Swine Flu a Potential Pandemic, Mexico, U.S. Declare Emergencies

The increase in the alert level signals an outbreak of human to human transmission in at least one country, which increases the risk of a global epidemic, but does not mean a pandemic is inevitable.

"Given the rapidly evolving situation [it was felt] that it was important to give a strong signal to countries that now is a good time to strengthen preparations for possible pandemic influenza," World Health Organization Assistant Director-General Keiji Fukuda told reporters in Geneva.

Fukuda explained that the emergency committee of health experts, set up to deal with the recent outbreak of the swine flu virus, raised the alert level because the virus had already spread to the United States, Mexico, and Canada, with a verified case in Spain.

On Saturday World Health Organization Director-General Margaret Chan said the outbreak of a deadly new strain of swine flu has the potential to become a pandemic. The animal virus has begun infecting people, giving it pandemic potential.

The situation is evolving quickly, she said. "We do not yet have a complete picture of the epidemiology or the risk, including possible spread beyond the currently affected areas."

Dr. Margaret Chan is World Health Organization director-general. (Photo courtesy UN)

The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans. It is a respiratory disease of pigs that can be transmitted to humans and passed from human to human. It is not transmitted by eating pork.

Symptoms of the new influenza virus are similar to those of other types of flu - sudden temperature of over 39°C, intense headache, cough, sore throat, body aches, chills and fatigue. Some people have reported diarrhea and vomiting as well.

In response to cases of swine flu A/H1N1, Dr. Chan Saturday convened a meeting of the WHO Emergency Committee to assess the situation and advise her on appropriate responses. Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.

Still, the Committee agreed that the current situation constitutes a public health emergency of international concern. WHO is not recommending any travel or trade restrictions, but today the U.S. government issued a notice recommending that American citizens avoid all nonessential travel to Mexico at this time.

Although WHO cannot predict whether the recent outbreak will become pandemic, the agency said the swine flu cases in Mexico and the United States are of the same genetic animal strain of the H1N1 virus, the agency said.

Chan told reporters in Geneva, "this is a serious situation which must be watched very closely."

The U.S. government Sunday declared a national public health emergency after lab confirmation of 20 human cases of A/H1N1 swine flu - eight in New York, seven in California, two in Texas, two in Kansas, and one in Ohio.

All 20 cases have had mild influenza-like illness with only one requiring brief hospitalization. No deaths have been reported.

WHO and the Global Alert and Response Network are sending experts to Mexico to work with health authorities there.

Dr. Chan said that all of the people reported to have contracted the virus in the United States have recovered and the cases have been mild, but in Mexico "we are seeing a range of severity from mild to severe and some deaths."

Worshippers wear protective masks at a mass Sunday at a cathedral in Mexico City. (Photo by Eneas de Troya)

President Felipe Calderon Saturday declared an emergency in Mexico's swine flu outbreak, giving him powers to order quarantines and halt public events.

At a news conference this morning, Mexican Health Secretary Jose Angel Cordova Villalobos said 149 people have died of the disease since the outbreak began in Mexico on April 13. The number of persons admitted to hospitals for severe pneumonia in the country is 1,995, of which 776 remain hospitalized, and 1,070 have been discharged.

Those figures have increased from the 81 people reported to have died on Sunday out of 1,384 patients possibly infected with swine flu.

Research is being carried out to confirm whether the biological agent involved produced severe pneumonia or swine fever in those who died.

School activities from primary school through university throughout the country will be suspended from tomorrow, April 28, to May 6 as a "precautionary measure," the health minister said.

On Sunday, he said schools would be closed only in Mexico City and the State of Mexico.

During a press conference Sunday the health minister requested public assistance in reducing the sources of contact through the total suspension of events in closed or open spaces of any nature where there are masses of people.

Troops are distributing filter masks free of charge to the entire population. Mexico City medical authorities urge people to avoid hospitals and clinics unless they have a medical emergency, since hospitals are centers of infection. Instead, those with health concerns are encouraged to stay home and call their physicians to avoid potential exposure.

In Washington, DC Sunday, White House Press Secretary Robert Gibbs told reporters that the health of President Barack Obama was "never in an any danger" after an official visit to Mexico on April 16.

Obama was greeted at an anthropology museum in Mexico City by Felipe Solis, an archeologist who died the next day from symptoms similar to flu, "Reforma" newspaper reported. The newspaper did not confirm whether or not Solis had swine flu.

Gibbs said the swine flu incubation period is 24 to 48 hours, adding, "We've been gone from Mexico for now more than nine days."

Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, told reporters, "We do think that this will continue to spread, but we are taking aggressive actions to minimize the impact on people's health."

"This is moving fast, but I want you to understand that we view this more as a marathon," Dr. Besser said. "We do think that this will continue to spread, but we are taking aggressive actions to minimize the impact on people's health."

Janet Napolitano, the Secretary of Homeland Security, told reporters that the declaration of a national public health emergency "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; it allows us to use medication and diagnostic tests that we might not otherwise be able to use, particularly on very young children; and it releases funds for the acquisition of additional antivirals," she said.

Laboratory testing has found the swine flu A/H1N1 virus susceptible to the prescription antiviral drugs oseltamivir, also called Tamiflu, and zanamivir, also called Relenza, and the CDC has issued interim guidance for the use of these drugs to treat and prevent swine flu infection.

Napolitan says the U.S. government has 50 million treatment courses of Tamiflu and Relenza in the strategic national stockpile and has released 12,500 of those courses, making them available to all states, but prioritizing the states with confirmed incidents of the flu. In addition, the Department of Defense has procured and strategically positioned seven million treatment courses of Tamiflu.

Dr. Besser said the CDC has begun preliminary work on creating a vaccine to protect against the A/H1N1 strain of swine flu. "We've created that seed stock, we've identified that virus, and discussions are underway so that should we decide to work on manufacturing a vaccine, we can work towards that goal very quickly," he said.

U.S. border personnel are implementing passive surveillance to screen out individuals from countries reporting swine flu who may be ill, said Napolitano. "Right now we don't think the facts warrant a more active testing or screening of passengers coming in from Mexico, although obviously we are letting air carriers and our employees at the gates on those flights make sure that they are asking people if they're sick; and if they're sick, that they shouldn't board the plane - you know, that sort of thing, passively.

Travelers who do present with symptoms "will be isolated per established rules," she said.

To date, the U.S. State Department has not issued official travel advisories for Mexico, but that could change, said Napolitano.

In the largest U.S. cluster of flu patients, last week more than 100 students at the at St. Francis Preparatory School in Queens, a borough of New York City, developed flu-like symptoms, including fever and sore throat. The New York City Health Department says the affected students have experienced only mild symptoms and many are already improving, but the school is suspending classes today.

In other countries, there have been six cases of swine flu A/H1N1 confirmed in Canada - four in Nova Scotia and two in British Columbia - all mild cases, health officials say.

In addition, there are suspected cases reported from New Zealand, Spain, France, and Israel, all involving travelers returning from Mexico.

Copyright Environment News Service (ENS) 2009. All rights reserved.