SWINE FLU OUTBREAK!

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Patients wait for medical attention at a health center in Mexico City.


Swine flu found in 7 people in...Past flu pandemics and pandemic threats
How swine flu spreads in humans
Swine flu? The plague? What's up in San Diego?

Eight swine flu cases identified in U.S.


All victims, six of them in California, have recovered. Officials say the new virus is easily passed, but does not appear to be especially virulent. Researchers plan to go to Mexico, where the viruses in 12 cases match six in the U.S.
By Thomas H. Maugh II
2:49 PM PDT, April 24, 2009

As Mexico City closed schools and began taking other measures to contain the spread of a swine flu outbreak that may have infected hundreds of people and killed as many as 60, U.S. officials said Friday they had found one new case in San Diego, bringing the total number in the United States cases to eight.

The most recent victim, a child, has recovered, as did the other seven victims, Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention said Friday in a telephone news conference. Six of the eight U.S. cases were in San Diego and Imperial counties and two in Guadeloupe County, Texas.

The cases were identified during routine screening of virus samples, and federal authorities have called for intensified screening of samples from flu victims in the area and in flu victims who have recently traveled to Mexico.

The outbreak has caused concern because the virus appears to be spread from human to human, which is the crucial requirement for a new virus to precipitate a large-scale outbreak.

CDC researchers have so far found no links among the U.S. victims or any common behaviors, Besser said, suggesting "that there has been transmission through several cycles" -- that is, there were several intermediaries who passed it among themselves before the virus reached the identified victims.


If that is the case, he added, many people have already been exposed to the virus and it is too late to contain a potential outbreak in the United States. But the good news is that none of the intermediaries appear to have developed serious illness, suggesting that the disease is not especially virulent.

None of the American victims has had any contact with pigs and only one of them has traveled to Mexico recently, he said.

The Pan American Health Organization said Friday that there have so far been 854 cases of "influenza-like illness" in Mexico City, with 59 deaths. Another 24 cases with three deaths have occurred in San Luis Potosi, in central Mexico, and 24 cases with no deaths in Mexicali, near the U.S. border.

Friday afternoon, Mexico's Health Minister Jose Angel Cordova held a news conference at which he said the rate of deaths is slowing. He also said that there are no plans to close the borders because of the outbreak.

U.S. health experts noted, meanwhile, that deaths from influenza are common. In an average year in the United States, about 35,000 people die from the flu, and in bad years nearly twice that number. Such deaths are most often among the very young and the elderly. Most of the cases in Mexico, however, have been among people who were apparently young and healthy.

That is potentially alarming, experts said, because the 1918 influenza epidemic also struck the young and healthy.

Besser said CDC researchers had so far analyzed 14 samples from seriously ill Mexican patients, but only eight of them tested positive for swine flu. "I think we are safe in saying it is the same virus in Mexico and California," he said. The six cases that did not test positive might have been caused by other strains of flu, but "we can't say what they were," he said.

Canadian laboratories have confirmed 18 of the Mexican cases as swine flu and have found that 12 are genetically identical to the swine flu virus found in California, according to the Pan American Health Organization .

"It is really critically important that we learn more about what is going on in Mexico," Besser said. "Sorting out which of the cases are caused by swine flu is an important public health question. . . . There is much uncertainty, more than anyone would like."

The agency has not yet sent investigators into Mexico, "but I anticipate we will have folks there very soon," he said.

The World Health Organization said it is monitoring the situation closely and will probably send a research team to Mexico as well.

Besser said the agency was not calling for any travel restrictions to Mexico or to the affected areas in the U.S. "We're reminding travelers of our standard recommendations," such as washing your hands frequently and covering your mouth when you cough or sneeze. "If you are sick and have the flu, you should stay home and not get on a bus or airplane."

The new swine virus is unlike any that researchers have seen before. It appears to be a combination of segments from four different viruses from three continents, including a human segment, an avian segment and pig segments.

Epidemiologists are typically concerned about swine flu because the animals often play a crucial role in the creation of new flu strains. While viruses from birds are rarely transmitted among humans, bird and human viruses can mix in pigs, creating hybrids that retain the virulence of bird flus while gaining the ability to pass from human to human.

The U.S. suffered outbreaks of swine flu in 1976 and 1988, but both were limited in scope and spontaneously disappeared.

http://www.latimes.com/news/science/...,1963704.story

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Story Highlights
NEW: Swine flu found in U.S. is same that killed at least 68 in Mexico

NEW: The latest U.S. case of swine flu occurred in California, the CDC says

Eight cases of the strain of swine flu have been confirmed in humans in the U.S.

(CNN) -- U.S. health officials expressed concern Friday that a swine flu virus that has infected eight people in the United States matches samples of a virus that has killed at least 68 people in Mexico.


U.S. health experts also are concerned because more than 1,000 people have fallen ill in Mexico City in a short period of time.

"This situation has been developing quickly," said acting CDC director Richard Besser. "This is something we are worried about."

New York health officials announced Friday they are testing about 75 students at a Queens school for swine flu after the students exhibited flu-like symptoms this week.

A team of state health department doctors and staff went to the St. Francis Preparatory School in Queens on Thursday after the students reported cough, fever, sore throat, aches and pains.

There have been no confirmed cases of swine flu there. The tests results are expected as early as Saturday.

Of the 14 Mexican samples tested by the Centers for Disease Control and Prevention, seven were identical to the swine flu virus found in Texas and Southern California, Besser said at a news conference.

An eighth U.S. case was reported Friday. All of the eight U.S. patients have recovered, Besser said. Watch for more on the U.S. cases »

As a precaution to avoid further contamination, schools and universities in Mexico City and the state of Mexico were closed Friday, said the national health secretary, Jose Angel Cordova Villalobos. He said the schools may remain closed for a while.

Sixty-eight people have died in Mexico City, Cordova said at a news conference. More than 1,000 other people have gotten sick, he said.

Mexican President Felipe Calderon canceled a trip Friday to northern Mexico so he could remain in Mexico City to monitor the situation, the state-run Notimex news agency reported. Calderon met with his Cabinet on Thursday night to discuss the outbreak.

Six of the U.S. cases were found in California, and two in Texas, near San Antonio, CDC officials said.

The Public Health Agency of Canada issued a respiratory alert for Mexico on Wednesday, recommending that health providers "actively look for cases" in Canada, particularly in people who've returned from Mexico within the last two weeks.

An alert issued Friday by the International SOS medical and consulting company said more than 130 cases of a severe respiratory illness have been detected in south and central Mexico, some of which are due to influenza.

"Public health officials in Mexico began actively looking for cases of respiratory illness upon noticing that the seasonal peak of influenza extended into April, when cases usually decline in number," the medical alert said. "They found two outbreaks of illness -- one centered around Distrito Federal (Mexico City), involving about 120 cases with 13 deaths. The other is in San Luis Potosi, with 14 cases and four deaths."

Authorities also detected one death in Oaxaca, in the south, and two in Baja California Norte, near San Diego, California.

There was no indication why the International SOS tallies did not match the Mexican health secretary's figures.

The majority of cases are occurring in adults between 25 and 44 years of age.

The CDC first reported Tuesday that two California children in the San Diego area were infected with a virus called swine influenza A H1N1, whose combination of genes had not been seen before in flu viruses in humans or pigs.

The first two cases were picked up through an influenza monitoring program, with stations in San Diego and El Paso, Texas. The program monitors strains and tries to detect new ones before they spread, the CDC said. Other cases emerged through routine and expanded surveillance.

The human influenza vaccine's ability to protect against the new swine flu strain is unknown, and studies are ongoing, Schuchat said. There is no danger of contracting the virus from eating pork products, she said.

The new virus has genes from North American swine and avian influenza, human influenza, and swine influenza normally found in Asia and Europe, said Nancy Cox, chief of the CDC's Influenza Division.

The new strain of swine flu has resisted some antiviral drugs.

The CDC is working with health officials in California and Texas and expects to find more cases, Schuchat said.

A pandemic is defined as: a new virus to which everybody is susceptible; the ability to readily spread from person to person; and the capability of causing significant disease in humans, said Dr. Jay Steinberg, an infectious disease specialist at Emory University Hospital Midtown in Atlanta. The new strain of swine flu meets only one of the criteria: novelty.

History indicates that flu pandemics tend to occur once every 20 years or so, so we're due for one, Steinberg said.

"I can say with 100 percent confidence that a pandemic of a new flu strain will spread in humans," he said. "What I can't say is when it will occur."


http://www.cnn.com/2009/HEALTH/04/24...flu/index.html

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The Associated Press
2:32 PM PDT, April 25, 2009
NEW YORK

At least eight students at a New York City high school probably have human swine influenza, but health officials said Saturday they don't know for sure whether they have the same virus that has killed scores of people in Mexico. At least two cases of the flu have been confirmed in Kansas.

A strain of the flu has killed as many as 68 people and sickened more than 1,000 across Mexico. The World Health Organization chief said Saturday the strain has "pandemic potential" and it may be too late to contain a sudden outbreak.

New York health officials said more than 100 students at the private St. Francis Preparatory School, in Queens, had come down with a fever, sore throat and other aches and pains in the past few days. Some of their relatives have also been ill.

New York City Health Commissioner Thomas Frieden said nose and throat swabs had confirmed that eight students had influenza type A, indicating probable cases of swine flu, but the exact subtypes were still unknown.

Samples had been sent to the U.S. Centers for Disease Control and Prevention in Atlanta for more testing. Results were expected on Sunday.

In Topeka, the Kansas Department of Health and Environment confirmed two cases of swine flu. A department spokeswoman said additional details would be released at a news conference later Saturday.

At least eight swine flu cases also have been reported in California and Texas.

The symptoms in the New York cases have all been mild and no students have been hospitalized, Frieden said, but the illnesses have caused concern because of the deadly outbreak in Mexico.

Frieden said that if the CDC confirms that the students have swine flu, he will likely recommend that St. Francis Preparatory remain closed on Monday out of an abundance of caution.

The city health department has also asked doctors to be extra vigilant in the coming days and test any patients who have flu-like symptoms and have traveled recently to California, Texas or Mexico.

He said New Yorkers having trouble breathing due to an undiagnosed respiratory illness should seek treatment, but shouldn't become overly alarmed. Medical facilities in the part of Queens near St. Francis Prep, he said, had already been flooded with people overreacting to the outbreak.

Overall, flu cases have been declining in the city in recent weeks and months as the flu season abated, Frieden said. .

http://www.latimes.com/news/nationwo...,5735133.story

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MEXICO CITY - President Felipe Calderón published an order Saturday that would give his government extraordinary powers to address a deadly flu epidemic, including isolating those affected by the rare virus, inspecting their homes and ordering the closure of any public events that might result in more infection.

The government has already taken steps to try to control the swine flu outbreak that has killed as many as 68 people and infected possibly 1,000 more. Since Friday, officials have canceled hundreds of public events and closed schools for millions of students in and around the capital.

"My government will not delay one minute to take all the necessary measures to deal with this epidemic," Mr. Calderón said in Oaxaca State during the opening of a new hospital, which he said will set aside an area for anyone who might be affected by the new swine flu strain.

But despite government efforts, alarm has continued to grow and on Saturday, another 24 suspected cases of the flu were reported in the city, according to The Associated Press. The decree published Saturday says Mr. Calderón as the authority to invoke the new powers whenever the situation warrants.

Early Saturday, officials said they were considering keeping schools here closed into next week, after a one-day closure Friday, and they announced that two soccer matches scheduled for Sunday would be played without spectators.

Mexico’s health minister, José Ángel Córdova, has said the country is dealing with “a new flu virus that constitutes a respiratory epidemic that is so far controllable.” He said the virus had mutated from pigs and had at some point been transmitted to humans.

The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention. A similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.

Most of Mexico’s dead were young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest.

Mexican officials have been urging people to avoid large gatherings and to refrain from shaking hands or greeting women with a kiss on the right cheek, as is common in Mexico.

On Friday, Mexico City closed museums and other cultural venues, and advised people not to attend movies or public events. Seven million students, from kindergartners to college students, were kept from classes in Mexico City and the neighboring State of Mexico on Friday, in what news organizations called the first citywide closing of schools since a powerful earthquake in 1985.

Because of the situation, the World Health Organization planned to consider raising the world pandemic flu alert to 4 from 3. Such a high level of alert — meaning that sustained human-to-human transmission of a new virus has been detected — has not been reached in recent years, even with the H5N1 avian flu circulating in Asia and Egypt, and would “really raise the hackles of everyone around the world,” said Dr. Robert G. Webster, a flu virus expert at St. Jude Children’s Research Hospital in Memphis.

Mexico’s flu season is usually over by now, but health officials have noticed a significant spike in flu cases since mid-March. The W.H.O. said there had been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Mr. Córdova said Friday that there were 1,004 possible cases.

Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to Gregory Hartl, a W.H.O. spokesman. Mexican authorities confirmed 16 deaths from swine flu and said 45 others were under investigation, most of them in the Mexico City area. The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.

“We are worried,” said Dr. Richard Besser, the acting head of the C.D.C. “We don’t know if this will lead to the next pandemic, but we will be monitoring it and taking it seriously.”

(Page 2 of 2)

There is no point in trying to use containment measures in the United States, he said, because the swine flu virus has already appeared from San Antonio to San Diego, without any obvious connections among cases. Containment measures usually work only when a disease is confined to a small area, he said.

The C.D.C. refrained from warning people not to visit Mexico. Even so, the outbreak comes at an awful time for tourism officials, who have been struggling to counter the perception that violence has made Mexico unsafe for travelers. The outbreak was also causing alarm among Mexicans, many of whom rushed to buy masks or get checkups.

“I hope it’s not something grave,” said Claudia Cruz, who took her 11-year-old son, Efrain, to a clinic on Friday after hearing the government warnings.

Health officials urged anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain to seek medical attention.

When a new virus emerges, it can sweep through the population, said Dr. Anne Moscona, a flu specialist at Cornell University’s medical school. The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.

The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs, Dr. Moscona said.

But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.

Despite the alarm in recent years over the H5N1 avian flu, which is still circulating in China, Indonesia, Egypt and elsewhere, some flu experts argued that it would never cause a pandemic, because no H5 strain ever had. All previous pandemics have been caused by H1s, H2s or H3s.

Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.

In Canada, hit by the SARS epidemic in 2003, health officials urged those who had recently traveled to Mexico and become ill to seek treatment immediately.

http://www.nytimes.com/2009/04/26/wo..._r=1&ref=world

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Story Highlights
.NEW: U.S. airline association: It's "time for appropriate precautions but not panic"

.NEW: U.S. military issues worldwide caution to look for illness signs in troops

.Total number of U.S. swine flu cases is 20

.CDC director says additional cases expected in next few days


(CNN) -- The United States stepped up preparations for a possible swine flu epidemic, and Canada confirmed its first cases on Sunday as researchers worked to determine how contagious the virus could be.

Keiji Fukuda, the assistant director-general of the World Health Organization, called the outbreak "serious" on Sunday. Researchers are still trying to determine how easily the virus is transmitted person to person and it's too early to predict whether there will be a mild or serious pandemic, said Fukuda.

By Sunday afternoon, Mexican President Felipe Calderon said 81 deaths were suspected to be from the outbreak and 374 people remained hospitalized. Another 929 people have been examined and sent home, he said.

"These people have shown up at some medical institution in the country with respiratory symptoms that required to be studied and diagnosed," he said.

Mexico City closed all of its schools and universities until further notice because of the virus, and troops passed out filter masks outside the National Cathedral on Sunday morning. No masses were scheduled at the cathedral, but dozens of worshippers put on masks and went inside the church to pray on their own.

Canada confirmed six cases of mild illnesses on Sunday, and the United States reported 20. Meanwhile, Spain, Israel and New Zealand were investigating possible but unconfirmed cases.

In Washington, the head of the Centers for Disease Control said 20 cases had been confirmed in five U.S. states by noon Sunday. The largest number of cases was in New York, where the CDC confirmed cases in eight students at a preparatory school in that city, Mayor Michael Bloomberg said Sunday.

Another seven cases have been confirmed in California, two each in Kansas and Texas and one in Ohio, said Dr. Richard Besser, the CDC's acting director. Only one person has had to be hospitalized, but Besser said authorities are likely to see "a broader spectrum of disease" in the days ahead.

"Given the reports out of Mexico, I would expect that over time we're going to see more severe disease in this country," he said.

The U.S. government declared a public health emergency -- a step Homeland Security Secretary Janet Napolitano said "sounds more severe than really it is."

"This is standard operating procedure and allows us to free up federal state and local agencies and their resources for prevention and mitigation," she said.

The outbreak "is of great concern to the White House," said White House spokesman Robert Gibbs, but, he added, "It's certainly not a time to panic."

"If you're sick, stay home, get treatment, go see a doctor," Gibbs told reporters. "The government is taking all the steps it needs to and must do to take the precautions to deal with whatever size and scope we may be facing," he said.


Meanwhile, the U.S. military issued a worldwide caution, telling its medical personnel to be on the lookout for troops with signs of swine flu and reiterated the need for public health precautions.

The WHO ordered countries worldwide to look out for "unusual" outbreaks of flu following an emergency meeting Saturday. WHO official Gregory Hartl said the strain of the virus seen in Mexico is worrisome because it has mutated from older strains.

"Any time that there is a virus which changes ... it means perhaps the immunities the human body has built up to dealing with influenza might not be adjusted well enough to dealing with this new virus," he said.

A spokeswoman for the Air Transport Association, which represents the U.S. airline industry, said the group is taking the matter seriously.

"This is a time for appropriate precautions but not panic," said ATA assistant general counsel Katherine Andrus. She said the industry group is following the lead of the CDC and is in regular contact with the agency.

Airport employees and flight crews are on the lookout for any passengers who show signs of illness, and procedures are in place for determining whether ill passengers may fly, Andrus said.

At Los Angeles International Airport, custodians have been instructed to pay additional attention to sanitizing door knobs, handrails and faucets in airport restrooms, according to a statement from Los Angeles World Airports.

"In addition, public education signs with general tips on preventing the spread of illnesses -- that are posted throughout the airport during regular flu season -- are being re-posted," the statement said.

The H1N1 strain of swine flu is usually associated with pigs. When the flu spreads person to person, instead of from animals to humans, it can continue to mutate, making it a tougher strain that is harder to treat or fight off. Symptoms of swine flu include fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea, the CDC said. Learn more about swine flu and how to treat it »

In New Zealand, officials said 22 students and three teachers, who returned from a three-week language trip to Mexico, may have been infected with the swine flu virus. The group remains quarantined at home, and Health Minister Tony Ryall said 10 students tested positive for influenza A -- the general category of strains that includes the H1N1 swine flu.

In Spain, six people, all of whom had recently returned from Mexico, were being isolated in hospitals, the country's health ministry reported. And in Israel, doctors are running tests on a man who recently returned from Mexico with light flu symptoms.

In London, a hospital spokesman said a British Airways crew member developed flu-like symptoms during a flight from Mexico City and was tested for swine flu, but the results came back negative. The flight attendant is back at work, British Airways told CNN.

Concerns over the virus have prompted Canada to issue a travel health notice, saying the public health agency was "tracking clusters of severe respiratory illness with deaths in Mexico." But Mexico's Tourist Board said Saturday there are no restrictions on travel to the country.

Neither Britain nor the United States have issued any travel warnings or quarantines. But South Korea said it will test airline passengers arriving from the United States, and Japan will convene a Cabinet meeting Monday to come up with measures to block the entry of the virus into the country.

Katherine Andrus, an attorney for the U.S. Air Transport Association, told CNN that the airline trade association was in regular contact with the CDC.

Andrus said airlines are following their own procedures to watch for ill passengers and crews have standard procedures for dealing with ill passengers. Any onboard communicable disease incidents must be reported to the CDC, she said.

"This is a time for appropriate precautions but not panic," she said.


http://www.cnn.com/2009/HEALTH/04/26...flu/index.html

[crimeshot1]

Swine flu illness in the United States and Mexico

26 April 2009 -- As of 26 April 2009, the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas and 1 in Ohio). All 20 cases have had mild Influenza-Like Illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country's 32 states.

WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other Member States as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management.

On Saturday, 25 April, upon the advice of the Emergency Committee called under the rules of the International Health Regulations, the Director-General declared this event a Public Health Emergency of International Concern.

WHO is not recommending any travel or trade restrictions.

For more information

Thomas Abraham
Communications in English
Mobile: +41 79 516 3136
E-mail: abrahamt@who.int
Fadela Chaib
Communications in English and French
Mobile: +41 79 475 5556
E-mail: chaibf@who.int
Sari Setiogi
Communications in English and Bahasa
Mobile: +41 79 701 9467
E-mail: setiogis@who.int
Gregory Hartl
Communications in English, French, German and Spanish
Mobile: +41 79 203 6715
E-mail: hartlg@who.int
Aphaluck Bhatiasevi
Communications in English, Thai and Hindi
Mobile: +41 79 484 2997
E-mail: bhatiaseviap@who.int

RELATED LINKS

- WHO Swine influenza website
Daily updates will be posted on this site.

[Bailey]

Story Highlights
NEW: U.S. urges travelers to avoid non-essential travel to Mexico

.Seventy-five cases of swine flu worldwide confirmed; 40 in United States

.Mexico health official: As many as 149 deaths may be from swine flu

.Mexico closes all schools until at least May 6

(CNN) -- The World Health Organization has raised its pandemic alert level in response to the outbreak of swine flu that originated in Mexico, U.S. Homeland Security Secretary Janet Napolitano said Monday.

The move from level three to level four on the WHO's six-level threat scale means the world body has determined the virus is capable of significant human-to-human transmission -- a major step toward a flu pandemic, said Dr. Keiji Fukuda, the agency's assistant director-general.

A pandemic is not considered "inevitable," Fukuda said. But Napolitano said the move "does indicate that we have a serious outbreak of swine flu on our hands."

At least 75 cases have been confirmed worldwide, including 40 cases in the United States and 26 in Mexico, the WHO said.

Hundreds more cases are suspected, especially in Mexico, where as many as 149 deaths are thought to have been caused by the virus, the country's health secretary said.

"Sadly, 149 people have died, of which we are working to confirm if they are linked to the swine flu," Mexico Health Secretary Jose Angel Cordova Villalobos said. "The number of cases, unfortunately, will continue to increase."

So far, 26 cases have been confirmed by laboratory tests in Mexico and reported to the World Health Organization. Nearly 2,000 people have been hospitalized and 776 remain in hospitals, Cordova said.

The U.S. government is urging travelers to avoid nonessential travel to Mexico because of the swine flu outbreak, and it has started distributing antiviral medications from its strategic stockpile in response to the outbreak, Napolitano said.

The confirmed cases in the United States have been mild so far but, "Scientists can't tell us right now why this is presenting so severely in Mexico City and not as severely up here," she said.

Federal officials confirmed 20 new U.S. cases on Monday.

A federal official said they were at the same school in New York in which eight U.S. cases were confirmed earlier. More than 100 students at the school were out with flu-like symptoms last week.

The outbreak is a particular concern because of who it is hitting hard, United Nations Secretary-General Ban Ki-moon said Monday.

"We are concerned that in Mexico, most of those who died were young and healthy adults," he said.

President Obama said Monday that the swine flu outbreak is a "cause for concern and requires a heightened state of alert," but is not a "cause for alarm."

He added that the federal government is closely monitoring emerging cases and had declared a public health emergency as a "precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively."

Meanwhile, Andorra Vassiliou, the European Union's health commissioner, on Monday urged people "to avoid nonessential travel to the areas which are reported to be in the center of the clusters" of a swine flu outbreak.

The EU later said that Vassiliou's remarks were her personal comments and that travel advisories can be issued only by member states and not by the EU itself.

Swine influenza, or flu, is a contagious respiratory disease that affects pigs. It is caused by a type-A influenza virus. Outbreaks in pigs occur year-round. The current strain is a new variation of an H1N1 virus, which is a mix of human and animal versions.

When the flu spreads person-to-person, instead of from animals to humans, it can continue to mutate, making it harder to treat or fight, because people have no natural immunity.

The symptoms are similar to the common flu. They include fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea.

The virus spreads when an infected person coughs or sneezes around another person. People can become infected by touching something with the flu virus on it and then touching their mouth, nose or eyes.

The WHO has called the outbreak a "public health emergency of international concern."

Researchers are trying to determine how easily it can jump from person to person. Fukuda, the WHO's assistant director-general, said it was too early to predict whether there will be a mild or serious pandemic.


In Mexico, authorities closed all schools until at least May 6 because of the virus.

They are considering whether to suspend other public activities but are analyzing what economic effects could result, Health Secretary Cordova said.

Military troops distributed 4 million filter masks in Mexico City, which has 20 million residents.

The streets of Mexico City were eerily quiet Sunday afternoon -- a time when families are usually out strolling.

Officials have talked about shutting down the bus and subway system, and incoming international passengers at the country's airports are asked on a form whether they have various symptoms that might indicate that they're carrying the virus.

Mexican Finance Minister Augustin Carstens said Sunday that the World Bank was lending his country $205 million to deal with the outbreak.

In Washington, the government declared a public health emergency -- a step Napolitano said, "sounds more severe that really it is."

"This is standard operating procedure and allows us to free up federal state and local agencies and their resources for prevention and mitigation," she said.

Meanwhile, Israel and New Zealand were investigating unconfirmed cases of swine flu.

Concerns about the virus prompted Canada to issue a travel health notice, and South Korea to say it will test airline passengers arriving from the United States.

Japan is expected to convene a Cabinet meeting Monday to come up with measures to block the entry of the virus into the country.

In New Zealand, officials said 22 students and three teachers, who returned from a three-week language trip to Mexico, might have been infected. The group remains quarantined at home, and Health Minister Tony Ryall said 10 students tested positive for influenza A -- the general category of strains that includes the H1N1 swine flu.

In Spain, six people -- all recently returned from Mexico -- were being isolated in hospitals, the country's Health Ministry said. Lab tests confirmed that one of the people had tested positive. In Israel, doctors are running tests on a man who recently returned from Mexico with light flu symptoms.

In 1968, a "Hong Kong" flu pandemic killed about 1 million people worldwide. In 1918, a "Spanish" flu pandemic killed as many as 100 million people.


http://www.cnn.com/2009/HEALTH/04/27...flu/index.html

[rach89]

we now have some cases of swine flu in new zealand as well

[Bailey]

Story Highlights
.NEW: WHO continues to recommend against restricting travel or closing borders

.Researchers conducting complete genetic sequencing of the H1N1 virus

."Actions now should be taken with increased urgency," director-general says

.World Health Organizations reports 148 cases in 11 countries

GENEVA, Switzerland (CNN) -- The World Health Organization raised its pandemic alert to 5, its second-highest level Wednesday, warning of widespread human infection from the swine flu outbreak that originated in Mexico.


Dr. Margaret Chan, the U.N. agency's director-general, said the decision mean to raise the alert on its 6-point scale indicated that all countries should "immediately" activate pandemic preparedness plans.

"This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharm industry and the business community that certain actions now should be taken with increased urgency and at an accelerated pace," Chan said.

The annoucement came as the number of confirmed swine flu cases increased rapidly across the world.

Germany and Austria became the latest European countries to report swine flu on Wednesday, while the number of cases increased in the United Kingdom and Spain.

The WHO and national governments have confirmed 148 cases of swine flu in 11 countries. Most of those are in the United States, where the Centers for Disease Control and Prevention has confirmed 91 cases.

The figures include seven deaths in Mexico and one in the United States. More than 2,700 other patients worldwide are believed to be suffering from the virus, known scientifically as H1N1.

Yet Chan reiterated the WHO's recommendation not to close borders or restrict trade in response to the outbreak, saying the world "is better prepared for an influenza pandemic than at any time" in history.

"We need to maintain a level of calmness so that we will continue to manage this in a rational manner," she said, adding that pork is safe for consumption as long as it is cooked properly.

Swine influenza, or flu, is a contagious respiratory disease that affects pigs. When the flu spreads person to person, instead of from animals to humans, it can continue to mutate, making it harder to treat or fight, because people have no natural immunity.

Symptoms include fever, runny nose, sore throat, nausea, vomiting and diarrhea.

The WHO's "Phases of Pandemic Alert," which has been in existence for five years, characterizes phase 5 as a human-to-human spread of the virus into at least two countries in one WHO region, signaling that a pandemic is imminent.

The highest level, phase 6, is defined by community-level outbreaks in at least one other country in a different WHO region, according to the agency.

"The question now is how severe will the pandemic be, especially now at the start," Chan said. "It is important for us to take this very seriously and take vigilance as the virus evolves."

The Pentagon is planning for a task force that would help with transportation, logistics and distributing medical supplies in the event of a pandemic, a spokesman said.

The U.S. government is distributing 25 percent of its stockpile of antiviral medications Tamiflu and Relenza to all states, Homeland Security Secretary Janet Napolitano said Wednesday. Health officials stress that the medications are effective only if taken in the early stages of the infection. Learn more about swine flu and how to treat it »

Researchers also are conducting a complete genetic sequencing of the H1N1 virus as the federal government considers more effective methods of combating the swine flu outbreak, a health official told a Senate committee Wednesday.

The 91 confirmed cases in the United States includes the country's first swine flu fatality: a 22-month-old child visiting from Mexico who died Monday at a Houston, Texas, hospital.

A U.S. Marine in California is the military's first suspected case of swine flu, and three military family members in San Diego have confirmed cases, the CDC said.

As a precaution, the military is banning travel to Mexico for nonessential personnel.

The first cases of the virus were detected in Mexico, where health officials suspect swine flu in more than 150 other deaths and roughly 2,500 illnesses. Only 26 cases have so far been confirmed, including the seven fatal cases.

The deadly outbreak has prompted authorities to order about 35,000 public venues in Mexico City to shut down or serve only takeout meals as health officials tried to contain spreading of the virus. iReport.com: "Regular life" in Mexico with masks

Mexican officials also said they believe they may have found "patient zero" -- the first case of the global outbreak -- in the small mountain village of La Gloria.

Edgar Hernandez, 5, survived the earliest documented case of swine flu. He lives near a pig farm, though experts have not established a connection between that and his illness.

Edgar has managed to bounce back from his symptoms and playfully credits ice cream for helping him feel better.

President Obama called on schools with confirmed or possible swine flu cases to "consider temporarily closing so that we can be as safe as possible."

At least 74 elementary, junior high and high schools have closed across the country due to confirmed or probable cases of swine flu, the Department of Education said Wednesday.

Another 30 schools have closed as a precautionary measure, Department of Education spokesman Massie Ritsch said.

Researchers do not know how the virus is jumping relatively easily from person to person, or why it's affecting what should be society's healthiest demographic. Many of the victims who have died in Mexico have been young and otherwise healthy.

Governments around the world are scrambling to prevent further outbreak.

Some countries, such as China and Russia, have banned pork imports from the United States and Mexico, though the WHO said the disease is not transmitted through eating or preparing pig meat. Several other countries, such as Japan and Indonesia, are using thermographic devices to test the temperature of passengers arriving from Mexico.


Egypt reportedly is considering culling all pigs although there have been no reported cases of swine flu there.

Common seasonal flu kills 250,000 to 500,000 people every year worldwide, far more than the current outbreak of swine flu. But there is a vaccine for seasonal flu.

http://www.cnn.com/2009/HEALTH/04/29...flu/index.html

[Bailey]

May 5, 2009, 7:33PM

McALLEN, Texas

Texas health officials on Tuesday announced the first death of a U.S. resident with swine flu, and said she was a 33-year-old school teacher who had recently given birth to a healthy baby.

The woman died early Tuesday and had been hospitalized since April 19, said Leonel Lopez, Cameron County epidemiologist.

Health officials stopped short of saying that swine flu caused the woman's death. State health department spokeswoman Carrie Williams said the woman had "chronic underlying health conditions" but wouldn't give any more details.

Lopez said the flu exacerbated the woman's condition. "The swine flu is very benign by itself," Lopez said. But "by the time she came to see us it was already too late."

The only other swine flu death in the U.S. was of a Mexico City boy who also had underlying health problems and had been visiting relatives in Brownsville, near Harlingen. He died last week at a Houston children's hospital.

There have been 26 other confirmed swine flu deaths, all in Mexico. Hundreds of cases of the disease have been confirmed in several countries, but mostly in Mexico and the U.S.

The teacher was from Harlingen, a city of about 63,000 near the U.S.-Mexico border. The school district where she worked announced it would close its schools for the rest of the week, though officials said anyone who might have contracted the disease from her would have shown symptoms by now.

The teacher was first seen by a physician April 14 and was hospitalized five days later. The woman delivered a healthy baby while hospitalized and stayed in the hospital until her death, said Lopez, who declined to give further details about the baby.

Doctors knew she had a flu when she came in, but did not know what kind, Lopez said. The area is undergoing a Type A influenza epidemic right now, of which the swine flu is one variety, he said. She was confirmed to have swine flu shortly before she died, he said.

Dr. Joseph McCormick, regional dean of the University of Texas School of Public Health's Brownsville campus, said the woman was extremely ill when she was hospitalized.

Mercedes Independent School District, where the woman taught, announced it would close its schools starting Wednesday and reopen May 11.

Based on the time the patient was admitted to the hospital and began to show symptoms of swine flu, anyone who had contracted the disease from her would have shown symptoms by now, McCormick said. Lopez also said students and employees of the school district where she worked shouldn't worry if they are currently healthy.

U.S. health officials changed course on their advice to schools Tuesday, saying they are no longer recommending that schools close for the swine flu. Last week, the government had advised schools to shut down for about two weeks if there were suspected cases of swine flu.

In Texas, swine flu worries closed some 830 schools, sending about 492,000 students home. But by late Tuesday afternoon, several schools originally closed for at least this week said they would re-open on Thursday. Those school districts include Corpus Christi, Denton and Lewisville.

The Fort Worth school district, which has about 80,000 students, said it would reopen on Friday.

Karen Permetti, a spokeswoman for the 50,000-student Lewisville district, said the district will get word out on the reopening on the Web site and with an e-mailed newsletter.

She said that as soon as the news broke about the new guidelines from the federal government, parents began calling to ask when the district would be reopening.

She said they decided on Thursday so they could finish cleaning the schools and to give students time to return home if, for instance, the kids had been sent out of town to the grandparents for the week.

The El Paso County district clerk is suspending passport processing at the county courthouse for three weeks over concerns about swine flu.

Officials with the city of El Paso Department of Public Health said there are seven confirmed cases of swine flu in El Paso involving people ranging in age from six to 32. All seven have recovered without complications. Six of the seven are school-age.

Mayor John Cook said no schools were being closed but that children who are ill are being sent home.

As of Tuesday afternoon, the Texas Education Agency and the Texas Department of State Health Services were not recommending school closures, said TEA spokeswoman Debbie Ratcliffe. She said when to reopen will be a local decision.

"It may not be immediate for them because they've got students scattered across the state," she said. "I think we'll start to see all these schools that have closed reopening fairly soon."

http://www.chron.com/disp/story.mpl/ap/tx/6409624.html

[Bailey]

By ALEXANDER G. HIGGINS and ELIANE ENGELER


GENEVA (AP) — Up to 2 billion people could be infected by swine flu if the current outbreak turns into a pandemic lasting two years, the World Health Organization said Thursday.

WHO flu chief Keiji Fukuda said the historical record of flu pandemics indicates one-third of the world's population gets infected in such outbreaks. Independent experts agreed that the estimate was possible but pointed out that many would not show any symptoms.

In Mexico, the hardest hit country so far, high schools and universities opened for the first time in two weeks as the government's top health official insisted the epidemic is on the decline. All students were checked for swine flu symptoms and some were sent home.

"If we do move into a pandemic, then our expectation is that we will see a large number of people infected worldwide," Fukuda said. "If you look at past pandemics, it would be a reasonable estimate to say perhaps a third of the world's population would get infected with this virus."

With the current total population of more than 6 billion, that would mean an infection total of 2 billion, he said, but added that the world has changed since pandemics of earlier generations, and experts are unable to predict if the impact will be greater or smaller.

"We don't really know." said Fukuda. "This is a benchmark from the past. Please do not interpret this as a prediction for the future."

Chris Smith, at flu virologist at Cambridge University in England, said the 2 billion estimate was possible.

"That doesn't sound too outlandish to me for the simple reason that this is a very infectious virus," Smith told The Associated Press. "You're talking about a virus that no one in the population has seen before and therefore everyone is immunologically vulnerable. Therefore it's highly likely that once it starts to spread, people will catch it. And since the majority of the world's population are in contact with one another, you're going to get quite a lot of spread."

John Oxford, professor of virology at St. Bart's and Royal London Hospital, agreed.

"I don't think the 2 billion figure should scare people because it's not as though 2 billion people are going to die. The prediction from WHO is that 2 billion people might catch it. Half of those people won't show any symptoms. Or if they show any symptoms, they will be so mild they will hardly know they've had it."

Fukuda said it also is impossible to say if the current strain of swine flu will become severe or mild, but that even with a mild flu, "from the global perspective there are still very large numbers of people who could develop pneumonia, require respirators, who could die."

A mild outbreak in wealthier countries can be "quite severe in its impact in the developing world," Fukuda said.

People react differently to the flu depending on their general state of health and other factors, he said. Some younger people in the Southern Hemisphere may be more vulnerable because of poor diet, war, HIV infections and other factors.

"We expect this kind of event to unfold over weeks and months," Fukuda said. "Really if you look over a two-year period that is really the period in which you see an increase in the number of illnesses and deaths during a pandemic influenza."

So far the swine flu virus has spread to 26 countries. Brazil and Argentina on Thursday became the second and third countries in South America to announce confirmed cases.

Mexican dance halls, movie theaters and bars were allowed to fully reopen Thursday after a five-day shutdown designed to curb the virus' spread. Businesses must screen for any sick customers, and restaurant employees must wear surgical masks.

Fans can attend professional soccer matches this weekend after all were played in empty stadiums last weekend.

Mexico confirmed two more deaths, for a total of 44, while 1,160 people have been sickened, up 90 from Wednesday. Despite death tolls and confirmed caseloads that rise daily, Health Secretary Jose Angel Cordova insisted the epidemic is waning in Mexico.

WHO raised its global total of laboratory-confirmed cases to 2,099, from 1,893 late Wednesday, and said swine flu also has caused two deaths in the United States.

This swine flu seems to have a long incubation period — five to seven days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. That means the virus can keep being spread by people who won't know to stay home.

Laughing and joking, high school students gathered at the entrance of the National School of Graphic Arts in Mexico City, waiting to fill out forms that asked about their health.

Of 280 students entering the school in the first 20 minutes, two showed symptoms of swine flu, including coughing and nasal congestion, said assistant principal Ana Maria Calvo Vega. Their parents were notified and they won't be readmitted without a statement from a doctor saying they don't have the virus, she said.

Students at a Mexico City vocational high school were welcomed with a hand sanitizer and a surgical mask. Joyful to see each other again, students embraced and kissed — some through masks.

But some worried that the virus could surge back once young people gather in groups again.

"My 17-year-old daughter is afraid. She knows she must go back but doesn't want to," said Silvia Mendez as she walked with her 4-year-old son, Enrique, in San Miguel Topilejo, a town perched in forested mountains near the capital.

Working parents have struggled to provide child care during the shutdown. It forced many to stay home from work, bring their youngsters to their jobs, or leave them at home.

Each school, Mexican officials said, had to be cleaned and inspected this week. Complicating the task: Many schools are primitive buildings with dirt floors and lack proper bathrooms. It was unclear how students attending those schools could adhere to the government's strict sanitary conditions.

The government promised detergent, chlorine, trash bags, anti-bacterial soap or antiseptic gel and face masks to state governments for delivery to public schools. But some local districts apparently didn't get the word.

U.S. health officials are no longer recommending that schools close because of suspected swine flu cases since the virus has turned out to be milder than initially feared. But many U.S. schools have done so anyway, including the school of a Texas teacher who died.

In Asia, top health officials said the region must remain vigilant over the threat of swine flu, stepping up cooperation to produce vaccines and bolstering meager anti-viral stockpiles.

The virus has so far largely spared Asia. Only South Korea and Hong Kong have confirmed cases. On Thursday, China and Hong Kong released dozens of people quarantined over suspected contact with one of the region's few swine flu carriers.

Experience has been the spur to WHO to make sure the world is as prepared as possible for a pandemic, which would be indicated by a rise to phase 6 from the current phase 5 in the agency's alert scale. That would mean general spread of the disease in another region beyond North America, where the outbreak so far has been heaviest.

"I'm not quite sure we know if we're going to phase six or not or when we would do so," Fukuda said. "It's really impossible for anybody to predict right now."

Officials said the agency was likely to shorten its annual meeting of its 193 member states later this month from 10 days to five because of the outbreak, which it was scheduled to discuss.

"That is under consideration," Fukuda said. "Sure it is possible."

http://www.google.com/hostednews/ap/...MM_EQD981N5T01

[crimeshot1]

U.S. Now Leads World in Swine Flu Cases

MONDAY, May 11 (HealthDay News) -- Confirmed cases of H1N1 swine flu in the United States climbed to more than 2,500 by Monday, and the U.S. now surpasses Mexico as the country most affected by the outbreak, according to World Health Organization figures.

The number of deaths in the United States linked to the illness rose to three over the weekend, with health officials in Washington state reporting late Saturday that an unidentified man in his 30s had succumbed to the infection.

In a state Department of Health news release, officials said the man, who had an underlying heart condition, died last week with what appeared to be complications from the swine flu, the Associated Press reported.

The man's death came after two prior fatal U.S. cases of swine flu: a 33-year-old woman in Texas, and a Mexican toddler who had been treated at a Texas hospital. Both of those individuals also had chronic underlying medical conditions.

The swine flu count in the United States now stands at 2,532 confirmed cases in 44 states, the U.S. Centers for Disease Control and Prevention said on Sunday. On Saturday, CDC officials said those numbers included 104 hospitalizations. The vast majority of cases are mild, however.

"We had expected more cases and we are continuing to find them," Dr. Anne Schuchat, interim deputy director for science and public health program at the Centers for Disease Control and Prevention, said during a Saturday teleconference.

The jump in confirmed cases is partly due to the reduction in the backlog of testing for infections. But the number of confirmed cases is probably an underestimation of the total number of actual cases as the virus continues to spread, Schuchat said.

"Transmission here in the U.S. is ongoing. This is a very easily transmittable virus," she said. "Fortunately, the severity of illness that we're seeing, at this point, doesn't look as terrible as a category-five pandemic or the severely devastating impact some had feared. But influenza viruses are unpredictable and can change over time. Going forward, it's really important to us that we pay attention to how this virus may or may not change."

Because the new swine flu virus is a highly unusual genetic mix of bird, flu and human viruses, health officials worry that it could continue to mutate and return in a more virulent form for next winter's flu season.

And, while most of the infections continue to cause only mild illness, similar to the seasonal flu, and virtually all patients recover quickly and fully, federal officials warned Friday that the swine flu outbreak in the United States is far from over.

"I want to address an issue that's been concerning me, that has to do with a sense of having dodged a bullet, a sense that this is over," Dr. Richard Besser, the CDC's acting director, said during a Friday teleconference. "While we have seen a lot of encouraging news in terms of severity, we continue to see hundreds and hundreds of new cases each day," he said.

While the swine flu -- technically known as the H1N1 virus -- is similar to seasonal flu, there are some important differences, Besser said. "One thing we are seeing, unlike seasonal flu, a higher percentage seem to be having vomiting and diarrhea," he said.

Besser said last week that most new cases of swine flu in the United States are now caused by person-to-person transmission and not some link to Mexico, as was the case when the outbreak began more than two weeks ago. Mexico is believed to be the source of the outbreak.

Testing has found that the swine flu virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza, according to the CDC.

So far, U.S. deaths linked to swine flu occurred in individuals with multiple underlying health problems, according to a CDC report released Thursday by the New England Journal of Medicine.

On Saturday, health officials in Costa Rica reported the first swine flu-related death in that country -- a 53-year-old man who also suffered from diabetes and heart disease. The death marked the first swine flu-linked death outside North America, according to the AP.

U.S. health officials last week said the outbreak of swine flu appears similar to the seasonal flu in its severity, so schools across the nation should remain open and any schools that did close should reopen.

On Monday, the World Health Organization was reporting 4,694 confirmed cases of swine flu in 30 countries, with Canada, Spain and the United Kingdom having the most cases outside of the United States and Mexico.

Japan and Australia reported their first cases of swine flu on Saturday.

And on Sunday health officials reported the first case in mainland China -- a man returning from studying at an American university.

Meanwhile in Mexico, the country continued to emerge from a virtual shutdown designed to limit infections. High schools, universities, dance halls, movie theaters and bars have reopened, and primary schools are to reopen this week, the Associated Press reported.

U.S. Human Cases of H1N1 Flu Infection

(As of May 10, 2009, 11:00 AM ET)

States # of laboratory confirmed cases Deaths

Alabama 4
Arizona 182
California 282
Colorado 39
Connecticut 24
Delaware 44
Florida 53
Georgia 3
Hawaii 6
Idaho 1
Illinois 466
Indiana 39
Iowa 43
Kansas 36
Kentucky** 3
Louisiana 9
Maine 4
Maryland 23
Massachusetts 88
Michigan 114
Minnesota 7
Missouri 10
Nebraska 13
Nevada 9
New Hampshire 4
New Jersey 7
New Mexico 30
New York 190
North Carolina 7
Ohio 6
Oklahoma 14
Oregon 17
Pennsylvania 10
Rhode Island 7
South Carolina 32
South Dakota 1
Tennessee 54
Texas 108 2
Utah 63
Vermont 1
Virginia 16
Washington 102 1
Washington, D.C. 4
Wisconsin 357
TOTAL*(44) 2532 cases 3 deaths

*includes the District of Columbia
**Case is resident of Ky. but currently hospitalized in Ga.
Source: U.S. Centers for Disease Control and Prevention



More information
For more on swine flu, visit the U.S. Centers for Disease Control and Prevention.

[Bailey]

Mon May 18, 2009 4:00pm EDT


* Pattern different from seasonal flu

* U.S. flu season running unusually long

* Average flu victim is teenager

By Maggie Fox, Health and Science Editor

WASHINGTON, May 18 (Reuters) - The new influenza strain circulating around most of the United States is putting a worrying number of young adults and children into the hospital and hitting more schools than usual, U.S. health officials said on Monday.

The H1N1 swine flu virus killed a vice principal at a New York City school over the weekend and has spread to 48 states. While it appears to be mild, it is affecting a disproportionate number of children, teenagers and young adults.

This includes people needing hospitalization -- now up to 200, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

"That's very unusual, to have so many people under 20 to require hospitalization, and some of them in (intensive care units)," Schuchat told reporters in a telephone briefing.

"We are now experiencing levels of influenza-like illness that are higher than usual for this time of year," Schuchat added. "We are also seeing outbreaks in schools, which is extremely unusual for this time of year."

New York City Health Commissioner Dr. Thomas Frieden agreed with Schuchat.

"We're seeing increasing numbers of people going to emergency departments saying they have fever and flu, particularly young people in the 5 to 17 age group, " Frieden, who has been named by U.S. President Barack Obama as the new CDC director, told a news conference.

About half of all cases of influenza are being diagnosed as the new H1N1 strain, while the rest are influenza B, or the seasonal H1N1 and H3N2 strains. Flu season in the United States is usually almost over by May.

CDC officials say around 100,000 people are likely infected with the new flu strain in the United States and Schuchat said the 5,123 confirmed and probable cases and six deaths in the United States were "the tip of the iceberg."

MORE ILLNESS OVERALL

"We are seeing more reports of influenza-like illness from outpatient visits that we monitor than is typical for this time of year," Schuchat said.

Because doctors usually treat symptoms and only occasionally give flu tests to patients, the CDC must monitor reports of symptoms such as fever, cough and muscle aches to track flu activity. Some centers are doing actual influenza tests to confirm the patterns that are seen.

Influenza is a factor in 36,000 deaths a year in the United States and 250,000 to 500,000 deaths globally, the CDC says.

"Unlike the seasonal flu, we are seeing relatively few cases or hospitalizations in people over 65," Schuchat said. Usually flu kills the elderly and people with chronic diseases.

There is no evidence that a second, bacterial infection is worsening the H1N1 cases, Schuchat said.

When family members are questioned, it seems clear that children and teens are more prone to infection than older adults, Schuchat said. "People under 18 are more likely to have infections when another person in the family is infected," she said.

"One of our working hypotheses is that older adults may have some pre-existing protection against this virus due to their exposure long ago to some virus that may be distantly related," Schuchat said.

An alternative hypothesis is that it just has not had a chance to make its way into the older population yet.

http://www.reuters.com/article/europ.../idUSN18510599

[Bailey]

Fri May 22, 2009 5:33pm EDT

* Chan says H1N1 could mutate in "unpredictable ways"

* Japan relaxes flu measures, but prepares big aid project

* U.S. gives companies $1 billion to start vaccine

* Gene analysis shows virus lurked undetected

(Updates with vaccine news and genetic studies)

By Laura MacInnis and Stephanie Nebehay

GENEVA, May 22 (Reuters) - The world must be ready for H1N1 swine flu to become more severe and kill more people, World Health Organization chief Dr. Margaret Chan said on Friday.

A genetic analysis of the new virus showed it must have been circulating undetected for some time, in pigs or perhaps in other animals.

The WHO is poised to declare a full pandemic of the virus, which has infected more than 11,000 people in 42 countries and killed 86. And U.S. health officials released $1 billion for companies to get started on a vaccine in case it is needed.

The virus must be closely monitored in the southern hemisphere, as it could mix with ordinary seasonal influenza and change in unpredictable ways, Chan told the WHO annual congress in Geneva. [ID:nLM945575]

"In cases where the H1N1 virus is widespread and circulating within the general community, countries must expect to see more cases of severe and fatal infections," she said. "This is a subtle, sneaky virus."

An international team of researchers who analyzed all eight genes of the new virus confirmed its sneakiness, saying it was so different from its ancestral strains that it must have been circulating undetected for years. [ID:nN22387017]

They confirmed it is a hybrid of two other mixtures -- one a so-called triple reassortant of pig, bird and human viruses, and another group of swine viruses from Europe and Asia.

"The results of the study show the global need for more systematic surveillance of influenza viruses in pigs," Dr. Nancy Cox, chief of the influenza division at the U.S. Centers for Disease Control and Prevention, told reporters.

The researchers said it is likely that other odd mixtures are infecting pigs but simply have not yet been seen.

"We do know that our veterinary colleagues at USDA (the U.S. Department of Agriculture) and elsewhere in the world are now looking to see if samples in freezers from pigs or other animals might provide the missing link," Cox said.

VACCINE CASH

The U.S. Health and Human Services Department said it was setting aside $1 billion to help companies develop a vaccine against the new strain.

HHS Secretary Kathleen Sebelius said the money will be used for clinical studies over the summer and for production of vaccine ingredients for the government's stockpile of drugs and vaccines that is on hold in case of a pandemic of influenza.

Companies approved to sell flu shots in the United States are Sanofi-Aventis SA (SASY.PA), Novartis AG (NOVN.VX), GlaxoSmithKline PLC (GSK.L) and CSL Ltd (CSL.AX). AstraZeneca (AZN.L) unit MedImmune also sells a nasal spray flu vaccine.

U.S. officials reported 6,552 suspected and confirmed cases, 300 hospitalizations and nine deaths but said there were likely far more than that. The CDC's Dr. Anne Schuchat said only about one in 20 cases of influenza are reported, which would put the U.S. caseload at about 130,000.

Flu activity was calming in general across the United States, with a few exceptions, she said.

"Today the situations in the New York City area and a few other parts of the country have led to more schools closing," she said. "We believe that there are 60 schools around the country that have dismissed students and that there are about 42,000 students out of schools because of this virus."

Russia reported its first confirmed case of the disease and the WHO was testing two suspected cases in Democratic Republic of Congo, which would be Africa's first. [IDLM967383]

Beijing's municipal health bureau reported the second case in the Chinese capital, a 65-year-old Chinese-American man who flew to Beijing from New York on Thursday.

STORING ANTIVIRALS

Japan said it would launch a $31.85 million project to fight the virus in poorer Asian states.[ID:nSP476538]

Under the initiative, Japan will store Roche AG's (ROG.VX) Tamiflu and GlaxoSmithKline's (GSK.L) Relenza flu drugs as well as masks and gowns, at a warehouse in Singapore in case of a major outbreak.

WHO officials say Asian nations, with young populations and endemic chronic illnesses, are particularly vulnerable to the spread of the new virus. [ID:nMAN91504]

Most of Japan's 300 infections appear mild and officials relaxed preventive measures to allow some suspected patients to go to regular medical institutions rather than special "fever centres," and schools will not be automatically shut down. [ID:nSP476538]

Robert Booy, who heads Sydney University's immune research and surveillance centre, said more people than usual in Southern Hemisphere countries could become infected this winter and die from the new flu because of its novelty.

"Once you have enough virus out there, evolution is simple," Booy said, adding that the H1N1 virus could change to the point that it could get "nasty."

In Australia, where cases have spread across several states, the government raised its flu alert level to mid-range "containment, which gives it authority to close schools.

http://www.reuters.com/article/asiaCrisis/idUSN22387871

[crimeshot1]

Swine flu cases hit 70 in Kansas

TOPEKA | A Colorado resident who became ill while traveling through Kansas is the state's latest confirmed case of swine flu.

The Kansas Department of Health and Environment said Saturday that the state has 70 cases of the H1N1 virus.

The latest case was a Colorado resident who was hospitalized in Gove County. Officials said the person likely contracted the disease outside of Kansas. No other details about the patient were released.

The case is the first confirmed case in Gove County. The other cases by county are two in Dickinson, one in Ford, 15 in Geary, 11 in Johnson, one in Ottawa, 21 in Riley, five in Saline, one in Sedgwick and 12 in Wyandotte.

Kansas Department of Health and Environment: http://www.kdheks.gov