CURRENT SITUATION – QUEENSLAND

Gold Coast

• Media are reporting concerns about the imminent arrival of almost 1,000 organ recipients on the Gold Coast for the World Transplant Games. The Local Organising Committee Chairman is said to be negotiating with a health provider to set up a flu clinic at the Games. [couriermail.com.au, 4/8/09]

• Queensland Health has had extensive correspondence with the United Kingdom Organising Committee for the Transplant Games regarding the event. The Organising Committee concluded it would continue with the Games as planned.

Metro North

• The Royal Queensland Show has banned pigs from the grounds to protect the animals from contracting the Pandemic (HINl) 2009 virus. The ban was prompted by a Pandemic (HINl) 2009 outbreak in a NSW piggery. [Ballarat Courier, 5/8/09]

• [03 August 2009] Prince Charles Hospital reported that the facility had three Extra- Corporeal Membrane Oxygenation (ECMO) stations in operation, all three of which were in use by patients with continned Pandemic (HINI) 2009.

Townsville

• [04 Jul 09] Townsville HSD reported that due to an increase in Pandemic (HINI) 2009 related Emergency Department presentations, an Emergency Department annexe would open to fast track mild cases.

• [30 Jul 09] Townsville HSD reported a youth at Cleveland Detention Centre was displaying influenza like symptoms. The inmate was swabbed, isolated and commenced on Tamiflu, with ten further courses of Tamiflu supplied to the Centre’s nurse. Two further suspected cases have been swabbed, administered Tamiflu and isolated. On Tuesday, 04 August 2009, Townsville HSD reported two positive cases of Pandemic (HINI) 2009 at the facility.

Central Queensland

• [03 Aug 09] Central Queensland HSD reported a total of eight continned of Pandemic (HlNI) 2009.

• [31 Jul 2009] Longreach has now reported their second continned Pandemic (HINI) 2009 case. The patients are one tourist and one local, and neither have required admission to hospital.

Torres Strait and Northern Peninsula

• [04 Aug 09] Torres Straight HSD reported that the PNG/Australian border (for the purposes of the Torres Strait – PNG treaty) had been re-opened last Wednesday, 29 July 2009, at 0900 AEST.

• [03 Aug 09] Torres Straight HSD reported that a series of public meetings in island communities would soon begin, outlining the importance of hygiene, hand washing and flu infection prevention.

Cape York

• [03 Aug 09] Cape York HSD has assessed data of continned cases and it is apparent that communities in Cape York have community transmission of Pandemic (HINI) 2009. As such all of Cape York HSD moved to PROTECT on Monday, 3 August 2009. On Friday, 31 July 2009, the Cape York HSD advised that the Indigenous Community of Hopevale is moving to the PROTECT phase due to an increase of community transmission of the Pandemic (H1N1) 2009 virus. Where relevant for those communities with low numbers of community transmission, sentinel surveillance mechanisms will continue to be implemented and early treatment instituted, especially for vulnerable groups.

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CURRENT SITUATION – QUEENSLAND

Metro North

• [03 August 2009] Prince Charles Hospital reported that the facility had three Extra- Corporeal Membrane Oxygenation (ECMO) stations in operation, all three of which were in use by patients with confirmed Pandemic (H1Nl) 2009.

Townsville

• [04 Jnl 09] Townsville HSD reported that dne to an increase in Pandemic (HlNl) 2009 related Emergency Department presentations, an Emergency Department annexe wonld open to fast track mild cases.

• [30 Jul 09] Townsville HSD reported a youth at Cleveland Detention Centre was displaying influenza like symptoms. The inmate was swabbed, isolated and commenced on Tamiflu, with ten further courses of Tamiflu supplied to the Centre’s nurse. Two further suspected cases have been swabbed, administered Tamiflu and isolated. On Tnesday, 04 Angnst 2009, Townsville HSD reported two positive cases of Pandemic (HlNl) 2009 at the facility.

Central Qneensland

• [03 Aug 09] Central Queensland HSD reported a total of eight confirmed of Pandemic (H1N1) 2009.

• [31 Jul 2009] Longreach has now reported their second confirmed Pandemic (H1N1) 2009 case. The patients are one tourist and one local, and neither have required admission to hospital.

• [30 Jul 09] Central West Health Service District reported the district’s first confirmed case of Pandemic (H1N1) 2009.

Torres Strait and Northern Peninsnla

• [04 Ang 09] Torres Straight HSD reported that the PNG/Anstralian border (for the purposes of the Torres Strait – PNG treaty) had been re-opened last Wednesday, 29 July 2009, at 0900 AEST.

• [03 Aug 09] Torres Straight HSD reported that a series of public meetings in island communities would soon begin, outlining the importance of hygiene, hand washing and flu infection prevention.

• [29 Jul 09] Extensive education regarding Pandemic (H1NI) 2009 is being distributed within the Bamaga Community on Wednesday, 29 July 2009, and to a further two outlying islands
on the 30 and 31 July 2009.

Cape York

• [03 Aug 09] Cape York HSD has assessed data of confirmed cases and it is apparent that communities in Cape York have community transmission of Pandemic (H1Nl) 2009. As such all of Cape York HSD will move to PROTECT on Monday, 3 August 2009. On Friday, 31 July 2009, the Cape York HSD advised that the Indigenous Community of Hopevale is moving to the PROTECT phase due to an increase of community transmission of the Pandemic (H1Nl) 2009 virus. Where relevant for those communities with low numbers of community transmission, sentinel surveillance mechanisms will continue to be implemented and early treatment institnted, especially for vulnerable groups.

• [03 Aug 09] Cape York HSD will receive the services of a temporary fly-in nurse to assist in the response to Pandemic (HIN1) 2009.

• [29 Jul 09] Cape York HSD is reporting the towns of Weipa and Cooktown moved from the CONTAIN phase to the PROTECT phase due to increased community transmission of the Pandemic (H1Nl) 2009 virus. Other outlying areas of the Cape York region (excepting Pormpuraaw) remain at the CONTAIN phase.

• [29 Jul 09] The Cape York HSD are reporting 82 confmned Pandemic CHlNI) 2009 cases across eight communities. To mitigate the impact of the virus on the communities, Queensland Health are undertaking media activities across the region, and letterbox drops in Weipa and Cooktown communities.

MouutIsa

• [04 Aug 09] Mt Isa HSD advised that effective Saturday, 01 August 2009, the whole of the Mt Isa Health Service District would move to PROTECT Phase.

• [03 Aug 2009] Mt Isa HSD has reported that the Mt Isa Population Health Unit and the Mt Isa City Council are liaising and in the process of producing various media for the public concerning Pandemic CHINI) 2009 at the forthcoming Mt Isa Rodeo.

• [31 Jul 2009] Rodeo 7-9 August expected to increase presentation at ED.

Cairus

• [29 Jul 09] Cairns Base Hospital has established a triage area at the entrance of the Emergency Department as of Tuesday, 28 July 2009. The area is staffed from 0700 to 2300 hours and is intended to section off an area for those who present with Influenza-Like Illness from other ED patients.

Recent Queensland Pandemic (HINl) 2009 Related Deaths

• [03 August 09] A 25 year old Pacific Islander male with a significant medical died within a few hours of presentation at Gold Coast Hospital. He presented with a three day history of febrile ILl associated with increasing dyspnoea. His death has since been verified as Queensland’s eleventh Pandemic CHINI) 2009 related fatality.

• [02 Aug 09] Queensland has reported its tenth Pandemic CHlNl) 2009 related death in a Townsville hospital of a 54 year old woman. The patient had underlying medical conditions.

• [31 luI 09] Queensland has reported its ninth Pandemic CHINI) 2009 related death in a Brisbane hospital of a 30 year old woman. The patient suffered multiple underlying medical conditions.

• [30 Jul 09] On Wednesday 29 July, Queensland reported it’s eighth Pandemic CHlNI) 2009 related death of a 58 year old male at Princess Alexandra Hospital. The patient had underlying medical conditions. This death was not reported in NIR SitRep #222.

• [29 Jul 09] Queensland has reported its seventh Pandemic CHINI) 2009 related death in an 82 year old female patient in Townsville. The patient suffered underlying medical conditions.

Flu Clinics

• [04 Aug 09] Mt Isa HSD reported that effective Saturday, 01 August 2009, Flu Clinics in Outpatient Departments were suspended. Presentations will be monitored through the Emergency Department and the clinic will re-open should nnmbers increase.

• [30 Jul 09] Darling Downs- West Moreton HSD reported that a flu clinic would open on Tuesday, 4 August 2009, in Toowoomba if the current level of emergency activity continues.

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CURRENT SITUATION – INTERNATIONAL

[04 Aug 09] The Solomon Islands have reported their first confirmed case of Pandemic (HINI) 2009. The person was a member of the Regional Assistance Mission that had flown to the Solomon Islands from Brisbane Thursday, 30 July 2009. The confirmed case and a further twelve colleagues that had travelled on the same flight have been quarantined with one displaying symptoms of ILl. [ABC Radio Australia News, 4/8/09]

[31 Ju12009] On Friday, 31 July 2009, the WHO issued its Pandemic (HINI) 2009 Briefing Note 5- reporting on research conducted in the USA and published Wednesday, 29 July 2009. The WHO
advised that media have drawn attention to the increased risk of severe or fatal illness in pregnant women when infected with the HINI pandemic virus. Several other countries experiencing
widespread transmission of the pandemic virus have similarly reported an increased risk in pregnant women, particularly during the second and third trimesters of pregnancy. An increased risk of foetal
death or spontaneous abortions in infected women has also been reported. [Pandemic (HINI) 2009 Briefmg Note 5, WHO, 31107/09]

[03 Aug 2009] On Monday, 27 July 2009, the WHO issued its Pandemic (HINI) 2009 – Update 59, advising that globally there had been 134,503 officially confirmed Pandemic (HINI) 2009 cases, and
816 related deaths. The update also advised that given countries are no longer required to test and report individual cases, the number of cases reported understates the actual number of cases. [Pandemic (HINI) 2009 Update 29, WHO, 27/07/09] For the full update, including a breakdown of case numbers by WHO region, go to: http://www.who.int/csr/donl2009 07 27/enlindex.html

[03 Aug 2009] On Monday, 24 July 2009, the WHO released Pandemic (HINI) 2009 Briefing Note 4 advising that the number of human cases of Pandemic (HI N 1) 2009 is still increasing substantially
in many countries, even in those countries that have been affected by Pandemic (HINI) 2009 for some time. [Pandemic (HINI) 2009 Briefing Note 4, 24/07/09] The WHO also stated that the average age of cases is increasing. For the full briefing note, go to: http://www.who.int/csr/disease/swineflulnotes/hlnl pregnancy 2009073I/enlindex.htrnl

[03 Aug 2009] The New Zealand Ministry of Health are reporting a total of 2,855 confirmed Pandemic (HINI) 2009 cases in the country, and a total of 14 related deaths. The latest death is of a man in his 50s, who died in Christchurch last week. [Media Release, NZ Govt, 03/08/09]

[01 Aug 2009]. The New Zealand Capital & Coast District Health Board has reported that 100 out of 4,500 staff in the Wellington region had tested positive for Pandemic (HINI) 2009, about the same
number calling in sick as at this time last year. The hospital has given staff with symptoms the option of taking Tamiflu. [Dominion Post website 0 I Aug 2009]

[31 Ju12009] ECDC reported 2403 new cases, including 738 new cases from Germany, 705 from the UK and the first death in France were confirmed and reported from the EU and EFT A countries, reaching a total of26,424. [ECDC website 01 Aug 2009]

[31 Ju12009] Media in New Zealand are reporting that the 39 year-old woman who died of pandemic (HIN1) 2009 in Wellington Hospital this week was a front-line health worker at Hutt Hospital. Her death, described as being from rare complications, is the 13th to be officially recorded in New Zealand. [Dominion Post 31107/2009]

[30 July 2009] BBC News reported that the number of new Pandemic (HINI) 2009 infections in England has doubled in the past week according to the Government. There were an estimated 100,00 new cases, with the under 14′ s worst hit. [BBC News Website, 31107/2009]

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This report is based on the most recent and accurate available information at the time of preparation. Given the rapidly changing nature of the incident, readers should be aware of the potential requirement for later confirmation or clarification.

Torres Strait and Northern Peninsula

• [22 Jul 09] The strategy to remain in a CONTAIN AND PROTECT Phase for an extended period of time has allowed the Torres Strait and Northern Peninsula district to limit the spread of the Pandemic (HINI) 2009 virus, however, as community transmission is now apparent on a number of islands within the area, the district moved from the CONTAIN AND PROTECT Phase to PROTECT at close of business Wednesday, 22 July 2009.

• [22 Jul 09] The Australian Department of Foreign Affairs and Trade have advised the border between the Torres Strait and Papua New Guinea will remain closed pending a fmiher visit and review by Papua New Guinea government officials. The next review is expected to take place on Monday, 27 July 2009.

Cape York

• [27 Jul 09] The Cape York HSD are reporting 68 confirmed Pandemic (HtNt) 2009 cases across eight commnnities. To mitigate the impact of the virus on the communities, Queensland Health are nndertaking media activities across the region, and letterbox drops in Weipa and Cooktown communities.

• [22 Jul 09] The discrete Indigenous community of Pormpuraaw in Cape York has moved to the PROTECT Phase. Due to an increase of confirmed Pandemic (H IN I) 2009 cases in the community, nursing and Indigenous Health staff are being re-deployed to Pormpuraaw from the wider district.

• [22 Jul 09] All other communities within the Cape York HSD remain in the CONTAIN Phase, with sentinel swabbing and ongoing surveillance.

MountIsa

• [23 Jul 09] Effective Thursday, 23 July 2009, Mount Isa, Cloncuny and Doomadgee moved from the CONTAIN phase to the PROTECT phase due to increased community transmission of the Pandemic (H I N I) 2009 virus. Other outlying areas of the Mount Isa region remain at the CONTAIN phase.

• [23 Jul 09] The first case of Pandemic (HINI) 2009 has been identified in Mornington Island. Contact tracing is being conducted.

Palm Island

• [27 Jul 09] There is currently one suspect Pandemic (HtNt) 2009 case hospitalised in Palm Island Hospital. Recent Queensland Pandemic (HtNt) 2009 Related Deaths

• [26 Jul 09] Queensland has repOlied its sixth Pandemic (HINI) 2009 related death in a 33 year old Brisbane male who was in a vulnerable group and had multiple underlying medical conditions. The man was admitted to hospital on Friday, 17 July 2009, and after spending four days in Intensive Care, died away on Saturday, 25 July 2009.

• [24 July 09] On Friday, 24 July 2009, Queensland repOited its fifth Pandemic (HlNI) related death. A man in his 20s died in a Brisbane south-side hospital today. He was in a vulnerable group. No other details will be released.

• [23 Jul 09] On Thursday, 23 July 2009, Queensland repOited its fourth Pandemic (HINI) 2009 related death. The patient was an 84 year old male with underlying medical conditions. The man died in Brisbane on Wednesday, 22 July 2009.

• [22 Jul 09] A teenager with multiple underlying medical conditions died in Nambour Hospital. The patient tested positive to Pandemic (HINI) 2009 after being admitted on Sunday, 12 July 2009 with respiratory difficulties.

• [22 Jul 09] A 70 year old male with multiple co-morbidities who died, Wednesday, 22 July 2009. The patient had been admitted to Townsville Hospital as a cardiology inpatient in the Critical Care Unit and had tested positive to Pandemic (HINI) 2009.

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CURRENT SITUATION – AUSTRALIA

[27 Jul 09] The number of Australian confirmed Pandemic (HINI) 2009 cases reported by the National Incident Room is 17,061. This is an increase of293 cases since the last SHECC SitRep.

[26 Jul 09) The New South Wales Department of Health released a statement on Friday, 24 July 2009 advising that as schools in the state were reopening on Monday, 27 July 2009, parents and schools should follow simple measures to reduce the transmission of Pandemic (HIN1) 2009 in the school community. The NSW Chief Health Officer stated that in the past two weeks they had seen a decrease in the number of children aged 5 - 16 years presenting to emergency depmtments with Influenza-Like Illness. School holidays slowed the spread of infection, however, it is inevitable that the case number will rise again in this age group with the return to school. [NSW Health Media Release, 24/07/09)

[24 July 09) On Friday, 24 July 2009 South Australian Health reported the State's fifth Pandemic (HINI) 2009 related death. The patient was a 12 year old girl admitted to the Women's and Children's Hospital with severe underlying medical conditions on Sunday, 19 July 2009 and died on Friday, 24 July 2009. [SA Health Media Release, 24/07/09)

[24 July 09) On Friday, 24 July 2009, South Australian Health authorities announced the states fourth Pandemic (HINI) 2009 related death. The 25 year old man was admitted to the Royal Adelaide
Hospital with underlying medical conditions on Sunday, 19 July 2009, and died late Wednesday, 22 July 2009. [SA Health Media Release, 23/07/09]

[23 Jul 09] On Thursday, 23 July 2009, the Tasmanian Government announced that a 77 year old woman suffering fi’om a number of chronic conditions became the second Pandemic (H I N I) 2009
related death in the state. The woman had been admitted to hospital and died Wednesday, 22 July 2009. [Tasmanian Gov!. Media Release, 23/07/09]

[23 Jul 09] On Wednesday, 22 July 2009, South Australian Health advised a 56 year old woman had become the third person to die in South Australia after being diagnosed with Pandemic (HINI) 2009.
The woman had underlying medical conditions and was admitted to hospital on Sunday, 12 July 2009. Her condition worsened and she died late Tuesday, 21 July 2009. South Australian Health also stated
the number of confirmed Pandemic (H I N I) 2009 cases in South Australia had reached 1,467. [South Australian Govt. Media Release, 22/07/09]

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CURRENT SITUATION – INTERNATIONAL

[26 Jul 09] The European Centre for Disease Prevention and Control (ECDC) stated in the Situation Report on Saturday, 24 July 2009. that Ministers from several Middle Eastern countries had agreed to
prevent the children, the elderly and people with chronic health conditions from attending the Hajj in November, 2009, due to the Pandemic (HIN1) 2009 situation. [ECDC SitRep, 24/07/09]

[26 Jul 09] The WHO South East Asian region are repOlting Pandemic (HINl) 2009 in eight countries, with 7,559 laboratOl), confirmed cases. Thailand has had 44 Pandemic (HIN1) 2009 related deaths, but no other deaths have been reported in the region. [WHO SEAR, 23/07/09]

[26 Jul 09] The WHO African Region have reported 12 countries combined have 175 laboratory confirmed Pandemic (HINl) 2009 cases, and no deaths in the region. [WHO AFRO, 22/07/09]

[26 Jul 09] The Public Health Agency of Canada has repOlted they will partner their National Microbiology LaboratOl), with Intensive Care units across the country in a study to determine how and why severe illness affects some people after they become infected with Pandemic (HIN1) 2009. It will examine risk factors for severe infection, and probe reasons why some people become severely ill very quickly, and also to determine how long a seriously ill person is infectious. The study aims to help physicians, intensivists and emergency care specialists prepare for the anticipated surge of Pandemic (HIN1) 2009 in the Northern Fall. [PHAC, 23/07/09]

[26 Jul 09] On Thursday, 23 July 2009, the United Kingdom Health Protection Agency (HPA) released its Pandemic (HINI) 2009 update. Key Points from the update are:

• GP consultation rates have risen sharply over the last week in England.

• Under-5s and 5-14 year olds are the age groups predominately affected, with the over 655 continuing to show much lower rates.

• The majority of cases continue to be mild. The provisional number of deaths related to swine flu is 26.

• HPA estimates that there were 100,000 new cases of swine flu in England last week (range 60,000 – 140,000).

The Pandemic (HINI) 2009 update can be found at: http://www.hpa.org.uklweb/HPAweb&HPAwebStandard/HPAweb C/I2478l6558780

[26 Jul 09] On Friday, 24 July 2009, the New Zealand Ministty of Health had confirmed 2,585 Pandemic (HINl) 2009 cases, and stated the level of illness would be much higher than the number of laboratory confirmed cases repOlted. Testing is now done only in the management of severe cases. Also, many people with Pandemic (H IN l) 2009 are able to look after themselves at home and do not need to see their GP. The total number of Pandemic (HINI) 2009 related deaths in the country remains at eleven. On Friday, 24 July 2009, they had 72 people in hospital, with 23 in Intensive Care. [NZ Government Media Release, 24/07/09]

[24 JULY 2009] WHO repOlts that he number of human cases of pandemic (HINI) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time. In most countries the majority of pandemic (HINI) 2009 cases are still occurring in younger people, with the median age repOlted to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.

[24 July 09] The US CDC have repOlted on four children aged between 7 and 17 years who were hospitalised with neurologic complications associated with pandemic (HINl) 2009. All cases have since fully recovered. The CDC repOlt notes that the complications were less severe than those recently described in cases related to seasonal influenza [US CDC MMWR, 24 July 2009].

[23 Jul 09] Media are repOlting an additional two instances of the Pandemic (HINI) 2009 virus showing Tamiflu resistance. The first instance was in a 60 year old Canadian male who had been given the antiviral after a family member was confirmed to have Pandemic (HINI) 2009. Media reported there was no evidence the man transmitted the resistant strain to anyone else. The second case of resistance was identified in the city of Yamaguchi, Japan. This case had been given the antiviral as post-exposure prophylaxis. The person has since recovered, and there appears to have been no transmission. The virus was sensitive to Relenza. There have now been five cases of Tamiflu resistance repmted globally. [Canadian Press, 23/07/09]

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