin. This information will enable policy-makers and
others to:
&#61591; appropriately allocate resources to prevent and control
foodborne diseases;
&#61591; monitor and evaluate food safety measures;
&#61591; develop new food-safety standards;
alors que la capacité des autorités de la santé publique d’appliquer
des mesures de lutte classiques ne semble pas cro&icirc;tre au
même rythme.10 Un article paru récemment a montré qu’environ
30% des nouvelles infections survenues au cours des
60 dernières années étaient dues à des agents pathogènes généralement
transmis par des aliments.11 Cette tendance est renforcée
par l’industrialisation croissante de la production des
denrées destinées à la consommation humaine et animale ainsi
que par l’agriculture intensive, catalyseur de l’apparition et de
la propagation d’agents pathogènes (ainsi, des prions associés
à l’encéphalopathie spongiforme bovine ont été à l’origine
d’une nouvelle variante de la maladie de Creutzfeldt-Jakob chez
l’être humain dans les années 1990, du fait de l’utilisation de
viandes et de farines préparées à base de carcasses pour
produire des aliments pour animaux).12
A elles seules, les maladies diarrhéiques – dont beaucoup ont
une origine alimentaire – tuent chaque année dans le monde
2,2 millions de personnes,13 mais il est évident que la charge
représentée par toutes les maladies d’origine alimentaire est
plus importante. C’est dans les pays pauvres que la charge de
morbidité est la plus lourde et compromet les efforts internationaux
en faveur du développement, y compris la réalisation
des objectifs du Millénaire pour le développement (OMD) (soit
8 objectifs spécifi ques de développement axés sur la lutte
contre l’extrême pauvreté dans le monde et censés être atteints
d’ici 2015.) Les OMD ont été approuvés lors du Sommet du
Millénaire réuni par l’Organisation des Nations Unies en
2000.14 En fait, plusieurs analyses ont montré que, pour atteindre
l’OMD 4, à savoir réduire de deux tiers, entre 1990 et 2015,
le taux de mortalité des enfants de <5 ans, il faudra redoubler
d’efforts pour lutter contre la diarrhée, entre autres maladies.
13
C’est pour obtenir des données sur l’ampleur et le co&ucirc;t réels
des maladies d’origine alimentaire que le Département OMS
Sécurité sanitaire des aliments, zoonoses et maladies d’origine
alimentaire a lancé l’initiative en 2006, lors d’une consultation
internationale.5 Il s’agit de donner pour la première fois une
description quantitative de la charge des maladies d’origine
alimentaire d’ici 2011, année où des estimations mondiales
seront établies et stratifi ées par &acirc;ge, par sexe et par Région de
l’OMS pour donner une liste précise des agents étiologiques
d’origine microbienne, parasitaire et chimique. A partir de là,
les décideurs et autres personnes concernées pourront:
&#61591; allouer les ressources en fonction des besoins pour lutter
contre les maladies d’origine alimentaire;
&#61591; suivre et évaluer l’application des mesures de sécurité sanitaire
des aliments;
&#61591; élaborer de nouvelles normes pour la sécurité sanitaire des
aliments;
10 First formal meeting of the Foodborne Disease Burden Epidemiology Reference
Group: 26–28 November 2007. Geneva, World Health Organization, 2007 (available
at http://www.who.int/foodsafety/publications/foodborne_disease/burden_nov07/
en/index.html; accessed April 2009).
11 Jones KE et al. Global trends in emerging infectious diseases. Nature, 2008,
451:990–993.
12 Smith PG, Bradley R. Bovine spongiform encephalopathy (BSE) and its epidemiology.
British Medical Bulletin, 2003; 66:185–198.
13 The Global Burden of Disease – 2004 update. Geneva, World Health Organization,
2008 (available at http://www.who.int/healthinfo/global_burden_disease/GBD_
report_2004update_full.pdf; accessed April 2009)
14 Millennium Development Goals. New York, United Nations, 2008 (http://www.
un.org/millenniumgoals/, accessed April 2009).
10 Première réunion offi cielle du groupe de travail de référence sur l’épidémiologie des maladies
d’origine alimentaire: 26-28 Novembre 2007. Genève, Organisation mondiale de la Santé, 2007
(disponible sur http://www.who.int/foodsafety/publications/foodborne_disease/burden_nov07/
en/index.html; consulté en avril 2009.)
11 Jones KE et al. Global trends in emerging infectious diseases. Nature, 2008, 451: 990-993.
12 Smith PG, Bradley R. Bovine spongiform encephalopathy (BSE) and its epidemiology. British
Medical Bulletin, 2003; 66: 185–198.
13 Charge mondiale de morbidité – mise à jour 2004. Genève, Organisation mondiale de la Santé,
2008 (disponible sur http://www.who.int/healthinfo/global_burden_disease/GBD_
report_2004update_full.pdf; consulté en avril 2009).
14 Objectifs du Millénaire pour le développement. New York, Organisation des Nations Unies, 2008
(http://www.un.org/millenniumgoals/; consulté en avril 2009).
206 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
&#61591; assess the cost effectiveness of interventions;
&#61591; quantify the burden in monetary costs; and
&#61591; attribute human illness to specifi c food sources to
support risk management strategies.3
The Foodborne Disease Burden Epidemiology
Reference Group
One of the main recommendations of the 2006 consultation
was that a Foodborne Disease Burden Epidemiology
Reference Group (FERG) be established to advise
WHO on generating comprehensive estimates of the
burden of foodborne diseases. The principles underlying
the reference group are based on a detailed analysis
of lessons learnt from other external WHO expert
groups, such as the Monitoring and Evaluation Reference
Group for malaria or the Child Health Epidemiology
Reference Group.15
The FERG unites disciplines that traditionally do not
tend to collaborate, such as risk assessment, epidemiology,
microbiology, virology, parasitology, toxicology, and
disease and exposure modelling. This multidisciplinary
approach enables the group to generate comprehensive
data for all major foodborne diseases. The FERG is mandated
to:
&#61591; assemble, appraise and report on existing estimates
of the burden of foodborne diseases;
&#61591; conduct epidemiological reviews of mortality, morbidity
and disability for each of the major foodborne
diseases as determined by the reference group (for
more details, see meeting report);10
&#61591; provide models for estimating the burden of foodborne
diseases where data are lacking;
&#61591; develop cause and source attribution models to estimate
the proportion of diseases that are foodborne;
and
&#61591; develop user-friendly tools for assessing the burden
of foodborne diseases at the country level.
The FERG operates through a Core group, 5 task forces
and ad hoc resource advisers. WHO’s Secretariat carries
out logistic, administrative and technical support functions
(Fig. 1).
Since its establishment, the FERG has met twice to:
(i) prioritize causative agents for which data on the burden
of disease should be generated (for more details,
see meeting report),10 (ii) develop extensive plans to
guide WHO’s Secretariat on the work to be commissioned,
and (iii) appraise the progress that had been
made in commissioned work. Major reviews, research
and modelling work have been undertaken by externally
commissioned scientists for the following causative
agents:
&#61591; chemicals and toxins – cyanide from cassava, afl atoxin,
dioxins, peanut allergens;
&#61591; déterminer le rapport co&ucirc;t/effi cacité des interventions;
&#61591; évaluer la charge en termes monétaires; et
&#61591; attribuer les cas de maladie humaine à une source alimentaire
précise pour appuyer les stratégies de gestion des
risques.3
Groupe de travail de référence sur l’épidémiologie
des maladies d’origine alimentaire
L’une des principales recommandations de la consultation de
2006 portait sur la création d’un Groupe de travail de référence
sur l’épidémiologie des maladies d’origine alimentaire (FERG)
chargé de donner des avis à l’OMS en vue de l’établissement
d’estimations globales de la charge de ces maladies. Les principes
sur lesquels se fonde le groupe de travail de référence ont
été défi nis à partir d’une analyse détaillée des enseignements
tirés de l’action d’autres groupes OMS d’experts extérieurs,
comme le groupe de référence pour le suivi et l’évaluation
concernant le paludisme ou le groupe de travail de référence
sur l’épidémiologie de la santé de l’enfant.15
Le FERG comprend des représentants de disciplines qui, traditionnellement,
ne collaboraient pas entre elles, comme l’évaluation
des risques, l’épidémiologie, la microbiologie, la virologie,
la parasitologie, la toxicologie ou la modélisation de la maladie
et de l’exposition. Cette approche multidisciplinaire lui permet
d’obtenir des données complètes pour les principales maladies
d’origine alimentaire. Son mandat est le suivant:
&#61591; rassembler, évaluer et communiquer les estimations actuelles
de la charge des maladies d’origine alimentaire;
&#61591; procéder à des études épidémiologiques de la mortalité, de
la morbidité et des incapacités pour chacune des grandes
maladies d’origine alimentaire, tel qu’il le détermine (pour
plus de détails, voir le rapport de la réunion);10
&#61591; établir des modèles pour l’évaluation de la charge des maladies
d’origine alimentaire là où les données manquent;
&#61591; mettre au point des modèles permettant de déterminer les
causes et l’origine pour évaluer la proportion des cas qui
est d’origine alimentaire; enfi n
&#61591; élaborer des outils faciles à utiliser pour évaluer la charge
des maladies d’origine alimentaire dans les pays.
Le FERG agit par le biais d’un Groupe central, de 5 groupes de
travail et de conseillers spéciaux. Le Secrétariat de l’OMS, quant
à lui, assure des fonctions logistiques, administratives et d’appui
technique (Fig. 1).
Depuis sa création, le FERG s’est réuni à 2 reprises pour:
i) établir par ordre de priorité la liste des agents étiologiques
pour lesquels il faudrait obtenir des données sur la charge de
morbidité (pour plus de détails, voir le rapport de la réunion),10
ii) établir des plans détaillés pour aider le Secrétariat de l’OMS
à déterminer les travaux à réaliser, et iii) évaluer les progrès
accomplis en ce qui concerne les travaux réalisés. Des études
et des travaux de recherche et de modélisation importants ont
été entrepris par des chercheurs extérieurs pour les agents étiologiques
suivants:
&#61591; substances chimiques et toxines – cyanure du manioc, afl atoxine,
dioxines, allergènes des cacahuètes;
15 Stein C, et al. The global burden of disease assessments – WHO is responsible?
Neglected Tropical Diseases, 2007, 1(3):1–8.
15 Stein C, et al. The global burden of disease assessments – WHO is responsible? Neglected Tropical
Disease, 2007, 1(3): 1-8.
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 207
Task Force 1: advancing work on the burden of disease in the areas of viral and
bacterial enteric diseases. – Groupe de travail 1: faire progresser les travaux sur
la charge de morbidité en ce qui concerne les maladies intestinales d’origine virale et
bactérienne.
Task Force 2: advancing work on the burden of disease in the area of parasitic
diseases. – Groupe de travail 2: faire progresser les travaux sur la charge de morbidité
en ce qui concerne les maladies parasitaires.
Task Force 3: advancing work on the burden of disease in the areas of chemicals
and toxins. – Groupe de travail 3: faire progresser les travaux sur la charge de
morbidité en ce qui concerne les substances chimiques et des toxines.
Task Force 4: advancing work in the area of source attribution. (This task force
identifi es the proportion of the disease burden that is directly caused by food contamination
and aims to attribute the relevant fraction of disease burden to the specifi c
food source responsible.) – Groupe de travail 4: faire progresser les travaux sur la
détermination de l’origine (déterminer la part de la charge de morbidité qui est due
directement à la contamination des aliments, dans le but d’attribuer la part pertinente
de la charge de morbidité à une source alimentaire précise).
Task Force 5: advancing work on estimating the burden of foodborne diseases at
country level. (This task force will be set up in June 2009 and will develop user-friendly
tools to aid countries in conducting their own studies of the burden of foodborne diseases,
enabling them to monitor the progress of their food-safety interventions). – Groupe
de travail 5: faire progresser les travaux concernant l’évaluation de la charge des
maladies d’origine alimentaire au niveau des pays (ce groupe de travail sera créé en
juin 2009 et mettra au point des outils faciles à utiliser qui aideront les pays à mener
leurs propres études sur la charge des maladies d’origine alimentaire, et donc à suivre
les progrès réalisés gr&acirc;ce à leurs interventions en matière de sécurité sanitaire des
aliments).
Fig. 1 Composition and structure of WHO’s Initiative to Estimate the Global Burden of Foodborne Diseasesa
Fig. 1 Composition et structure de l’Initiative OMS pour l’évaluation de la charge mondiale des maladies d’origine alimentairea
FERG = Foodborne Disease Burden Epidemiology Reference Group – FERG = Foodborne Disease Burden Epidemiology Reference Group (groupe de travail de référence pour l’épidémiologie des maladies d’origine alimentaire)
a First formal meeting of the Foodborne Disease Burden Epidemiology Reference Group: 26–28 November 2007. Geneva, World Health Organization, 2007 (available at http://www.who.int/foodsafety/publications/foodborne_disease/burden_nov07/en/index.html;
accessed May 2009). – Première réunion offi cielle du groupe de travail de référence pour l’épidémiologie des maladies d’origine alimentaire: 26-28 novembre 2007. Genève, Organisation mondiale de la Santé, 2007 (disponible sur http://www.who.int/foodsafety/
publications/foodborne_disease/burden_nov07/en/index.html; consulté en mai 2009).
WHO Secretariat – Secrétariat de
l’OMS
FERG ad hoc Resource
Advisers – Conseillers
spéciaux du FERG
FERG Core or Steering
Group – Groupe central
ou groupe d’orientation
du FERG
FERG Thematic Task
Forces – Groupes de
travail thématiques du
FERG
The FERG Core or Steering Group functions as a steering committee and consists of scientists from each of the task forces below.
It monitors and appraises the technical and epidemiological work of all task forces and is chaired by a scientist with extensive international
experience in both foodborne diseases and burden-of-disease methodology. – Le Groupe central ou Groupe d’orientation
du FERG, qui agit en tant que comité d’orientation, est composé de chercheurs membres des différents groupes de travail
indiqués ci dessous. Chargé de suivre et d’évaluer les travaux techniques et épidémiologiques des différents groupes de travail, il est
dirigé par un chercheur doté d’une très grande expérience internationale concernant les maladies d’origine alimentaire et la méthodologie
d’évaluation de la charge de morbidité.
The WHO Secretariat, led by the
Department of Food Safety, Zoonoses and
Foodborne Diseases, is composed of staff
from 8 WHO departments that have a
stake in foodborne diseases or the burden
of disease, or both, as well staff from UN
partner organizations. – Le Secrétariat
de l’OMS, avec en premier lieu le Département
Sécurité sanitaire des aliments,
zoonoses et maladies d’origine alimentaire,
comprend des membres du personnel de
8 départements de l’OMS qui s’occupent
des maladies d’origine alimentaire et/ou
de la charge de morbidité, ainsi que de
membres de personnel d’organisations
partenaires du système des Nations Unies.
FERG resource advisers: Additional
external experts may be called on to join the research
group on an ad hoc basis to supplement
the skills required. – Conseillers spéciaux
du FERG: des experts extérieurs supplémentaires
peuvent être appelés à se joindre ponctuellement
au FERG pour apporter les compétences
nécessaires.
208 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
&#61591; parasites – intestinal protozoa, Fasciola hepatica,
Taenia solium, Echinococcus multilocularis;
&#61591; enteric pathogens – global burden of diarrhoeal diseases
in people aged >5 years.
The fi rst interim results are expected later in 2009. A
peer-review system using external reviewers increases
the quality and scientifi c rigour of the work of the
FERG.
The Task Force on Source Attribution (also known as
Task Force 4) aims to attribute the relevant fraction of
the disease burden to the specifi c food source responsible;
this task force commenced work in April 2008.
The Task Force on Country Studies (Task Force 5) will
commence work in June 2009. The work of this task
force will increase the capacity of countries to conduct
their own assessments of the burden of foodborne diseases.
Eighteen country studies are planned (3 in each
of WHO’s 6 regions); these will provide fi rst-hand fi eld
data, fi ll data gaps identifi ed by the reference group and
help validate the burden results generated by modelling
approaches.
Partnerships – joining efforts for results
The multifactorial nature of foodborne diseases necessitates
close collaboration among WHO’s initiative and
a large number of partners and stakeholders in order
to bring together the necessary expertise and resources
and minimize the duplication of efforts. The initiative
capitalizes on existing in-house experience at WHO by
including staff from several departments that deal with
diseases that are potentially of foodborne origin, including
the Department of Child and Adolescent Health and
Development, the Department of Control of Neglected
Tropical Diseases and the Department of Public Health
and Environment.
Collaboration with external stakeholders
The initiative relies on an alliance of external collaborators
to provide technical expertise, information-sharing
platforms, networking possibilities or fi nancial support,
or a combination of these. Through the FERG members,
>30 internationally renowned scientifi c institutions
from all over the world have been linked with the initiative.
WHO has established close technical collaboration
with several organizations involved in global and regional
burden of disease initiatives, including (among
others):
&#61591; the European Centre for Disease Prevention and
Control in Stockholm, Sweden, which has embarked
on a burden of disease study covering nearly
30 countries and up to 49 infectious diseases, of
which at least 18 may also be transmitted by food
(see section below on collaboration with the centre);
&#61591; the Institute for Health Metrics and Evaluation in
Seattle, WA, USA, which is updating the global burden
of disease data for 2005, the year of reference.
The risk factor “unsafe food” will not be examined
by the institute, but will instead be assessed by the
&#61591; parasites – protozoaires intestinaux, Fasciola hepatica,
Taenia solium, Echinococcus multilocularis;
&#61591; agents pathogènes intestinaux – charge mondiale des maladies
diarrhéiques pour les personnes de >5 ans.
Les premiers résultats intermédiaires devraient être disponibles
dans le courant de 2009. Un système d’examen collégial faisant
appel à des examinateurs extérieurs renforce la qualité et la
rigueur scientifi que des travaux du FERG.
Le groupe de travail sur la détermination de l’origine (également
appelé groupe de travail 4) vise à attribuer la part pertinente
de la charge de morbidité à une source alimentaire
précise; il a entamé ses travaux en avril 2008. Le groupe de
travail sur les études de pays (groupe de travail 5) commencera
ses travaux en juin 2009 et aidera ainsi les pays à mieux évaluer
eux-mêmes la charge des maladies d’origine alimentaire. Dixhuit
études de pays sont prévues (3 dans chacune des 6 Régions
de l’OMS); elles apporteront des données provenant directement
du terrain, aideront à combler les lacunes d’information
repérées par le groupe de travail de référence et contribueront
à valider les résultats obtenus par modélisation.
Les partenariats – travailler ensemble pour réussir
Les maladies d’origine alimentaire étant multifactorielles, une
collaboration étroite doit s’instaurer entre l’initiative de l’OMS
et de nombreux partenaires et acteurs de manière à rassembler
les compétences et les ressources nécessaires tout en réduisant
le plus possible les doubles emplois. L’initiative tire parti de
l’expérience acquise par l’OMS gr&acirc;ce à la présence de membres
du personnel de plusieurs départements qui s’occupent de
maladies susceptibles d’avoir une origine alimentaire, notamment
le Département Santé et développement de l’enfant et de
l’adolescent, le Département Lutte contre les maladies tropicales
négligées et le Département Santé publique et environnement.
Collaboration avec des acteurs extérieurs
L’initiative s’appuie sur une alliance de collaborateurs extérieurs
pour fournir des compétences techniques, des instances d’échange
d’information, des possibilités de réseau ou un appui fi nancier
– quand ce ne sont pas tous ces éléments à la fois. Par le biais
du FERG, >30 institutions scientifi ques du monde entier et de
renommée internationale ont été mises en contact avec l’initiative.
L’OMS a instauré une étroite collaboration technique avec
plusieurs organisations associées à des initiatives régionales et
mondiales relatives à la charge de morbidité, y compris (entre
autres):
&#61591; le Centre européen pour la prévention et le contr&ocirc;le des
maladies, Stockholm (Suède), qui a entrepris une étude sur
la charge de morbidité dans près de 30 pays sur un maximum
de 49 maladies infectieuses dont au moins 18 pourraient
être également transmises par des aliments (voir la
section ci-après sur la collaboration avec le centre);
&#61591; l’Institute for Health Metrics and Evaluation, Seattle (WA,
Etats-Unis), qui est en train de mettre à jour les données
sur la charge mondiale de morbidité pour 2005, année de
référence. Le facteur de risque &laquo;aliments insalubres&raquo; ne sera
pas examiné par l’institut mais il sera évalué par l’initiative,
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 209
initiative, given to WHO’s specifi c knowledge in this
area;
&#61591; the International Collaboration on Enteric Disease
Burden of Illness Studies, which facilitates communication
among experts who have conducted studies
of the burden of enteric or foodborne infectious
diseases;
&#61591; Med-Vet-Net, a European research network for
zoonoses, which will produce estimates of the disease
burden and cost of illness of selected foodborne
and zoonotic pathogens in 8 European countries.
WHO has assembled an alliance and continues to expand
this alliance of funding agencies and in-kind
supporters of the FERG to ensure that no individual
agency, foundation or government exerts undue infl uence
on the initiative. WHO and other institutions
(such as the Ministry of Health, Welfare and Sport, the
Netherlands; the Centers for Disease Control and Prevention
and the Department of Agriculture, United
States; the Ministry of Health, Labour and Welfare, Japan;
the Department of Health, United Kingdom) continue
to make considerable fi nancial investments in
the initiative. WHO is discussing additional funding
options with a number of governmental and nongovernmental
donors.
Events with stakeholders
The initiative has implemented a detailed communication
strategy covering the internal and external sharing
of information, mechanisms for accountability and all
aspects of advocacy. Key food-safety stakeholders were
invited to the fi rst formal meeting of the reference
group in November 2007 to provide input to the initiative.
This involvement proved fruitful, and the input
received from stakeholders was endorsed in the technical
deliberations of the FERG.10
The second meeting of the FERG took place in November
2008 and also incorporated a gathering of stakeholders.
Representatives attended from >30 stakeholder
constituencies, including WHO Member States, bilateral
and multilateral organizations, the agriculture and food
industries, consumer groups, academia and the scientifi
c and public media. Stakeholders welcomed WHO’s
efforts to estimate the burden of foodborne diseases.
Group sessions provided an opportunity for all participants
to interact directly with the members of the
FERG as well as with the initiative’s Secretariat and to
suggest potential activities to be undertaken in the areas
of communications, advocacy and policy.16
gr&acirc;ce aux connaissances particulières de l’OMS dans ce
domaine;
&#61591; l’International Collaboration on Enteric Disease Burden of
Illness Studies, qui facilite la communication entre les
experts ayant étudié la charge des maladies infectieuses
intestinales ou d’origine alimentaire;
&#61591; Med-Vet-Net, un réseau européen de recherche sur les
zoonoses, qui livrera des estimations de la charge de morbidité
et du co&ucirc;t des maladies provoquées par certains agents
pathogènes d’origine alimentaire et zoonotique dans 8 pays
européens.
L’OMS continue d’élargir cette alliance avec des organismes
de fi nancement et des entités qui apportent un appui en nature
au FERG de telle sorte qu’aucune institution, aucune fondation
ou aucun gouvernement ne puisse exercer individuellement
une trop grande infl uence sur l’initiative. L’OMS et d’autres
institutions (comme le Ministère néerlandais de la Santé, de
l’Action sociale et des Sports, les Centers for Disease Control
and Prevention et le Ministère de l’Agriculture des Etats-Unis,
le Ministère japonais de la Santé, du Travail et de l’Action
sociale, et le Ministère de la Santé du Royaume Uni) continuent
d’investir beaucoup d’argent dans l’initiative. L’OMS envisage
actuellement des options de fi nancement supplémentaire avec
plusieurs donateurs gouvernementaux et non gouvernementaux.
Activités de collaboration avec les parties prenantes
L’initiative a mis en oeuvre une stratégie de communication
détaillée pour l’échange interne et externe d’information, les
mécanismes liés à l’obligation de résultats et tous les aspects
de l’action de sensibilisation. Les principaux acteurs dans le
domaine de la sécurité sanitaire des aliments ont été invités
à la première réunion offi cielle du groupe de travail de référence
en novembre 2007 afi n d’apporter leur concours à l’initiative.
Cette participation a porté ses fruits et les contributions
ont été prises en compte dans les débats techniques du
FERG.10
La deuxième réunion du FERG s’est tenue en novembre 2008 et
a été elle aussi l’occasion de rassembler les parties prenantes,
en particulier des représentants de >30 partenaires concernés,
dont des Etats Membres de l’OMS, des organisation bilatérales
et multilatérales, des acteurs de l’industrie agro-alimentaire, des
groupes de consommateurs, des groupes universitaires et des
médias scientifi ques et publics. Les partenaires se sont félicités
des efforts déployés par l’OMS pour évaluer la charge des maladies
d’origine alimentaire. Les sessions de groupe ont offert à
tous les participants la possibilité d’interagir directement avec
les membres du FERG et avec le Secrétaire de l’Initiative,
pouvant ainsi suggérer la mise en place d’activités possibles
dans les domaines de la communication, de la sensibilisation
et de la politique.16
16 Increasing impact through collaboration: foodborne disease stakeholder meeting,
20 November 2008, Geneva. Geneva, World Health Organization, 2009 (http://
www.who.int/foodsafety/foodborne_disease/FERG_Stakeholder_2008.pdf, accessed
April 2009).
16 Increasing impact through collaboration; foodborne disease stakeholder meeting, 20 November
2008, Geneva. Genève, Organisation mondiale de la Santé, 2009 (http://www.who.int/foodsafety/
foodborne_disease/FERG_Stakeholder_2008.pdf; consulté en avril 2009).
210 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
Collaborating with the European Centre
for Disease Prevention and Control
WHO has a global mandate to assemble health information,
assist countries in shaping their agenda for health
research, set public health norms and standards, monitor
and assess health trends, and provide technical support
to countries. The European Centre for Disease
Prevention and Control is responsible for identifying,
assessing and communicating current and emerging
threats to human health from infectious diseases within
the European Union.17 WHO and the European Centre
for Disease Prevention and Control work together to
avoid duplicating efforts and to make the best use of
limited resources.
In 2006, the European Centre for Disease Prevention and
Control recognized that a composite measure of disease
burden, such as the DALY, could be used to guide public
health policy-making and action in the area of communicable
diseases.18 Therefore, a 3-month pilot study
was conducted to explore the potential of the concept
of disease burden to be applied to the assessment of
7 communicable diseases.19
A study of the present and future burden of communicable
diseases in Europe will build on the results of the
pilot study and will use methodologies, such as those
developed by WHO for its Global Burden of Disease
Study,6 to estimate the burden of a range of communicable
diseases and associated health issues in countries
in the European Union and European Free Trade Association.
The European Centre for Disease Prevention
and Control’s project will start later in 2009, with the
initial phase (refi nement of methodology, fi eld testing
and the full study) estimated to last 4 years. The estimates
of the burden of disease will be updated regularly.
While there is some overlap between the reference
group and the European Centre for Disease Prevention
and Control with regards to the diseases being studied
(about one third of the diseases covered in the European
Union study of foodborne pathogens are also being investigated
by the reference group), WHO’s initiative
focuses on the global picture of all major foodborne
diseases, including those resulting from chemical and
parasitic hazards; these are not covered by the European
Centre for Disease Prevention and Control’s study. Additionally,
the reference group aims to attribute causes
of disease burden to particular food commodities when
possible. To ensure a synergistic approach, scientists
from the European Centre for Disease Prevention and
Control and all relevant networks act as advisers to the
FERG.
Collaboration avec le Centre européen
pour la prévention et le contr&ocirc;le des maladies
L’OMS a pour fonction générale de rassembler l’information en
matière de santé, d’aider les pays à défi nir leur programme de
recherche en santé, de fi xer des normes et critères en santé
publique, de suivre et d’évaluer les tendances sanitaires et,
enfi n, d’apporter un appui technique aux pays. Le Centre européen
pour la prévention et le contr&ocirc;le des maladies est chargé
de repérer, d’évaluer et de faire conna&icirc;tre les menaces actuelles
et nouvelles que représentent les maladies infectieuses pour la
santé humaine dans l’Union européenne.17 L’OMS et le Centre
collaborent afi n d’éviter les doubles emplois et d’utiliser au
mieux les ressources limitées.
En 2006, le Centre a reconnu qu’il était possible d’utiliser une
mesure composite de la charge de morbidité sous forme de
DALY pour guider la prise des décisions et les actions à mener
en santé publique concernant les maladies transmissibles.18
Une étude pilote de 3 mois a donc été faite en vue d’examiner
le potentiel offert par la notion de charge de morbidité appliquée
à l’évaluation de sept maladies transmissibles.19
Une étude sur la charge actuelle et future des maladies transmissibles
en Europe s’inspirera des résultats de cette étude
pilote et fera appel à des méthodes telles que celles qui ont été
mises au point par l’OMS pour son étude sur la charge mondiale
de morbidité,6 afi n d’évaluer la charge de diverses maladies
transmissibles et de problèmes de santé associés dans les pays
de l’Union européenne et de l’Association européenne de Libre
Echange. Le projet du Centre débutera dans le courant de 2009
et la phase initiale (mise au point de la méthodologie, essais
de terrain et étude proprement dite) devrait durer 4 ans. Les
estimations de la charge de morbidité seront régulièrement
mises à jour.
Bien qu’il y ait un certain chevauchement entre les activités du
groupe de travail de référence et celles du centre en ce qui
concerne les maladies étudiées (environ un tiers des maladies
visées par l’étude des agents pathogènes responsables de maladies
d’origine alimentaire dans l’Union européenne fait également
l’objet d’études menées par le groupe de travail de référence),
l’initiative de l’OMS privilégie le tableau mondial des
principales maladies d’origine alimentaire, y compris celles qui
sont liées à des risques chimiques et parasitaires et qui ne sont
pas étudiées par le centre. De plus, le groupe de travail de référence
s’efforce dans la mesure du possible d’attribuer les causes
de la charge de morbidité à des denrées alimentaires particulières.
Pour garantir la synergie, des chercheurs du centre et de
tous les réseaux concernés font offi ce de conseillers auprès du
FERG.
17 European Centre for Disease Prevention and Control (http://ecdc.europa.eu/en/
About_us/Default.aspx, accessed April 2009).
18 Jakab Z. Why a burden of disease study? Eurosurveillance, 2007; 12(12):750. (Also
available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=750.)
19 van Lier EA et al. The burden of infectious diseases in Europe: a pilot study. Eurosurveillance,
2007, 12(12):751 (available at http://www.eurosurveillance.org/ViewArticle.
aspx?ArticleId=751; accessed April 2009).
17 Centre européen pour la prévention et le contr&ocirc;le des maladies (http://ecdc.europa.eu/en/
About_us/Default.asp; consulté en avril 2009).
18 Jakab Z. Why a burden of disease study? Eurosurveillance, 2007; 12(12):750 (disponible sur
http://www.eurosurveillance.org/ViewArticle.aspx?Articleld=750; consulté en avril 2009).
19 Van Lier EA. The burden of infectious diseases in Europe: a pilot study. Eurosurveillance, 2007,
12(12):751. (Egalement disponible sur http://www.eurosurveillance.org/ViewArticle.
aspx?Articleld=751).
RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, No 22, 29 MAI 2009 211
Conclusions
It is important to assess the global burden of foodborne
diseases from all major causes using summary health
metrics in the form of DALYs to aid decision-makers
in allocating appropriate resources to food safety, and
to the control and prevention of these diseases. To
tackle this large task, the Initiative to Estimate the
Global Burden of Foodborne Diseases combines WHO’s
capacity for leadership in public health with the independent
advice of a reference group and relies on an
intersectoral alliance of partners and stakeholders.
Multi-stakeholder partnerships work best if aligned
with the strategic interests of each party. This is the
case for the European Centre for Disease Prevention
and Control and WHO’s initiative. Both institutions aim
to estimate the burden of foodborne diseases by capitalizing
on their respective strengths. The European Centre
for Disease Prevention and Control will generate
data on the burden of communicable diseases (including
those transmitted by food) for European countries;
WHO will focus on the global burden of foodborne diseases
from all major causes. Using these complementary
strengths, this process will enable both institutions to
avoid duplication of effort, share technical expertise
and data, and ensure the comparability of results.
WHO’s initiative continually seeks to broaden cooperation
with external partners. The annual meetings of
stakeholders have proven to be an effective platform
for fostering constructive dialogue and interaction
among WHO, the reference group and stakeholders in
the food-safety community. These meetings will increase
in size and importance and further catalyse international
collaboration and funding for effective prevention
of foodborne diseases and intervention measures.

Conclusions
Il est important d’évaluer la charge mondiale des maladies
d’origine alimentaire attribuables aux principales causes à
l’aide de mesures sanitaires concises (DALY) pour aider les décideurs
à allouer les ressources voulues à la sécurité sanitaire des
aliments et à la lutte contre ces maladies. Face à cette t&acirc;che
ambitieuse, l’initiative pour l’évaluation de la charge mondiale
des maladies d’origine alimentaire associe la capacité de direction
de l’OMS en santé publique et les avis indépendants d’un
groupe de travail de référence tout en s’appuyant sur une
alliance intersectorielle de partenaires et de différents acteurs.
Les partenariats multiples fonctionnent de fa&ccedil;on optimale s’ils
concordent avec les intérêts stratégiques de chaque partie. C’est
bien le cas pour l’initiative qui associe l’OMS et le Centre européen
pour la prévention et le contr&ocirc;le des maladies. Les deux
institutions ont pour but d’évaluer la charge des maladies d’origine
alimentaire en comptant sur leurs atouts respectifs. Le
centre livrera des données sur la charge des maladies transmissibles
(y compris celles qui sont d’origine alimentaire) pour les
pays européens, tandis que l’OMS se concentrera sur la charge
mondiale des maladies d’origine alimentaire attribuables aux
principales causes. Gr&acirc;ce à ces atouts complémentaires, les deux
institutions pourront éviter les doubles emplois, mettre en
commun leurs compétences techniques et leurs données et,
enfi n, garantir la comparabilité des résultats.
L’initiative de l’OMS cherche sans cesse à élargir la coopération
avec les partenaires extérieurs. Les réunions annuelles
des parties prenantes se sont avérées extrêmement utiles pour
favoriser le dialogue et l’interaction entre l’OMS, le groupe de
travail de référence et les partenaires qui travaillent dans le
domaine de la sécurité sanitaire des aliments. Ces réunions,
dont la taille et l’importance vont assurément cro&icirc;tre, renforceront
la collaboration et les fi nancements internationaux, le
but étant de garantir une véritable prévention des maladies
d’origine alimentaire et de prendre des mesures d’intervention
effi caces. 
How to obtain the WER through the Internet
(1) WHO WWW SERVER: Use WWW navigation software to
connect to the WER pages at the following address:
http://www.who.int/wer/
(2) An e-mail subscription service exists, which provides by
electronic mail the table of contents of the WER, together
with other short epidemiological bulletins. To subscribe,
send a message to [email protected] The subject fi eld
should be left blank and the body of the message should
contain only the line subscribe wer-reh. A request for
confi rmation will be sent in reply.
Comment accéder au REH sur Internet?
1) Par le serveur Web de l’OMS: A l’aide de votre logiciel
de navigation WWW, connectez-vous à la page d’accueil
du REH à l’adresse suivante: http://www.who.int/wer/
2) Il existe également un service d’abonnement permettant de recevoir
chaque semaine par courrier électronique la table des matières
du REH ainsi que d’autres bulletins épidémiologiques. Pour vous
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212 WEEKLY EPIDEMIOLOGICAL RECORD, NO. 22, 29 MAY 2009
Monthly report on dracunculiasis
cases, January–April 2009
In 2004, during the 57th World Health Assembly, the Ministers
of Health of countries where dracunculiasis
(guinea-worm disease) is endemic pledged to interrupt
transmission of the disease by the end of 2009. To monitor
the progress accomplished, the number of cases reported
to WHO by national programmes will be regularly
published in the Weekly Epidemiological Report. 
Country – Pays
Date of last report
received – Date
du dernier rapport
re&ccedil;u
Proportion of villages
under active
surveillance reported
as of last report
(%) – Proportion
des villages sous
surveillance active
signalés comme
ayant remis leur
dernier rapport (%)
No. of new dracunculiasis cases
reported in 2009* – Nombre
de nouveaux cas de dracunculose
signalés en 2009*
Total no. of
reported cases for
the same months
of – Nombre total
de cas signalés au
cours des mêmes
mois en
No. of villages
reporting cases
in – Nombre de
villages signalant
des cas en
Date of
emergence of
last reported
indigenous
case – Date
d’émergence
du dernier cas
autochtone
signalé
2009 January

Janvier
February

Février
March –
Mars
April –
Avril
2009 2008 2009 to
date –
2009 à
ce jour
2008
Endemic countries – Pays d’endémie
Ethiopia – Ethiopie 19 May/mai 2009 100 0 0 1 7 8 33 2 11 Apr./avr. 2009
Ghana 20 May/mai 2009 95 45 50 52 28 175 269 36 131 Apr./avr. 2009
Mali 15 May/mai 2009 100 0 0 0 0 0 2 0 69 Dec./déc. 2008
Niger 18 May/mai 2009 100 0 0 1 0 1a 1b 1 3 Oct. 2008
Nigeria – Nigéria 18 May/mai 2009 83 0 0 0 0 0 37 0 5 Nov. 2008
Sudan – Soudan 18 May/mai 2009 78 12 18 46 206 282 412 ND 1243 Apr./avr. 2009
Precertifi cation countries – Pays au stade de la précertifi cation
Benin – Bénin 30 Apr./avr. 2009 100 0 0 0 0 0 0 0 Mar. 2004
Burkina Faso 18 May/mai 2009 86 0 0 0 0 0 1a 0 1 Nov. 2006
Chad – Tchad 05 Nov. 2008 ND 0 0 0 0 0 0 ND 0 Sept. 2000
C&ocirc;te d’Ivoire 23 Apr./avr. 2009 100 0 0 0 ND 0 0 0 0 July/Juil. 2006
Kenya 23 Sept. 2008 ND ND ND ND ND ND 0 ND 0 1994
Mauritania –
Mauritanie
03 May/mai 2009 100 0 0 0 ND ND 0 0 0 June/June 2004
Togo 17 May/mai 2009 100 0 0 0 0 0 0 0 0 Dec./Déc. 2006
Uganda – Ouganda 05 May/mai 2009 100 0 ND 0 ND ND 0 0 0 July/Juil. 2003
Total 57 68 100 241 466 755 39 1463
Source: Ministries of Health – Source: Ministères de la Santé
* Dracunculiasis reported cases (provisional data) by month of emergence of fi rst worm; both indigenous and imported cases. – Cas de dracunculose signalés (données provisoires), par mois
d’émergence du premier ver; cela concerne à la fois les cas importés et autochtones.
a Case reported to be imported from Ghana. – Cas de dracunculose signalé comme ayant été importé du Ghana.
b Case reported to be imported from Mali. – Cas de dracunculose signalé comme ayant été importé du Mali.
ND, no data received. – ND, données non re&ccedil;ues.
Rapport mensuel des cas de dracunculose,
janvier-avril 2009
En 2004, lors de la 57e Assemblée mondiale de la Santé, les
ministres de la santé des pays où la dracunculose (maladie du
ver de Guinée) est endémique ont déclaré vouloir faire en sorte
que la transmission de cette maladie soit interrompue d’ici à
fi n 2009. Afi n de suivre les progrès réalisés, le Relevé épidémiologique
hebdomadaire publiera régulièrement le nombre de cas
signalés à l’OMS par les programmes nationaux. 
2009
2008
2007
2006
466
4619
9585
25 217
No. of dracunculiasis cases reported worldwide, 2006–2009
Nombre de cas de dracunculose signalés dans le monde, 2006-2009
Year – Année
The shaded portion indicates the total number of dracunculiasis cases
reported for that year. The unshaded portion indicates the number of
cases reported for the same period in 2009. – La portion colorée indique
le nombre total de cas de dracunculose pour l’année en question. La
portion non colorée indique le nombre total de cas de dracunculose
pour la même période en 2009.



What can I do?

http://www.who.int/csr/disease/swineflu/frequently_asked_questions/what/en/index.html

Updated 11 June 2009

What can I do to protect myself from catching influenza A(H1N1)?
The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

avoid touching your mouth and nose;
clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
avoid close contact with people who might be ill;
reduce the time spent in crowded settings if possible;
improve airflow in your living space by opening windows;
practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.
What about using a mask? What does WHO recommend?
If you are not sick you do not have to wear a mask.

If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards.

When and how to use a mask?
If you are sick and must travel or be around others, cover your mouth and nose.

Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A(H1N1)?
You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

What should I do if I think I have the illness?
If you feel unwell, have high fever, cough or sore throat:

stay at home and keep away from work, school or crowds;
rest and take plenty of fluids;
cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully. Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
inform family and friends about your illness and try to avoid contact with other people;
If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.
Should I take an antiviral now just in case I catch the new virus?
No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

Warning on purchase of antivirals without a prescription [pdf 35kb]
What about breastfeeding? Should I stop if I am ill?
No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

When should someone seek medical care?
A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Should I go to work if I have the flu but am feeling OK?
No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

Can I travel?
If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider.

 
4   [USMedEdu 于 2009-06-16 16:10:32 提到] [FROM: 140.]
阿根廷出现首例甲型流感死亡

Jun 16, 2009


阿根廷卫生官员说,一个3个月大的婴儿死于甲型H1N1流感。这是南美国洲家出现的首例死亡病例。有关部门星期一公布这个死亡病例时没有说明这个婴儿是如何感染上甲型H1N1流感病毒的。

世界卫生组织的资料显示,阿根廷有343个甲型流感病例。在世界其它地区,约旦卫生官员星期二报告了该国首次发现两个感染甲型流感的病例。这些官员仅提供了很少的细节,但是表示,两名被感染的年轻女性最近曾去过海外。

卡塔尔的卫生部长星期二也宣布卡塔尔出现头两个甲型流感病例。他说,两名两岁的外国男孩分别从奥地利和美国乘飞机进入卡塔尔后,被诊断受到这种病毒感染。
 
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