SWINE FLU - UPDATES & USEFUL INFORMATION

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MEXICO PIGS



Even if the virus were traced to a pig in Mexico, it might have been imported from the United States. Mexico is the world's biggest importer of U.S. hogs.

All the deaths have been in Mexico, which could indicate that the illness emerged there, Nichols said.

Mexican authorities began to look closely at the outbreak after the death of the woman in Oaxaca, which they initially thought was due to a coronavirus, the same family of viruses that includes the SARS virus, rather than influenza.

Among the cases later discovered was a large influenza outbreak near Perote, a small town in Veracruz state, which was reported on April 2.

The presence nearby of a giant pig farm operated by a joint venture of a large U.S. pork processor has prompted speculation that the town is the epicenter of the epidemic.

But the Mexican government has dismissed the Perote outbreak as the source of the illness, arguing that all but one of the 20 or so victims tested positive for another type of human flu virus known as H3N2. A 4-year-old boy later tested positive for the H1N1 swine flu.

Mexican agriculture officials say they inspected pig farms around the town over the weekend and found no pigs infected with respiratory ailments. No infected pigs have been found anywhere in Mexico, the government said in a statement on Tuesday.



(Reporting by Robert Campbell; Editing by Maggie Fox and Eric Beech)

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                               Outbreak Like Mexican Swine Flu Predicted 14 Months Ago
           





Robin Lloyd
LiveScience Senior Editor
– Mon Apr 27, 2009


A team of scientists predicted more than a year ago that Mexico and other tropical locales were emerging "hotspots" for so-called zoonotic diseases that jump from animals to humans, getting it right on the newly reported swine flu.

This week, the scientists are analyzing the patterns of the new swine flu virus's spread and trying to predict its next moves. The researchers "should have preliminary findings by the weekend," team leader Peter Daszak of the Wildlife Trust told LiveScience.

Daszak and his colleagues cautioned in February 2008 that infectious disease-fighting resources are not effectively deployed around the globe and that the U.S. government has not always accurately investigated how flu strains will arrive here.



Hot spots

The tropics prediction came from an analysis of 335 "disease events" involving emerging infectious diseases between 1940 and 2004 - examples include Ebola, HIV, yellow fever and SARS. The analysis showed that such events peaked in the 1980s and that the threat of these diseases to global health is increasing.

The events, mostly caused by zoonotic diseases, were found to be correlated with socio-economic, environmental and ecological factors.

That allowed the scientists to make a predictive map of where emerging diseases are most likely to emerge - pointing to Latin America, tropical Africa and Asia. The map also pointed up that global resources to fight disease emergence are misguided - focusing on richer, developed countries of Europe, North America, parts of Asia and Australia, rather than in developing countries. The report was published in the Feb. 21, 2008, issue of the journal Nature.

The disease event prediction map is like an earthquake risk map, Daszak said. "If we live in one of these 'hotspots,' we need to protect ourselves, and our trading and traveling partners from the risk of new diseases," he said.

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What You Can Do



For right now and for the next few days, the only people who need to worry about infection are those who have been in Mexico or those who have been around people who have visited that country, said Dr. Mark Metersky, a spokesman for the American College of Chest Physicians.

Experts say precautions against catching swine flu are similar to those recommended for the regular flu, including the following:

Stay away from sick people if possible.
Stay home if you experience flu-like symptoms.
Wash your hands often.
Don't participate in events in crowded places.
 


More information:

There's more on swine flu at the U.S. Centers for Disease Control and Prevention.

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                                   Swine flu spreads to Germany amid Mexican lockdown
           





Marc Burleigh
April 29, 2009
MEXICO CITY
(AFP)

– The global swine flu outbreak spread further on Wednesday as Germany became the latest country to confirm cases on its soil while Mexico desperately tried to keep the lid on the virus.

With fears rising of easy transmission between people, authorities in Mexico City shut down bars, cafes, gyms, cinemas and tourist sites, including the world-famous Aztec and Mayan pyramids.

But as the Mexican government revised down its confirmed number of swine flu dead to seven from 20 after more rigorous testing was introduced, officials said more than 100 people were still suspected to have died from the virus and more than 1,600 were thought to be infected in the outbreak's epicentre.

And only hours after Costa Rica joined the list of affected countries, Germany became the eighth when it confirmed that it was dealing with three definite cases.

Officials at Berlin's Robert Koch Institute, responsible for disease control and prevention, said a 22-year-old woman was in hospital in Hamburg and that a 37-year-old woman and a man in his 30s were in separate hospitals in Bavaria.

While Mexico remained the only country to have recorded deaths from the virus, other nations announced their infection tallies had increased.

Authorities in Israel, New Zealand and Spain increased their confirmed cases of infection with the virus, believed to be a previously unseen amalgam of different flu viruses.

"We are dealing with a new strain of influenza," said Richard Besser, acting head of the US Centers for Disease Control (CDC).

The World Health Organization (WHO) has raised its warning level to Phase 4 on a 1-6 scale, which indicates the illness is being passed from person to person, although officials said much about the outbreak was still unknown.

"We don't have information on how it acts, how it transmits," said Gregory Hartl of the WHO, which was to convene experts from affected countries later Wednesday to review what is known about the illness.

Experts say the current virus -- a version of swine flu identified as A/H1N1 -- cannot be caught from eating meat from pigs, and instead are recommending simple hygiene procedures like washing hands.

Some have suggested that those who died in Mexico were treated too late or with insufficient drugs, or that perhaps the strain mutated into something less virulent when it left the country.

In addition to the health concern, there have also been worries that the outbreak will badly hurt the airline and travel industries, which have already been suffering because of the global economic slowdown.

Major European tour agencies and US cruise lines announced they were suspending trips to Mexico, while Argentina said it was barring flights from the country until next week.

Among those confirmed to have contracted the virus are a couple from Scotland who recently returned from honeymoon in Mexico's Cancun resort and a second set of Cancun honeymooners were quarantined in their own Edinburgh home on Wednesday as they awaited the results of swine flu tests.

WHO assistant director general Keiji Fukuda said it was "critical" to identify travellers from Mexico who might be infected with swine flu.

"It helps us to monitor the spread of the virus worldwide and how it is moving," Fukuda said.

US President Barack Obama is seeking 1.5 billion dollars from Congress to boost US efforts to contain the flu's spread, the White House said.

California declared a state of emergency and said they had detected a death in Los Angeles that might have resulted from the virus.

South Korean officials said the country had nine suspected cases of swine flu infection, but that four of those had turned out negative.

China meanwhile angrily rejected foreign media reports pointing to the country as the source of a deadly swine flu outbreak, saying they were baseless and aimed at tarnishing the nation's image.

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                                  Flu Rx? Russia blocks U.S. pork, Costa Rica bars kissing

           





Tyler Bridges,
Mcclatchy Newspapers
– Tue Apr 28, 2009
CARACAS,
Venezuela

— The government of Cuba suspended flights to and from Mexico for 48 hours, Russia banned imported pork from at least 11 U.S. states and medical help lines in Europe were inundated, as the world reacted apprehensively Tuesday to the swine flu outbreak.

Venezuela , Russia and Guatemala warned their citizens against traveling to Mexico and the United States . Peru and Britain limited the warning to Mexico .

In Costa Rica , the health minister suggested that its citizens temporarily stop greeting one another with the traditional kiss on the cheek. Costa Rican officials confirmed their first case Tuesday, a 21-year-old woman who came on a flight from Mexico last week.

Government officials everywhere were screening air travelers from Mexico for signs of the potentially deadly flu. At Caracas and many other airports, they wore masks and rubber gloves.

"Fear spreads around the globe like a Mexican wave," declared the London Times , which gave the flu story a banner headline, as did most big newspapers in Europe .

People everywhere were changing their habits to avoid the virus.

"We're trying not to go to any big gatherings, and we're washing our hands constantly," said Luis Garcia , a 57-year-old auto parts seller who was interviewed in a Caracas park Tuesday. "I think this can be controlled. But it's important to take the precaution of having good hygiene."

In London , hundreds of people contacted one doctor's office seeking Tamiflu, an anti-viral medication. They included "very senior people in various parts of government," Dr. Laurence Gerlis , who operates a private practice, told the British Broadcasting Corp.

There were indications that many governments may be overreacting.

Going beyond pork, Russia prohibited imports of all raw meat from Mexico as well as from California , Texas and Kansas . Health officials said, however, that there's no link between eating any kind of meat and being infected with swine flu.

Despite the rising number of suspect cases in Europe , officials at the European Center for Disease Prevention and Control in Stockholm, Sweden , noted that outside Mexico , all confirmed cases of the flu appeared to be minor and no one had died.

European government officials attempted to express concern without stoking panic. The European Union's health minister had to backtrack after suggesting Monday that Europeans should avoid traveling to the United States and Mexico .

The World Health Organization has said the epidemic isn't serious enough yet to clamp down on traveling from one country to another.

That didn't stop Cuba from becoming the first country to halt air traffic with Mexico .

Venezuelan Vice President Ramon Carrizalez recommended that travelers to the United States and Mexico "postpone or suspend their trips to diminish the risk" of being infected.

Israel took a more measured approach, after an emergency meeting chaired by Prime Minister Benjamin Netanyahu .

The outbreak "is currently a relatively mild — and not fatal — disease" in the Middle East , the prime minister's office said.

Israel hospitalized in isolation two recent returnees from Mexico who were suffering from swine flu.

Israel's deputy health minister irked some Mexican leaders by trying to label the cause of the outbreak the "Mexican flu" instead of the "swine flu." The change would have allowed strict religious Jews from having to utter the word of an animal that's considered dirty and nonkosher.

Nicaragua prohibited imports of live pigs from Mexico .

Nicaragua's health minister, Guillermo Gonzalez , declared a national emergency and announced plans to train 35,000 teachers and student volunteers to detect the virus throughout the country.

A leading specialist in respiratory diseases issued worrisome forecasts for London .

Peter Openshaw , the director of the Center for Respiratory Infection at Imperial College , predicted that there are people walking around London with the virus who don't know it yet. The first suspected case in London was admitted to the hospital Wednesday.

"The next week will be critical as we will begin to see just how severe the infections are outside Mexico ," Openshaw added. "The hope is that this will just be an 'ordinary' flu. But looking at the fatalities in Mexico , it is impossible to say how bad it will be at the moment."

In Brazil , a 40-year-old man was hospitalized with swine flu Tuesday in the northern coastal city of Salvador , the Brazilian government news agency reported. The man had just returned from Miami . He was the 12th person known to be suffering from the malady in Brazil .

Guatemala has yet to confirm the presence of swine flu, but government officials acknowledge a high vulnerability to the virus since Guatemala borders Mexico and has close commercial ties with its neighbor.

Waleska Cecena , the director of the National Center of Epidemiology , told a local radio station that Guatemala faced the "imminent arrival of an epidemic." Authorities say they're prepared to confront it. Meanwhile, a smattering of Guatemala City residents have begun to wear face masks in public.

In Bogota, Colombia , pork consumption has declined even though health authorities say it presents no risk.

"You feel afraid, especially when you go to the airport," said Liliana Gonzalez , a 34-year-old expectant mother. "You can get the illness from anyone."

( Dion Nissenbaum in Jerusalem , Tom Lasseter in Moscow and McClatchy special correspondents Blake Schmidt in Managua, Nicaragua , Julie Sell in London , Jenny Carolina in Bogota, Colombia , and Jill Replogle in Guatemala City , Guatemala , contributed to this article.)


MCCLATCHY

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                                               Swine flu expected to come to Italy



                                             First suspected case reported in Venice






 (ANSA) -
Rome,
April 27, 2009

- A leading Italian expert said on Monday that it was inevitable that swine flu would sooner or later spread to Italy but added that there was no risk of a pandemic.

Genoa University virologist Pietro Crovari explained that ''there will not be a crisis because this is a 'normal' strain of the flu virus and different from the bird flu strain. Of course, the later it arrives the better''.

Crovari made his observations at the same time that Europe's first case of swine flu was confirmed in Spain, where there are 17 other suspected cases.

Italy currently has one suspected case, a 31-year-old woman from the Veneto region, who has been placed in quarantine in a Venice hospital but is said to be in good condition.

The woman had returned from San Diego, in southern California near the Mexican border, with a high fever and was hospitalised as a precaution.

A sample of her blood has been sent for testing at Padua University, which hosts Italy's top center for infectious diseases.

Italy, like many advanced countries, is at an advantage because many people are still protected by the general flu vaccine they took for the winter flu season.

The outbreak of swine flu began in Mexico where 103 people have died so far and there are another 1,614 suspected cases.

The flu quickly spread to the United States, where there are some 20 suspected cases.

European Health Commissioner Androulla Vassiliou has called for an emergency meeting of European Union health ministers to monitor the situation and the Czech Republic, which holds the EU rotating presidency, has scheduled a meeting for Thursday.

Vassiliou said on Monday that the EU was ready to take ''appropriate action'' to avoid teh spread of the flu.

According to Crovari, the virus in Mexico ''appears to have mutated by 60-70% but this is nothing new. This virus is an evolution of the H1N12 virus which was isolated in 1933''.

The fact that the virus has infected for the most part young adults, he observed, could be explained by the fact that the very young and the elderly are those most likely to have been vaccinated for the winter flu season.

''However, it is still too early to confirm this for sure,'' he added.

The Italian health ministry has set up a crisis coordination center and is said to be its examining a vaccination strategy.

On a European level, checks on arriving passengers have been stepped up at airports to identify anyone with flu symptoms, while EU health ministries are pooling information on suspected cases and vaccine stocks.

Europeans have also been advised to avoid travelling to areas where swine flu has been reported.

Elsewhere in Europe, four suspected cases in France and one in Britain have proved negative.

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                                              New flu: Fazio downplays fears



                                           Mexican woman hospitalised in Naples






 (ANSA)
- Rome,
April 29, 2009

- New flu will in all likelihood arrive in Italy but it appears to be less aggressive than normal seasonal flu, Welfare Undersecretary Ferruccio Fazio said on Wednesday.

''We expect to see the first confirmed cases in Italy quite soon but we are not alarmed given the clinical evolution of the flu in other countries,'' Fazio observed.

While there have been no confirmed cases in Italy yet, on Wednesday a resident of Salerno was transferred to a Naples hospital for tests and analyses on suspicion she had contracted the new flu.

The patient, a 63-year-old Mexican female university lecturer, was taken to Cotugno Hospital which hosts the regional center for infectious diseases.

''I'm optimistic because this virus does not appear to be very aggressive. Of course, there is always the risk of a mutation, but from what we have seen in the United States this flu is less aggressive than a normal winter influenza''.

Between 250,000 and 500,000 people die each year from seasonal flu.

A total of 159 people have died from flu in Mexico, where the outbreak originated, but the death rate has slowed considerably and Mexican authorities said Tuesday that only seven deaths can definitively be attributed to the specific variation of the new flu virus, which is apparently a mutated combination of swine, bird and human flu.

Until now there have been no deaths outside of Mexico, but on Wednesday there were reports of a first flu death in the United States, apparently a 23-month child.

Germany on Wednesday became the eighth country to report confirmed cases of the new flu. The others are Mexico, where the outbreak originated, the United States, Canada, New Zealand, Israel, Britain and Spain.

Fazio, who holds the portfolio for health, also said he was in favor of not calling the new flu 'swine flu', as it was originally named.

''I'm in favor of a name change because this new virus passes from man to man and pigs have nothing to do with it,'' he explained.

''While bird flu continues to pass between birds and to man, as recent cases in Egypt have shown, this flu is only passing from man to man and thus it makes no sense to call it 'swine' flu,'' he added.

The undersecretary said he was in favor of the World Health Organization (WHO) changing the name of the influenza to either 'new flu', as the European Union has, or 'Mexican flu', as some Asian countries and Israel have.

Pig farmers and major pork-producing countries have been pushing for an official name change to avoid a consumer backlash similar to the one which hit poultry sales during the bird flu scare.

According to Italian Agriculture Minister Luca Zaia, the media is blowing the risk of a pandemic out of proportion which is not only putting pork sales at risk but also opening the door to market speculation.

''What we are seeing is a media pandemic because by calling this swine flu there is a serious risk of major damage to a whole sector,'' Zaia observed.

According to the minister, there has been an 8% drop in pork sales and, if prices fall, ''people should stock up on the meat because it is perfectly safe to eat''.

Zaia also threw his support to have the WHO to officially change the flu's name and said he preferred 'Mexican flu'.

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What You Can Do



For right now and for the next few days, the only people who need to worry about infection are those who have been in Mexico or those who have been around people who have visited that country, said Dr. Mark Metersky, a spokesman for the American College of Chest Physicians.

Experts say precautions against catching swine flu are similar to those recommended for the regular flu, including the following:



Stay away from sick people if possible.

Stay home if you experience flu-like symptoms.

Wash your hands often.

Don't participate in events in crowded places.
 


More information:

There's more on swine flu at the U.S. Centers for Disease Control and Prevention.

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                          Toddler here from Mexico for treatment is first US death from Flu





By Maggie Fox
WASHINGTON,
April 29, 2009
(Reuters)

- A baby in Texas has died of the H1N1 flu strain, the first confirmed death outside Mexico from a virus which health officials fear could cause a pandemic as it spread to two more countries in Europe.

Nearly a week after the threat emerged in Mexico, where up to 159 people have died, a U.S. official said on Wednesday a 23-month-old had died in the state bordering Mexico. A health official said the baby was Mexican and was in the United States for medical treatment.

Richard Besser, acting head of the U.S. Centers for Disease Control and Prevention, said he expected more bad news even though most of the 65 U.S. cases of swine flu were mild.

President Barack Obama said the death showed it was time to take "utmost precautions" against the possible spread of the virus.

Germany reported its first three infections and Austria one, taking to nine the number of countries known to be affected.

"We have about 100 cases outside Mexico, and now you have one death. That is very significant," said Lo Wing Lok, an infectious disease expert in Hong Kong. 

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                                      Experts Say Panic Over Swine Flu Is Premature
         





HealthDay Reporter
Amanda Gardner
1 hr 46 mins ago
April 28, 2009
(HealthDay News)

-- As the death toll from swine flu in Mexico rises and new cases appear in the United States and elsewhere, it's easy to get caught up in a sense of mounting dread.


But experts in influenza and infectious disease say the exact level of danger from the virus is still far from certain.


"This is something of concern [but] I think we should hold back on calling it a real threat," said David Topham, co-director of the New York Influenza Center of Excellence, part of the University of Rochester Medical Center. "We always have to take these things seriously, but we have a very good system in place to respond."


Another expert agreed.


"The gravity of the situation will not be clear for a few more days till we find the extent of the cases and the number of countries involved and explain why we haven't had any deaths in the U.S," said Dr. Scott R. Lillibridge, a professor with the Texas A&M Health Science Center School of Rural Public Health in Houston and executive director of the university's National Center for Emergency Medical Preparedness and Response.


The real verdict on just how dangerous this outbreak might be will hinge at least partly on seeing how the disease spreads in the United States, along with expected announcements from the World Health Organization as to how many other countries are affected, the experts said.


So, as can happen in these situations, "the panic is a little bit undue," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "There are many facts that we don't know."


Looming large among the unknowns: Why is the virus causing more severe illness in Mexico than in the United States? Why have the only deaths reported been in Mexico? Why is mortality concentrated among young, healthy adults? Will the swine flu acquire more lethality as time goes on? And will the virus have a seasonality to it, like the "regular" flu?


Most of these questions have no solid answers -- at least not yet -- but there are some intriguing possibilities.


The death rate from the swine flu in Mexico (149 by late Monday) hovers at about 7 percent of the more than 1,900 so far thought to be nfected -- a percentage that's alarmingly higher than the 1918 Spanish flu pandemic, which is thought to have killed about 2.5 percent of infected persons.


But this early in the outbreak, no one really knows the true extent of the Mexican outbreak, the experts noted, so that 7 percent figure might well be too high.


"We don't know the total number of people exposed," Topham said. "It could be many more people exposed, so we're only hearing about the ones who got really sick and died," he explained.


It's also not clear if all the deaths attributable to swine flu were actually caused by the virus.


"The strain in the U.S. seems to be the same as in Mexico, but in Mexico we've not had confirmation of all those hospitalizations or deaths," Lillibridge said. "We're comparing apples and oranges."


And to put things into perspective, even with the death toll in Mexico, the swine flu does not appear to be as dangerous as SARS (Severe Acute Respiratory Syndrome), which appeared seemingly out of nowhere in 2003.


"SARS had high human-to-human transmission, there was a high death rate and no treatment," Horovitz noted. With the swine flu outbreak, "we're not talking about anything like that," he said.


In fact, all 40 U.S. cases so far have been mild or the patients have recovered, the U.S. Centers for Disease Control and Prevention reported.


And, in absolute numbers, the death toll is still nowhere near the roughly 35,000 lives snatched each year by the regular "garden variety" seasonal flu, Horovitz pointed out.

But could this outbreak morph into something more alarming?

"We just don't know yet," said Dr. Mark Metersky, spokesman for the American College of Chest Physicians and a professor of pulmonary and critical care medicine at the University of Connecticut School of Medicine in Farmington. "It's early in the outbreak."

Metersky pointed to a 1976 outbreak of swine flu that erupted at Fort Dix, N.J., caused a scare, but then quickly petered out with one death.

Perhaps the most disturbing trend in the Mexican outbreak is the fact that it is primarily young adults who are dying. That's not typical, experts said.

"It is usually people who are weakest, at extremes of age, very young and very old who succumb to influenza and this is a little bit scary because this is a pattern we saw in the [flu] pandemic in 1918," Metersky said.

On the upside, there's a good chance that swine flu may not stick around for long in northern climes, at least not this year. "This will probably have seasonality similar to the one of the regular flu," Topham said. He pointed out, however, that the regular winter flu is never quite gone, because as it wanes from the Northern Hemisphere, it re-establishes in the Southern one.

U.S. health officials declared a public health emergency Sunday in response to the swine flu outbreak, and the number of confirmed cases nationwide had doubled by Monday to 40. The 20 new cases all came from the New York City high school that had previously reported eight cases of the infectious disease.

Some of the U.S. cases, all of which so far have been mild, involved people who had recently returned from trips to Mexico.

Meanwhile, in Mexico, believed to be the source of the outbreak, authorities continued to take dramatic steps over the weekend -- including suspending public gatherings -- to try to contain the swine flu outbreak.

U.S. health officials have reported that they have 50 million doses of the antiviral flu medication Tamiflu. A quarter of those doses were being released to states, if needed.

"The benefits of antivirals are twofold," Lillibridge explained. "In treatment, to shorten the illness and promote recovery at an earlier time and to prevent complications. Second, it can be used in prevention. If you have been exposed to someone who has swine flu, [the drugs are] 70 to 90 percent effective if taken early enough."

Steps have also been taken to perhaps devise a vaccine against this strain of swine flu.

Swine flu is a respiratory disease of pigs caused by type A influenza. Swine flu does not normally infect humans. However, human infections do occur, usually after exposure to pigs. Symptoms resemble those of the regular flu, including sore throat, coughing and fever. The strain of swine flu circulating in North America appears to be a combination of pig, bird, and human flu strains, experts say. 

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                                                Science takes aim at the swine flu







YAHOO NEWS
Peter N. Spotts
– Mon Apr 27, 2009


Governments confronting a new strain of swine flu from Mexico have an unprecedented set of scientific tools to help them. The result is steady improvement in dealing with outbreaks like the current one.

Yet experts say a lack of clear communication in Mexico about the status of the outbreak and what people could do to protect themselves was perhaps a major factor in how the strain spread throughout the country and the world.

In the US, public-health officials said Monday they have identified 40 cases, with one person hospitalized. But "things are working well, from what I can see," says Peter Hotez, who heads the department of microbiology, immunology, and tropical medicine at George Washington University in Washington.

The faster speed of communications helps: Word of a problem gets out much more quickly than it did 20 years ago. But science, too, has improved its ability to identify an illness's origins, assess its susceptibility to existing vaccines, and model the trajectory the outbreak could take, experts say.

Researchers say they have increased their capacity to recognize and understand the nature of the biological agents involved. Even six years ago in the case of SARS, scientists needed only a relatively short time – six weeks – to characterize the agent involved, says Myron Cohen, director of the University of North Carolina's Institute of Global Health and Infectious Diseases. And SARS was something no one had seen before. Previously, that process might have taken years.

As for the outbreak of illness in Mexico: "Look how quickly we understood that it was an influenza agent, which in many ways is reassuring," Dr. Cohen says. "The ability to gain information on the agent and its pedigree is really quite remarkable."

Moreover, there are more labs and equipment that can do the work. When US labs reportedly required extra paperwork to analyze samples of the flu agent, public-health officials in Mexico simply sent the samples to labs in Canada. In California, the first diagnosed cases of swine flu from the Mexican outbreak were uncovered by researchers developing new test kits physicians could use in their offices, according to Richard Besser, acting director of the Centers for Disease Control and Prevention (CDC) in Atlanta during a briefing Monday.

In the US, officials already have started moving vaccines out of stockpiles and to healthcare providers. At this point, the CDC has released about 25 percent of that stockpile.

If the outbreak becomes more serious than it currently appears, Dr. Besser says, "doctors will have what they need."

For all the technological progress, however, more needs to be done, say some specialists.

Though the technology now exists to respond quickly – reducing the time it takes to design and evaluate a new or modified vaccine, it will take money to put the technologies in place, says Dr. Hotez.

Early detection remains an issue in some parts of the world, as well. The outbreak's origins in Mexico, for example, are largely a mystery. "We do not know how long this virus has been circulating and capable of human-to-human transmission," says Ted Cohen, an assistant professor of medicine at Brigham and Women's Hospital in Boston. "Certainly, the wide geographic distribution of cases indicates that our detection systems were not able to contain the virus where it initially emerged."

"This delay undoubtedly has limited our ability to respond to this potential crisis with travel restrictions or others methods that might have potentially prevented the long-distance spread of this pathogen," he adds.

Lessons from the past also show clearly that keeping people well-informed and apprised of developments is the best thing to do. "But it's not a lesson all governments have learned," says David Ozonoff, a communicable-disease specialist at Boston University.

He points to Mexico, which, he says, has been "authoritarian on one hand and not very informative on the other" with the public. The situation is compounded by a general lack of public trust in anything government officials say, he adds.

The United Nations' World Health Organization (WHO) generally has done a good job responding to the outbreak, Dr. Ozonoff says, but has underplayed the outbreak's severity. During the weekend, it hovered at 3 on the agency's 1-to-6 scale – even when it was clear by the scale's definitions that the outbreak was a 4 or 5, he says. "There are consequences" to higher ratings, he says, which include trade and travel restrictions. Today, the WHO raised the severity of the outbreak to Level 4.

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                                 Only 7 swine flu deaths around world, not 152, says WHO






April 29, 2009
The Sydney Morning Herald
 

A member of the World Health Organisation (WHO) has dismissed claims that more than 150 people have died from swine flu, saying it has officially recorded only seven deaths around the world.

Vivienne Allan, from WHO's patient safety program, said the body had confirmed that worldwide there had been just seven deaths - all in Mexico - and 79 confirmed cases of the disease.


"Unfortunately that [150-plus deaths] is incorrect information and it does happen, but that's not information that's come from the World Health Organisation," Ms Allan told ABC Radio today.

"That figure is not a figure that's come from the World Health Organisation and, I repeat, the death toll is seven and they are all from Mexico."


Ms Allan said WHO had confirmed 40 cases of swine flu in the Americas, 26 in Mexico, six in Canada, two in Spain, two in Britain and three in New Zealand.

Ms Allan said it was difficult to measure how fast the virus was spreading.

She said a real concern would be if the flu virus manifested in a country where a person had had no contact with Mexico, and authorities were watching all countries for signs of that.

"There is no pattern that has emerged at this stage to be able to say that it is spreading in a particular way or it is spreading into a particular country ... the situation is continuing to evolve," she said.

She said the WHO was not recommending against overseas travel, but urged those who felt sick to stay home and others to ensure they kept their hands clean.

No decision had yet been made about vaccinations.

"This virus is not airborne, it's caused by droplets ... so it's not a time for worry. It's a time to be prepared," Ms Allan said.

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                                       Mexico plans shutdown as WHO raises flu alert
           





Mark Stevenson And
Andrew O. Selsky,
Associated Press Writers
– 48 mins ago
April 30, 2009

MEXICO CITY

– Mexico took even more drastic action to squelch a swine flu epidemic, ordering a suspension of private business activity and nonessential federal government activities, as the World Health Organization ratcheted up an alert, warning that "all of humanity" is threatened.

The dire warning showed that world health officials are very worried about the potential for massive numbers of deaths worldwide from the mutated virus, even though the epidemic so far has claimed only a confirmed eight lives in Mexico and one in the United States. Roughly 170 deaths are suspected of having been caused by the virus in Mexico.

Switzerland on Thursday became the latest country to report a swine flu infection — a 19-year-old student who health officials said was mistakenly released from a hospital and then hastily readmitted. European Union health ministers planned emergency talks in Luxembourg to coordinate national efforts in preventing the spread of swine flu in Europe.

The Phase 5 alert, indicating a pandemic could be imminent as the virus spread further in Europe, prompted Mexico to announce the partial May 1-5 shutdown, Mexican Health Secretary Jose Cordova said late Wednesday.

In Washington, President Barack Obama promised "great vigilance" in confronting the outbreak which has sickened nearly 100 people in 11 states and forced schools to close. A Mexican toddler who visited Texas with his family died Monday night in Houston, becoming the first fatality in the U.S., and 39 Marines were confined to their base in California after one came down with the disease.

The virus, a mix of pig, bird and human genes to which people have limited natural immunity, has also spread to Canada, New Zealand, Britain, Germany, Spain, Israel and Austria.

"It really is all of humanity that is under threat during a pandemic," WHO Director General Margaret Chan said in Geneva. "We do not have all the answers right now, but we will get them."

In a televised address, Mexican President Felipe Calderon praised "the heroic work" of doctors and nurses and asked his countrymen to literally stay in their homes between May 1 and May 5, saying "there is no safer place to protect yourself against catching swine flu, than in your house."

"In recent days, Mexico has faced one of the most serious problems in recent years," Calderon said Wednesday night. He brushed aside criticisms that his government's response was slow, stressing several times that authorities had reacted "immediately."

School in Mexico has already been canceled until May 6. During the shutdown, essential services like transport, supermarkets, trash collection and hospitals will remain open.

Calderon said authorities would use the partial shutdown to weigh whether to extend the emergency measures, or "if it is possible to phase out some" restrictions.

The outbreak appeared to already be stabilizing in Mexico, the epicenter. Confirmed swine flu cases doubled Wednesday to 99, but new deaths finally seemed to be leveling off after an aggressive public health campaign was launched when the epidemic was declared April 23. Although 17 new suspected deaths were reported, only one additional confirmed death was announced Wednesday night, for a total of eight countrywide. The virus is believed to have sickened as many as 2,955 people across the country, though hospital records suggest the outbreak may have peaked here last week.

The WHO said the global threat is nevertheless serious enough to ramp up efforts to produce a vaccine against the virus. It declared a Phase 5 outbreak — the second-highest on its threat scale — for the first time ever, indicating a pandemic could be imminent.

In the U.S., eight states closed schools Wednesday, affecting 130,000 students in Texas alone.

Obama said his administration has made sure that needed medical supplies are on hand and he praised the Bush administration for stockpiling 50 million doses of antiviral medications.

"The key now is to just make sure we are maintaining great vigilance, that everybody responds appropriately when cases do come up. And individual families start taking very sensible precautions that can make a huge difference," he said.

Ecuador joined Cuba and Argentina in banning travel to or from Mexico and Peru banned flights from Mexico. The Panama Canal Authority ordered pilots and other employees who board ships passing through the waterway to use surgical masks and gloves. An average of 36 ships per day use the canal, most from the United States, China, Chile and Japan.

In France, President Nicolas Sarkozy met with Cabinet ministers to discuss swine flu, and the health minister said France would ask the European Union to suspend flights to Mexico.

The U.S., the European Union and other countries have discouraged nonessential travel to Mexico. Some countries have urged their citizens to avoid the United States and Canada as well. Health officials said such bans would do little to stop the virus.

Medical detectives have not pinpointed where the outbreak began. Scientists believe that somewhere in the world, months or even a year ago, a pig virus jumped to a human and mutated, and has been spreading between humans ever since.

China has gone on a rhetorical offensive to squash any suggestion it's the source of the swine flu after some Mexican officials were quoted in media reports in the past week saying the virus came from Asia and the governor of Mexico's Veracruz state was quoted as saying the virus specifically came from China.

One of the deaths in Mexico directly attributed to swine flu was that of a Bangladeshi immigrant, said Mexico's chief epidemiologist Miguel Angel Lezana.

Lezana said the unnamed Bangladeshi had lived in Mexico for six months and was recently visited by a brother who arrived from Bangladesh or Pakistan and was reportedly ill. The brother has left Mexico and his whereabouts are unknown, Lezana said. He suggested the brother could have brought the virus from Pakistan or Bangladesh.

By March 9, the first symptoms were showing up in the Mexican state of Veracruz, where pig farming is a key industry in mountain hamlets and where small clinics provide the only health care.

The earliest confirmed case was there: a 5-year-old boy who was one of hundreds of people in the town of La Gloria whose flu symptoms left them struggling to breathe.

Days later, a door-to-door tax inspector was hospitalized with acute respiratory problems in the neighboring state of Oaxaca, infecting 16 hospital workers before she became Mexico's first confirmed death.

Neighbors of the inspector, Maria Adela Gutierrez, said Wednesday that she fell ill after pairing up with a temporary worker from Veracruz who seemed to have a very bad cold. Other people from La Gloria kept going to jobs in Mexico City despite their illnesses, and could have infected people in the capital.

Cordova, the Mexican health secretary, said getting proper treatment within 48 hours of falling ill "is fundamental for getting the best results" and suggested the virus can be beaten if caught quickly and treated properly. But it was neither caught quickly nor treated properly in the early days in Mexico, which lacked the capacity to identify the virus, and whose health care system has become the target of widespread anger and distrust.

In case after case, patients have complained of being misdiagnosed, turned away by doctors and denied access to drugs. Monica Gonzalez said her husband, Alejandro, already had a bad cough when he returned to Mexico City from Veracruz two weeks ago and soon developed a fever and swollen tonsils.

As the 32-year-old truck driver's symptoms worsened, she took him to a series of doctors and finally a large hospital. By then, he had a temperature of 102 and could barely stand.

"They sent him away because they said it was just tonsillitis," she said. "That hospital is garbage."

Gonzalez finally took her husband to Mexico City's main respiratory hospital, "dying in the taxi." Doctors diagnosed pneumonia, but it may be too late: He has suffered a collapsed lung and is unconscious. Doctors doubt he will survive.

Swine flu has symptoms nearly identical to regular flu — fever, cough and sore throat — and spreads like regular flu, through tiny particles in the air, when people cough or sneeze. People with flu symptoms are advised to stay at home, wash their hands and cover their sneezes.

___



AP writers

Frank Jordans
in Geneva,

Tom Raum and
Lauran Neergaard
in Washington,

Olga Rodriguez
in Oaxaca, Mexico,

Paul Haven and
E. Eduardo Castillo
in Mexico City, and

Mike Stobbe
in Atlanta

contributed to this report.

[Bianca]

                                                       Mexico's first flu death






Olga R. Rodriguez,
Associated Press Writer
– Thu Apr 30, 2009
OAXACA,
Mexico

– Almost two weeks before tests confirmed she was the first person to die of swine flu, doctors in the southern colonial town of Oaxaca couldn't figure out what was wrong with a 39-year-old woman who arrived at their hospital gasping for air, her hands and feet blue from oxygen-starved blood.

They administered antibiotics, but she only got worse. They hooked her to a ventilator. They sent a saliva sample to a local private lab. On April 12, her third day in the intensive care unit, the test results indicated coronavirus — a highly contagious disease associated with severe acute respiratory syndrome, or SARS.

Dr. Jesus Salcedo, director of the Dr. Aurelio Valdivieso General Hospital, realized he had a potential crisis on his hands. The ward Adela Maria Gutierrez shared with at least 20 seriously ill patients had to be quarantined. His terrified staff demanded better protective gear or a transfer.

"The religious ones said, 'This is a punishment from God and we're all going to die,'" Salcedo recalled Wednesday in an exclusive interview with The Associated Press.

A day later, Gutierrez died — just before a second round of tests came back negative for coronavirus.

Hospital and health workers then began a desperate hunt to find the source of the mystery disease and who else may have been contaminated. It has since been identified as a mutated swine flu suspected in 168 deaths in Mexico that has spread to at least eight other countries, triggering an unprecedented global alert.

The case vividly shows why the virus has been so difficult to contain in Mexico.

The medical teams did some of the sleuthing that epidemiologists recommend for tracking a killer bug, interviewing 472 people who may have come into contact with Gutierrez, a mother of three who worked with the public in her job with Mexico's tax collection agency.

They took more samples from Gutierrez and sent them to Mexico's National Institute of Epidemiological Diagnosis and Reference, which forwarded them to a lab in Canada.

They closed the ICU to new patients until the exposed ones were well enough to leave, telling them they should return immediately if they had flu symptoms. None did, Salcedo said.

But the follow-up appears to have been weak — just like the national response to swine flu outbreaks in other parts of Mexico, where victims' families have yet to be contacted by health workers to see if they also contracted the illness.

In the end, only 18 people — all hospital workers — were tested for swine flu after Gutierrez's sample came back positive around April 20, said Dr. Ruben Coronado, director of Oaxaca's department of epidemiology.

In her last days, Gutierrez had worked closely with a temporary employee from Veracruz, the state where Mexico's earliest case of swine flu was confirmed: 5-year-old Edgar Hernandez, who survived.

About 450 people were diagnosed in the Veracruz town of La Gloria with acute respiratory infections, but only 35 were tested for the new virus. Edgar's was the only test that came back positive.

Gutierrez lived in a two-story home where the family runs a convenience store. Her husband, a welder, declined to be interviewed.

"They're really afraid and they don't know what's going on," state Health Secretary Dr. Martin Vasquez said of the family.

Gutierrez was buried the day she died, odd in Mexico where a wake is customarily held overnight, with burial held the next day. Already rumors were circulating that she died of a very contagious disease.

Four houses away, Hermelinda Leon was too frightened to attend the wake. She, her husband and three children had all been ill with similar symptoms starting April 7. Leon had a fever of 104 degrees Fahrenheit and spent several days in bed before her doctor gave her antibiotic injections.

"When they told me the neighbor died from a sore throat, I was worried because I was so sick from a sore throat, I felt like I was going to die," she said.

Three days later, health workers came to interview Leon, who caters food to Oaxaca hotels. They asked about the family's illness, symptoms, their medications and said they would return to give them a special test. She said they never did.

A day after Salcedo learned from the Canadian lab that Gutierrez had swine flu, two other patients died of pneumonia in the Oaxaca hospital. They weren't tested for swine flu because they didn't show atypical symptoms, Salcedo said. Gutierrez's family also never showed any symptoms, he said.

Coronado said only 18 of all the people interviewed were tested for swine flu because the others didn't show signs of the disease — even though Leon's family had similar symptoms. Coronado told AP he wasn't familiar with the Leon case.

Of the 18 saliva samples taken from medical staff, 12 did not have enough cells to be tested. The other six came back negative for swine flu, Coronado said.

Oaxaca now has 11 suspected cases of swine flu — all unrelated to Gutierrez, health officials say. Three victims are still hospitalized and eight went home after receiving anti-viral drugs. No other cases in Oaxaca have been confirmed.