Norway, the Republic of Moldova, the Russian Federation (Urals region) and Sweden also reported very high activity. Bulgaria, Denmark, Finland, Germany, Iceland, Ireland, Lithuania, Luxembourg, Poland, Portugal, the Russian Federation, Serbia, Turkey and Ukraine reported high pandemic activity during this period.

Although still high in some instances, influenza activity has passed its peak in Belgium, Iceland, Ireland and parts of the United Kingdom (England and Northern Ireland).

In addition, 181 deaths in 21 countries were associated with laboratory-confirmed pandemic (H1N1) 2009 virus infection. This raises the total number of deaths reported in the WHO European Region since April 2009 from 471 to 652.

Public health significance of virus mutation detected in Norway

The Norwegian Institute of Public Health has informed WHO of a mutation detected in three H1N1 viruses. The viruses were isolated from the first two fatal cases of pandemic influenza in the country and one patient with severe illness. The virus with this mutation remains sensitive to the antiviral drugs, oseltamivir and zanamivir, and studies show that currently available pandemic vaccines confer protection against these viruses.

Safety of pandemic vaccines

As of 20 November 2009, 17 countries in the European Region had started vaccination campaigns against pandemic (H1N1) 2009 influenza, with a focus on people in defined risk groups including pregnant women. Reports of adverse events are fewer than for seasonal influenza vaccination, and most events are mild local or systemic reactions.