19 February 2010 -- As of 14 February 2010, worldwide more than 212 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15921 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

The situation is largely unchanged since the previous update. In the temperate zone of the northern hemisphere, active but declining pandemic influenza transmission persists in limited areas of eastern and southern Europe, South Asia, and in East Asia. Several countries in West Africa reported increases in the number of cases but there is as yet insufficient evidence to conclude that widespread community transmission is occurring. An increasing trend in respiratory diseases activity was reported in Thailand and Jamaica, however the cause of the respiratory disease is uncertain at this point.

In Southeast Asia, several countries reported an increasing trend of respiratory diseases activity but overall intensity remained low. After several months of sporadic influenza activity, Thailand reported increasing respiratory diseases activity marked by increased ILI in 24 provinces; however, the overall intensity of activity nationally remains low. In Myanmar and Indonesia, localized geographic spread of influenza activity, an increasing trend of respiratory diseases, and low overall intensity was reported. In South Asia, influenza activity persists in the northern and western states of India, however, overall influenza activity continued to decline or remained low in India, Nepal, Bangladesh, and Sri Lanka. In East Asia, transmission of pandemic influenza virus persists but has been steadily declining in most countries of region (China, Japan, and the Republic of Korea), with the exception of DPR Korea, where an increasing trend of respiratory diseases activity was reported. In West Asia, pandemic influenza virus continues to circulate in many countries, however the overall intensity of current activity remains low in the region.

In North Africa, pandemic influenza transmission persists but substantial declines in activity continue to be reported over the past month. In Sub-Saharan Africa, limited data suggest that pandemic influenza virus transmission may be sporadic in most areas of the continent. Several countries in West Africa continue to report increases in the numbers of confirmed cases of pandemic influenza, however, currently, no countries in the region are reporting an increasing trend in respiratory diseases activity.

In Europe, pandemic influenza virus continues to circulate across central and southeastern Europe, but the overall intensity of activity remained low in most places; only Greece, Bulgaria, Turkey, Slovakia, the Republic of Moldova, and the Russian Federation reported a moderate intensity of respiratory diseases activity. Several weeks of increases in ARI/ILI were reported in Slovakia and in the Russian Federation, but increased activity in these countries may be associated with other circulating respiratory viruses. Among 12 countries testing at least twenty sentinel respiratory specimes, only Hungary reported that greater than 20% specimens had tested positive for influenza.

In the Americas, both in the tropical and northern temperate zones, pandemic influenza virus continues to circulate at low levels but overall pandemic influenza activity continued to decline or remain low in most places. In Central America and Caribbean, pandemic influenza virus transmission persists but overall activity remains low or unchanged in most places. Jamaica reported an increasing trend of respiratory diseases activity but the overall intensity remains low.

Pandemic influenza (H1N1) 2009 virus continues to be the predominant influenza virus circulating worldwide. In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, and Asia.

The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza. For more information on virological surveillance and antiviral resistance please see the weekly virology update (Virological surveillance data, below).

*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of the Tropic of Capricorn, while countries in tropical regions are defined as those between these two latitudes.

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute respiratory infection (SARI)

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic on health-care services.

The maps below display information on the qualitative indicators reported. Information is available for approximately 60 countries each week. Implementation of this monitoring system is ongoing and completeness of reporting is expected to increase over time.

The countries and overseas territories/communities that have newly reported their first pandemic (H1N1) 2009 confirmed cases since the last web update (No. 87): None.

The countries and overseas territories/communities that have newly reported their first deaths among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 87): none.

* The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related.