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Page last updated at 18:10 GMT, Tuesday, 21 July 2009 19:10 UK

World response to swine flu crisis

Hand sanitiser being used to combat swine flu
Good hygiene can help prevent infection with swine flu

The rapid spread of the swine flu pandemic has forced the World Health Organization (WHO) to change tack.

The focus now should be on quick response to severe outbreaks to minimise impact, rather than on attempting to halt growth of the virus, it says.

The WHO has stopped producing lists of laboratory-confirmed cases of swine flu as it says this is a waste of resources.

It does not advocate a uniform global plan, saying each country will prefer to tailor its response to its own circumstances.

The BBC News website looks at a selection of key regions around the world to see what they are doing to combat swine flu.

NORTH AMERICA

Canada

Canada has recorded more than 10,000 cases and dozens of deaths.

But it says it is confident that everyone who needs a dose of the flu vaccine will get at least one shot before Christmas, thanks to its domestic production facilities and a pre-existing contract obligating pharmaceutical giant GlaxoSmithKline to prioritise Canada's needs in the event of a pandemic.

New infections seem to be declining, but there remain areas of great need - for example, the Canadian Broadcasting Corporation reports that in Manitoba province, swine flu prevalence is 20 times the provincial average.

Remote communities will be among the priority groups to receive the first immunisations, say health officials.

Mexico

The virus originated in Mexico - which has had more than 13,500 cases and 125 deaths - but now appears to be subsiding there.

At the height of the crisis, which is thought to have cost the economy billions of dollars, restaurants, cafes, schools, businesses and public institutions were shut down in a dramatic move to curb the crisis.

President Felipe Calderon assumed new powers to isolate infected people.

US

The US has experienced the greatest number of reported cases, at 40,000, and the greatest number of deaths, at 263, and the government has declared a public health emergency.

Officials believe there may actually have been more than a million cases, but because they have been mild most have gone unreported. There are now signs, they say, that overall influenza activity is abating.

There is currently a debate over which populations should be targeted with the first flu vaccines, which the government hopes will be available in about October, amid fears there will not be enough for a mass vaccination programme.

Nearly $2bn of emergency funds will go towards purchasing vaccine components as well as helping plan for immunisation campaigns.

SOUTH AMERICA

Argentina

Argentina is the country with the second-highest number of swine flu fatalities, after the US, with 165 deaths and more than 3,000 cases. It was criticised for failing to respond quickly enough when the flu outbreak began - leading some to accuse it of being reluctant to impose tough measures in the run-up to mid-term elections.

Schools, universities, cinemas, theatres and gymnasiums have been closed, and pregnant women and children urged to stay indoors. Pregnant women have been told they can take two weeks off work to avoid contracting the virus.

The Catholic Church has urged worshippers to sit far apart, to avoid handshakes and to take the communion wafer in their hands rather than directly on the tongue.

Doctors urged people not to greet each other with a kiss and not to share mate, a herbal drink traditionally consumed from a straw and passed between friends.

New animal health measures have been announced after farm workers passed the virus on to pigs.

Chile

Chile has seen more than 10,000 cases, but with 40 deaths some are comparing its response to that of Argentina, whose outbreak began at roughly the same time, but which has suffered more than three times the number of deaths.

Before it had any confirmed cases Chilean authorities had set up sanitary barriers at airports and pre-emptively administered tens of thousands of antiviral treatments.

In Chile's heavily privatised health system, private hospitals were offered government resources in exchange for prioritising swine flu cases. The rate of infection is now thought to be declining.

Chile is among the countries calling for assurances that a future vaccine will not be reserved for rich nations in North America and Europe.

ASIA-PACIFIC

Australia

The outbreak is said to be putting the health system under strain in Australia, which has seen more than 14,000 cases of swine flu, and close to 40 deaths. Pregnant women and indigenous people are said to be particularly vulnerable.

In some hospitals elective surgery has been cancelled to reserve beds for swine flu sufferers and new cardiac bypass machines have been brought in to cope with the surge of patients in intensive care. A mass vaccination scheme is planned as soon as a vaccine is available.

There has been debate around whether the government should roll out a flu vaccine before waiting for the completion of clinical trials - possibly before October - in a bid to contain the virus. But this would be a controversial move, and one not advocated by the WHO.

China

China has recorded just a few thousand cases of the virus, and no deaths - low numbers in a population of more than 1.3 billion.

It is employing strict controls to contain swine flu - trying to prevent infected people from getting into China, and quarantining those already there.

It says these tough policies are needed because of its high population and low hygiene standards in the countryside.

It has quarantined hundreds of foreign students and held New Orleans Mayor Ray Nagin when he visited in June.

At its ports and airports, incoming passengers fill out forms asking if they have any flu-like symptoms. They also have their temperatures checked. Any with flu-like symptoms are taken to hospital for tests. People who have had contact with infected people are also put into quarantine or under observation.

One foreign student put in isolation after being found to have swine flu told the BBC his food was placed in a compartment between double doors.

Medical staff wearing protective clothing left the food in the compartment and then closed the outside door before he was allowed to open it on his side and collect the meal.

Thailand

Thermal scanners are being used to detect people with high temperatures at airports in one of the region's worst-hit countries, with around 4,000 cases and at least 24 deaths.

A vaccine plant has hurriedly been opened south of Bangkok to increase the country's domestic production capability once a vaccine is found.

EUROPE

France

France, which has a few hundred cases of infection and no deaths, says it has ordered 94m swine flu vaccine doses.

According to the French health minister, France is putting in place simple containment measures such as those recommended for seasonal flu.

It has also bought a billion "anti-projection" masks (for those already infected) and 723m protective masks (for preventative use).

Germany

Germany, which has under 1,000 recorded cases of swine flu, has ordered 50m doses of the flu vaccine.

It is braced for case numbers to surge as its well-travelled citizens return from their summer holidays around Europe and beyond.

It is planning to implement a mass vaccination programme as part of an anti-swine flu drive in September - which will prioritise health and public workers, as well as pregnant women and the chronically ill.

Russia

Russia has recorded just nine confirmed cases. The government has warned of a "sharp" increase in the number of suspected cases, though it says all are among people who have travelled abroad, with no evidence so far of its transmission inside the country.

Public Health Chief Gennady Onishchenko announced that the virus was now spreading to all parts of Europe's largest country - "now not just Moscow's property but also that of the regions".

He warned that infections could spike in the autumn as people return from holidays and said "I advise maximum vaccination" once a vaccine is available.

Spain

The first European country to confirm a case of the virus, Spain now has more than 1,300 cases and has recorded four deaths.

It is planning to vaccinate 40% of the population - the 30% considered to be at special risk plus another 10%.

UK

Britain is Europe's worst-hit territory with more than 10,000 recorded cases - 65% of the total number of cases reported in Continental Europe.

But the actual number is probably much higher: Britain's health agency estimated there were 55,000 new cases in the second week of July.

England is about to set up a National Pandemic Flu Service, which will provide phone and internet diagnoses.

Hygiene guidance to every household, and antiviral drugs are being offered to those who have contracted swine flu.

Britain wants to start a mass vaccination campaign in August, but has few domestic production facilities of its own so is depending on sourcing large enough quantities of the vaccine from overseas.

The UK was criticised by the WHO for suggesting it could begin vaccinating high-risk patients before clinical trials were complete.

MIDDLE EAST

Egypt

Egypt, which has about 120 cases, with one related death, controversially culled several hundred thousand pigs in May, in spite of advice from global health authorities that this was unnecessary.

Its first death was recently reported when a 25-year-old woman who had returned from a tour of Muslim holy places in Saudi Arabia died in hospital.

Egypt's top cleric or mufti, Sheikh Ali Gomaa, said he would not issue a decree barring Egyptians from making the pilgrimage, but health officials said all returning pilgrims would be quarantined.

Israel

Israel has only recorded about 1,000 cases, but has warned that the virus could hit a quarter of its population within months.

In some cases it has sent sufferers home instead of isolating them in hospital.

And outbreaks of the flu among its defence forces have in some cases prompted authorities to order mandatory leave.

SOUTH ASIA

India

Only 265 confirmed cases in the entire country of more than a billion people, but there is still screening and medical checks at all international airports and rail stations. Schools with infected pupils have been shut - and confirmed cases are being treated in hospital with Tamiflu, regardless of how mild their symptoms may be.



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