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Pandemic H1N1 influenza is now worldwide, with more than 199 countries and territories reporting laboratory-confirmed cases, according to the World Health Organization. The official toll is now more than 6,000 deaths, but WHO authorities think that is an underestimate, since laboratory testing has been reduced and most countries have stopped counting individual cases. Influenza-like illnesses accounted for 8% of visits to physicians’ offices in North America during the most recent week for which data were reported to the WHO — although more current figures from the Centers for Disease Control and Prevention said it had declined slightly to 7.7% — and 40% of respiratory samples tested were positive for influenza. Virtually 100% of those influenza samples were swine flu.

Activity has been increasing in Europe and Central and Western Asia, signaling an unusually early start to the winter flu season. Early reports from China had indicated that the H3N2 strain of seasonal flu was circulating along with swine flu, but more recent reports indicate that swine flu now predominates. That does not mean, however, that the seasonal flu will not come back after this wave of pandemic influenza passes.

– What appears to be an outbreak of swine flu is sweeping an isolated whaling village on a remote Alaska island. The Alaska Army National Guard has been called in to transport an emergency medical team from Nome, 135 miles away, because so many of the 130 residents of Diomede have been stricken. Most of the residents of the town are Ingalikmiut Inuit, who depend on subsistence fishing to survive. Anecdotal reports have previously suggested that indigenous peoples may be more susceptible to influenza, but there has so far been no firm evidence of such an association.

– Ukraine has been suffering an outbreak of swine flu, and officials now say that a January presidential election may have to be postponed until May if it is not brought under control.  The WHO and European health authorities have sent in emergency teams to help with the situation, but the outbreak has become a political football, with recriminations being traded by the two main presidential candidates. Some authorities have estimated that as many as 750,000 Ukrainians have been infected with the virus, but only 30 cases have been laboratory-confirmed so far. At least 86 people have died of what appears to be swine flu.

– Officials from the European Center for Disease Control and Prevention are predicting that, in a worst case,  as many as 40,000 Europeans could be killed by the swine-flu virus and a similar number by a succeeding wave of seasonal flu. The ECDC said 389 deaths had so far been linked to the virus in Europe, including 154 in Britain, 73 in Spain, 25 in Italy and 22 in France.

– The U.S. military said it had begun receiving swine-flu vaccine and will begin immunizations soon. Vaccination is mandatory for all military personnel and highly recommended for civilian employees and family members of service people. The Department of Defense has so far ordered 3.7 million doses of the vaccine.

– Thomas H. Maugh II