# 2009 swine flu pandemic in Asia

The 2009 flu pandemic in Asia, part of an epidemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu, afflicted at least 394,133 people in Asia with 2,137 confirmed deaths: there were 1,035 deaths confirmed in India, 737 deaths in China, 415 deaths in Turkey, 192 deaths in Thailand, and 170 deaths in South Korea. Among the Asian countries, South Korea had the most confirmed cases, followed by China, Hong Kong, and Thailand.
* Cases of the A(H1N1) virus in Asia: Deaths Confirmed cases Suspected cases No reported cases
* Number of confirmed deaths of A(H1N1) virus in Asia: No deaths 1+ deaths 5+ deaths 10+ deaths 50+ deaths 100+ deaths 500+ deaths 1000+ deaths 5000+ deaths
* Number of confirmed cases of A(H1N1) virus in Asia: 50 000+ cases 5 000+ cases 500+ cases 50+ cases 5+ cases 1+ cases
* Community Outbreaks in Asia: Community Outbreaks

## Azerbaijan

On 27 April 2009 Azerbaijan imposed a ban on import of animal husbandry products from the Americas. AZAL took additional safety measures and a sanitary quarantine unit of the Health Ministry started to operate in Heydar Aliyev International Airport with all aircraft and passengers being checked.
On 31 July, the first case of influenza A (H1N1) was confirmed.

## Bahrain

In July, the Ministry of Health launched an awareness campaign ahead of the start of the academic year, with many fearing the reopening of schools would lead to a much greater outbreak of the flu. By early August, 18 confirmed cases of the flu were reported. Haj travel agencies reported that thousands of Bahraini pilgrims cancelled their trips to Mecca over fears of contracting swine flu. Over 180 confirmed cases of the flu were reported in late August, all of whom had returned from traveling abroad.
On 31 August, a 30-year-old Filipino housemaid died after contracting the H1N1 virus, becoming Bahrain's first confirmed death as a result of the virus. On 3 September, it was reported that a 24-year-old Bahraini man died after succumbing to the H1N1 virus, being the first Bahraini to die of the disease. On 8 September, it was announced that patients with flu-like symptoms would be treated with Tamiflu nationwide, regardless of having a fever or not. It was also announced that a million doses of the swine flu vaccine were ordered. The Bahraini Ministry of Education had decided to postpone the opening of schools until October as a precaution, a decision that drew criticism from the World Health Organization. In November 2009, the government stated that up to 1,346 cases of the H1N1 virus were confirmed in the country, along with 15,000 suspected cases of the virus.

## Bangladesh

As of 22 August 98 cases of the A (H1N1) virus were confirmed in Bangladesh.

## Burma (Myanmar)

On 1 May 2009 Chairman of Global Human Flu Prevention and Response Work Committee Deputy Minister for Health Dr Mya Oo inspected preventive measures against the human flu at Yangon International Airport, Burma (also known as Myanmar). On 27 June, Burmese state-run Radio Myanmar confirmed the first case of influenza A/H1N1 – a 13-year-old girl who just returned from a trip to Singapore.

## China

The first suspected case found on mainland China was reported on 11 May 2009. As of 29 July 2009, the number of confirmed A/H1N1 cases on the Chinese mainland topped 2,000, with no deaths or serious cases reported, according to the Ministry of Health (MOH). Of the total 2,003 confirmed cases, 1,853 had recovered, said a statement on the MOH website.
The General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) of China issued an emergency notice on the evening of 26 April that visitors returning from flu-affected areas who experienced flu-like symptoms within two weeks would be quarantined.
In early September 2009, China's State Food and Drug Administration granted approval to a homegrown swine flu vaccine, which producer Sinovac Biotech claimed to be effective after only one dose.
On 4 January 2010, the Chinese Health Ministry announced that 659 deaths from swine flu have been recorded in 2009, with 120,940 confirmed detected cases throughout the year.

## Cyprus

Cyprus identified its first case of H1N1 on 30 May in a 39-year-old woman from Moldova, living in Cyprus, who returned from the United States on 28 May. As of 11 July 250 cases were confirmed in Cyprus.

## Hong Kong

The Food and Health Bureau of Hong Kong issued travel advice for Mexico on 26 April 2009, which advised Hong Kong residents not to travel to Mexico unless absolutely necessary. The first case reported was a Mexican who flew in from Shanghai. The Bureau also escalated the alert level from "alert" to "serious" on the same day, which activated health protection measures in all ports of entry of Hong Kong. As such, temperature screening machines were used at all checkpoints to identify passengers with fever and respiratory symptoms. Any passenger who failed the temperature test and was confirmed as having a fever was quarantined and sent to public hospital for further investigation. Hong Kong also became one of the first jurisdictions to declare swine flu as a notifiable disease, and much of the procedures against the spread of the swine flu were learned from the 2003 SARS outbreak, of which Hong Kong was the epicenter of the outbreak.
The Secretary for Food and Health York Chow stated that special attention will be paid to passengers who came from countries where human infection of swine influenza cases were reported.
On 1 May, one case became the first confirmed case of swine flu in Hong Kong and also the first in Asia after being tested positive by the University of Hong Kong and the Department of Health of Hong Kong. The Mexican patient, who travelled with two companions from Mexico to Hong Kong with a stopover in Shanghai Pudong Airport, arrived in Hong Kong on 30 April. Metropark Hotel Wanchai, where the patient stayed, was cordoned off by the police and health officials from the Centre for Health Protection. All 350 guests and hotel staff had to remain inside the hotel for seven days. After the first swine flu case was confirmed by laboratory, Chief Executive Sir Donald Tsang raised Hong Kong's response level from "serious" to "emergency".
As of 27 August 2009, there have been 10,468 confirmed cases of swine flu in the city.

## India

The Government of India decided to screen all people entering India via the main airport hubs of Mumbai, New Delhi, Goa, Jaipur, Kochi, Kolkata, Chennai, Bangalore and Hyderabad, with the primary focus being passengers entering from the United States of America, United Kingdom, Canada, Mexico, France, and New Zealand. All in all, 50,000 people were affected by the virus, with 2,700 confirmed deaths.

## Indonesia

After a coordination meeting about the flu on 27 April 2009, the Indonesian government halted the importation of pigs and initiated the examination of 9 million pigs in Indonesia. Thermal scanners, which can detect human body temperature, were installed at Indonesian ports of entry. Temperatures above 38 degrees Celsius (100.4 Fahrenheit) cause the devices to beep, indicating fever.
As of 18 August 2009, one death was reported.

## Israel and the West Bank

Over 4000 cases were confirmed in Israel, and over 60 people died. In response to the outbreak, the Israeli Deputy Minister of Health, Yaakov Litzman, said that because swine are unclean, the outbreak needed to be renamed; and so in Israel, out of respect for the religious sensibilities of Muslims, it was called "Mexican Flu". This was done so as to not confuse the population into thinking that they could not acquire the virus if they did not eat pork. The Israeli government retracted this proposal following Mexican complaints.

## Japan

The Ministry of Agriculture, Forestry and Fisheries of Japan instructed animal quarantine offices across Japan to examine any live pigs being brought into Japan to make sure they were not infected with the influenza. Japanese Agriculture Minister Shigeru Ishiba appeared on television to reassure customers that it was safe to eat pork. The Japanese farm ministry said that it would not ask for restrictions on pork imports because the virus was unlikely to turn up in pork, and would be killed by cooking.
On 8 May, the first three cases were confirmed. The infected patients had spent time in Oakville, Canada and returned to Japan via Detroit. On 10 May, another case was confirmed from a student who came from a school trip to Canada, making it the fourth case in Japan.
There have been 944 case confirmed in Japan as of 24 June 2009.
On 2 July, the first case of oseltamivir-resistant virus in Asia was announced in Japan, in a woman who had been taking Tamiflu prophylactically.

## Kazakhstan

The first cases of A (H1N1) virus were discovered in 3 students from the capital Astana according to Natalia Buenko, an advisor to the Ministry of Health of Kazakhstan.

## Laos

The Lao government agreed to buy 10 thermal imaging machines and install them at the country's major immigration border checkpoints. The machines would help officials identify anyone entering the country with a high temperature and create confidence among Laotians, foreigners living in Laos and people traveling to Laos. Health officials would be on hand at international border checkpoints to ensure anyone found to be infected could be treated immediately. Each machine could cost about US$25,000. The decision to buy them was made after the government found visitors to Laos included people coming from the United States, Spain and other affected countries.
The Prime Minister Bouasone Bouphavanh said masks should be made available and health officials would be assigned to work at border checkpoints. Health officials would be on hand at international border checkpoints to ensure anyone found to be infected could be treated immediately. On 18 June, the first case in Laos was confirmed.

## Lebanon

A Lebanese man suffering from a serious illness died from the H1N1 swine flu strain on Thursday 30 July 2009, which makes the first death in Lebanon, Health Minister Mohammad Khalifeh told Reuters. The 30-year-old victim had been receiving treatment for leukemia when he contracted the virus, possibly from relatives who had just traveled from Australia to Lebanon, the minister said. Lebanon has recorded more than 100 cases of H1N1.

## Malaysia

Malaysia detected the first case of influenza A(H1N1) on 15 May 2009 in a 21-year-old student who returned from the United States. As of 11 August 2009 there were 2,253 confirmed cases in Malaysia. The Health Ministry announced that from 12 August 2009 they had discontinued the counting of the total number of H1N1 cases in line with guidelines issued by the World Health Organization.

## Maldives

The first death from H1N1 flu virus was confirmed on 19 November.

## Mongolia

The Mongolian Health Ministry sought to prevent the spread of swine flu in Mongolia by urging people to avoid public places.
As of 22 October 126 cases were confirmed in Mongolia. Just after seven days, the number increased to 394 with five deaths.

## North Korea

Most defectors with backgrounds in health care agree that, considering the isolation of North Korean society and its highly inadequate health care system, incidents of swine flu are likely to be either suppressed or merely misdiagnosed.
Following the confirmation of the first case of the disease in Mongolia, heightened concerns arose.
On 16 November, the first known case was confirmed by the Ministry of Unification, released in a report by Korea Times. The first case was confirmed in a South Korean worker in Gaeseong Industrial Complex.

## Oman

As of 13 August 2009, 337 cases have been confirmed by the National Pandemic Influenza Committee in Oman.

## Pakistan

There were 90 confirmed cases as of 26 January 2010.

## Philippines

Health Secretary Francisco T. Duque III ordered the Bureau of Quarantine to use thermal imaging equipment at airports to screen passengers coming from the US for flu symptoms. The Philippines may quarantine travelers arriving from Mexico with fevers. Also, the Secretary of the Department of Agriculture issued an order banning the importation of hogs from the U.S. and Mexico, and the retraction of the restriction of swine influenza vaccine use. The medical alert phase is already Code White, the lowest.
On 18 May 2009, a Filipina girl who arrived from Houston, Texas, United States was the first confirmed case of H1N1 virus in the Philippines.
The highest confirmed in one day was on 24 June 2009 with 131 cases. The next day, the confirmed cases added was 123. Because of that, the Department of Health ordered the people that should get swab tests are the only people with very complicated cases (e.g. with lung disorders, hearth disorders, babies etc.). The government said that the very fast spreading of the disease was caused by the population density of the country.

## Saudi Arabia

By 17 August, there have been about 2,000 cases of the flu, resulting in 14 deaths.

## Singapore

On 30 April 2009, the Singapore Ministry of Health raised its Disease Outbreak Response System to "Alert Orange". The first case of the H1N1 virus in Singapore was confirmed on 27 May 2009, in which a then 22-year-old woman picked up the virus after visiting New York City, United States. As of 7 July 2009, there were 1,217 confirmed cases. As of 17 October 2009, there were 18 confirmed deaths from the H1N1 virus in Singapore. On 12 February 2010, the Singapore Ministry of Health moved its alert level to Green.

## Sri Lanka

The first case of Influenza A (H1N1-2009) was confirmed on 16 June 2009 in Sri Lanka.

## South Korea

On 28 April, South Korea reported its first probable case of swine flu after positive preliminary tests on a nun who had recently returned from a trip to Mexico. South Korea became the third infected nation in Asia, after Israel and Hong Kong. On 15 August, the first Korean death by the new influenza was confirmed and a second death was announced on 16 August. Around late November 2009, there was a double cases from the US. Around 15000 cases and 14 deaths have been reported as of 12 October 2009.

## Taiwan (Republic of China)

On 20 May 2009, the first case of the influenza was confirmed in Taiwan.
There were 5,474 confirmed cases of H1N1 in Taiwan.

## Turkey

The first case of A(H1N1) in Turkey was reported on 16 May 2009. A U.S. citizen, flying from the United States via Amsterdam was found to be suffering from the swine flu after arriving Istanbul's Atatürk International Airport. Turkey is the 36th country in the world to report an incident of swine flu. The Turkish Government has taken measures at the international airports, using thermal imaging cameras to check passengers coming from international destinations. As of 11 August, there were 312 confirmed cases in Turkey. As of 24 October, there is 1 confirmed death in Turkey. It is reported by Ministry of Health that one person died in Ankara. In addition, there are 958 confirmed cases in Turkey.

## Vietnam

On 31 May 2009, The government of Vietnam announced its first case of A (H1N1) virus in the country.

## Yemen

As of 4 July 2009 there have been reported 7 cases of A(H1N1) flu in Yemen.

## Timeline

| 2009 | A(H1N1) Outbreak and Pandemic Milestones in Asia |
| 28 April | First case confirmed in Israel. |
| 1 May | First case confirmed in Hong Kong. |
| 2 May | First case confirmed in South Korea. |
| 8 May | First case confirmed in Japan. |
| 10 May | First case confirmed in China. |
| 12 May | First case confirmed in Thailand. |
| 15 May | First case confirmed in Malaysia. |
| 16 May | First case confirmed in India. |
| 16 May | First case confirmed in Turkey. |
| 17 May | Community outbreaks confirmed in Japan. |
| 19 May | First case confirmed in Taiwan. |
| 21 May | First case confirmed in the Philippines. |
| 22 May | First case confirmed in Russia. |
| 24 May | First case confirmed in Kuwait. |
| 24 May | First case confirmed in the United Arab Emirates. |
| 25 May | First case confirmed in Bahrain. |
| 27 May | First case confirmed in Singapore. |
| 30 May | First case confirmed in Cyprus. |
| 30 May | First case confirmed in Lebanon. |
| 31 May | First case confirmed in Vietnam. |
| 3 June | First case confirmed in Saudi Arabia. |
| 11 June | First case confirmed in the Palestinian Territories. |
| 11 June | Community outbreaks confirmed in Hong Kong. |
| 14 June | Community outbreaks confirmed in Philippines. |
| 16 June | First confirmed case in Jordan. |
| 16 June | First confirmed case in Qatar. |
| 16 June | First confirmed case in Sri Lanka. |
| 16 June | Community outbreaks confirmed in Thailand. |
| 16 June | First confirmed case in Yemen. |
| 17 June | First case confirmed in Oman. |
| 17 June | Community outbreaks confirmed in Malaysia. |
| 18 June | First case confirmed in Macau, China. |
| 18 June | First case confirmed in Laos. |
| 19 June | First case confirmed in Bangladesh. |
| 22 June | First death confirmed in the Philippines. |
| 22 June | First case confirmed in Iran. |
| 23 June | Community outbreaks confirmed in Macao. |
| 24 June | First case confirmed in Indonesia. |
| 24 June | First case confirmed in Cambodia. |
| 24 June | First case confirmed in Iraq. |
| 26 June | Community outbreaks confirmed in China. |
| 27 June | First death confirmed in Thailand. |
| 27 June | First case confirmed in Myanmar. |
| 29 June | First case confirmed in Nepal. |
| 29 June | Community outbreaks confirmed in Singapore. |
| 1 July | Community outbreaks confirmed in South Korea. |
| 2 July | First death confirmed in Brunei. |
| 2 July | First case of Oseltamivir (Tamiflu) resistance found in Japan. |
| 3 July | First case of Oseltamivir (Tamiflu) resistance found in Hong Kong. |
| 4 July | First case confirmed in Syria. |
| 8 July | First case confirmed in Afghanistan. |
| 10 July | First death confirmed in Hong Kong. |
| 13 July | Community outbreaks confirmed in Saudi Arabia. |
| 16 July | First death confirmed in Singapore. |
| 19 July | First case confirmed in Georgia. |
| 19 July | Community outbreaks confirmed in Israel. |
| 21 July | Community outbreaks confirmed in Indonesia. |
| 22 July | Community outbreaks confirmed in India. |
| 22 July | Community outbreaks confirmed in Vietnam. |
| 22 July | First death confirmed in Laos. |
| 23 July | First death confirmed in Malaysia. |
| 23 July | First case confirmed in Bhutan. |
| 23 July | First case confirmed in Kazakhstan. |
| 24 July | First case confirmed in Maldives. |
| 25 July | Community outbreaks confirmed in Brunei. |
| 25 July | Community outbreaks confirmed in Taiwan. |
| 26 July | Community outbreaks confirmed in Cyprus. |
| 26 July | Community outbreaks confirmed in Turkey. |
| 26 July | First death confirmed in Indonesia. |
| 27 July | First death confirmed in Israel. |
| 27 July | First death confirmed in Saudi Arabia. |
| 27 July | Community outbreaks confirmed in United Arab Emirates. |
| 30 July | First case confirmed in Azerbaijan. |
| 30 July | First death confirmed in Taiwan. |
| 30 July | First death confirmed in Lebanon. |
| 31 July | First death confirmed in Qatar. |
| 2 August | First death confirmed in India. |
| 3 August | First case confirmed in Pakistan. |
| 4 August | First death confirmed in Vietnam. |
| 5 August | First death confirmed in Iran. |
| 7 August | First death confirmed in Palestine. |
| 8 August | First case of Oseltamivir (Tamiflu) resistance found in Thailand. |
| 9 August | First death confirmed in Iraq. |
| 12 August | First case confirmed in East Timor. |
| 14 August | First case of Oseltamivir (Tamiflu) resistance found in Singapore. |
| 14 August | First case of Oseltamivir (Tamiflu) resistance found in China. |
| 15 August | First death confirmed in South Korea. |
| 15 August | First death confirmed in Japan. |
| 18 August | First death confirmed in Yemen. |
| 20 August | First death confirmed in Kuwait. |
| 20 August | First death confirmed in United Arab Emirates. |
| 21 August | First death confirmed in Oman. |
| 24 August | First case confirmed in Kyrgyzstan. |
| 26 August | First death confirmed in Syria. |
| 29 August | First death confirmed in Bangladesh. |
| 31 August | First death confirmed in Bahrain. |
| 2 September | First death confirmed in Macau. |
| 10 September | First case of Oseltamivir (Tamiflu) resistance found in Israel. |
| 21 September | Mass vaccinations in China, which is the first one in the world, begins. |
| 28 September | First death confirmed in Cambodia. |
| 30 September | First completed clinical trials by a company for 2009/H1N1 vaccine in the world. |
| 4 October | First case confirmed in Tajikistan. |
| 6 October | First death confirmed in China. |
| 12 October | First case of Oseltamivir (Tamiflu) resistance found in Vietnam. |
| 12 October | First death confirmed in Jordan. |
| 13 October | First case confirmed in Mongolia. |
| 19 October | Mass vaccinations in Japan begins. |
| 23 October | First death confirmed in Mongolia. |
| 24 October | First death confirmed in Turkey. |
| 26 October | Mass vaccinations in Oman begins |
| 27 October | First death confirmed in Russia. |
| 27 October | Mass vaccinations in South Korea begins. |
| 29 October | First death confirmed in Afghanistan. |
| 1 November | Mass vaccinations in Kuwait begins |
| 3 November | Mass vaccinations in Singapore begins. |
| 3 November | Mass vaccinations in Qatar begins |
| 7 November | First death confirmed in Pakistan. |
| 7 November | First death confirmed in Sri Lanka. |
| 7 November | Mass vaccinations in Saudi Arabia begins |
| 7 November | Mass Vaccinations in Bahrain begins |
| 8 November | First case confirmed in Armenia. |
| 13 November | First death confirmed in Cyprus. |
| 16 November | First case confirmed in North Korea. |
| 18 November | First death confirmed in Maldives. |
| 20 November | Mass vaccinations in Jordan begins |
| 7 December | First death confirmed in North Korea. |
| 13 December | First death confirmed in Armenia. |
| 14 December | First death confirmed in Georgia. |
| 27 December | First death confirmed in Nepal. |

## Top 5 countries

| Top 5 cases | Top 5 deaths |
| China | India |
| Hong Kong | Thailand |
| Thailand | Turkey |
| India | South Korea |
| South Korea | China |