# 3230
One of the mysteries surrounding the H1N1 `swine flu’ outbreak is why 90% of all known cases are documented in North America, and so few have been detected in Europe.
As unpolitic as it may sound, many people (including this blog) have suggested that some European nations are simply turning a blind eye to suspect cases, failing to test them, so as not to force the WHO into moving to a Phase 6 Pandemic declaration.
Today, The New Scientist Magazine has a story that details the strict case definitions that the ECDC recommends must be met before an H1N1 test can be ordered by a physician.
Adhering to these rules make it almost impossible to document `community spread’ of the virus – which is the criteria the WHO is looking for before raising the pandemic alert.
This from The New Scientist.
Europe may be blind to swine flu cases
EUROPE might have more H1N1 swine flu than it knows. The virus could be circulating widely but not being spotted simply because people are not being tested.
As New Scientist went to press, the World Health Organization was still undecided about declaring a full-blown pandemic, despite a surge in swine flu cases in Japan. To do this it needs evidence of "sustained transmission" outside the Americas, where the virus originated. This means finding cases in the general population that have not had known contact with places or people confirmed to have the virus. Japan found H1N1 this week in over 100 people, many without known contact.
But European countries are using a case definition from the European Centre for Disease Prevention and Control (ECDC) in Stockholm, Sweden, that virtually precludes discovering such cases. It recommends testing people with symptoms only if they have been to affected countries or had contact with a known or suspected case in the past seven days.
"We can't test every mild case of flu symptoms," says Johan Giesecke, chief scientist at ECDC. "But it's true, we might not be seeing community spread because we aren't looking." On 18 May, the UK had 101 confirmed cases of H1N1, of which only three fell outside the case definition.
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