Worldwide Pandemic Flu Declaration 'Close'

The virus, also called human swine flu, has spread to 73 countries that have reported 26,563 laboratory confirmed cases of the illness, with 140 deaths, Dr. Keiji Fukuda, assistant director-general for health, security and environment, told reporters on a teleconference today.

"We are getting close to declaring a pandemic. But we are trying to get as much information out to countries as we can that would relieve anxiety," Dr. Fukuda said. "Right now we consider the situation to be relatively moderate."

Since April 25, when WHO declared the H1N1 flu virus to be a public health emergency of international concern, the world health body has raised the threat level from Phase 4, characterized by human-to-human transmission, to Phase 5, characterized by human-to-human spread of the virus into at least two countries in one WHO region.

Customer service representative at the Buenos Aires International Airport wears a mask to protect herself from the H1N1 virus. (Photo by Alejandro Kirchuk)

The current WHO phase of pandemic alert is Phase 5, based on the viral outbreak in one WHO region, North America, where the virus was first detected in Mexico and quickly spread to the United States and Canada.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Over the past few weeks the virus has spread across the Southern Hemisphere, which is going into its wintertime period when even seasonal influenza normally spreads.

Current outbreaks and spread of the virus in South America, and particularly in Australia, make it more likely that WHO will declare a Phase 6 pandemic, the highest category of threat, Dr. Fukuda said.

"We are mindful of what is going on in Australia and we are getting closer," he said.

In the Australian state of Victoria, at least 1,011 people have been diagnosed with the disease, out of the 1,211 Australians who have tested positive for the H1N1 virus since late May. No deaths have been reported.

Sign in the window of Charles Pharmacy, Hughesdale, Victoria, Australia (Photo by Erin Beel)

Victorian health officials report they are focusing treatment on members of the community most vulnerable to viral infections, such as the elderly, students at special development schools, hospital patients and people with a chronic illness.

The spread of this virus in Australia appears to meet the WHO criteria for community level outbreaks in at least one other country in a different WHO region from the original outbreak in North America.

Dr. Fukuda said today that if WHO moves to declare a Phase 6 pandemic alert "it is not just a matter of getting up in front of cameras and making a declaration, it's to prepare countries for this situation so that they have the information, the knowledge, and the tools to handle the increased numbers of people who may be sick - to make sure all the steps that can be taken are being taken."

He said WHO is doing a lot of work on communications, on vaccine development, on improving the anti-viral supply, and on developing clinical guidelines.

"For WHO the most important principle of all this is that the actions we take, the announcements we make they are to help people, to help countries to have the most positive effect possible, make countries as resilient as possible.This requires a lot of effort and a lot of time, that's what we're doing right now."

But today, Australian health officials were thrown a curve ball by the announcement that the most modern test for the H1N1 virus may be only 90 percent accurate.

The most recent information from the World Health Organization and from the U.S. Centers for Disease Control and Prevention indicates the newly developed rRT-PCR real-time testing method gives only a "presumptive positive" rather than a "definitive positive" result for H1N1 influenza.

Some healthy Australians may have been falsely diagnosed with the virus while others with the illness may have been told their symptoms were caused by something else.

A fact sheet from the Centers for Disease Control states that the test has been designed "to minimize the likelihood of false positive test results." If false positive results occur, the CDC acknowledges that risks to patients could include a recommendation for quarantine of household or other close contacts, a recommendation for patient isolation that might limit contact with family or friends and the ability to work.

"A negative rRT-PCR test should not be interpreted as demonstrating that the patient does not have novel influenza A (H1N1) infection, if other aspects of the patient's clinical presentation or recent epidemiologic exposures indicate novel influenza A (H1N1) infection is likely, and diagnostic tests for other causes of acute respiratory illness are negative," the CDC states.

Confusion and unnecessary anxiety is exactly what the World Health Organization is trying to prevent by communicating all facts to member countries, Dr. Fukuda said.

He expressed concern about possible eroneous adverse reactions such as, "questioning the safety of pork, trade embargoes issued, concerns about travellers coming from certain areas, border closures, travel restrictions, these are the potential kinds of adverse reactions you can have," he said.

"In earlier outbreaks we've seen worried people who are not sick overrun hospitals. So many going to emergency rooms can adversely affect people who really require those facilities. We want to minimize these consequences," Dr. Fukuda said.

While WHO considered changing the definition of a Phase 6 pandemic in response to the concerns of member countries that it should reflect severity of illness as well as geographic spread, Dr. Fukuda said WHO officials have decided to stay with current criteria but augment the information provided "when we go to Phase 6" by "explaining what we understand about the severity of the pandemic."

Many of the member countries have existing national pandemic plans based on what Dr. Fukuda called "a more severe scenario," the avian influenza H5N1 virus that was spreading several years ago.

These plans may be inappropriate for the H1N1 virus, said Dr. Fukuda. He said WHO wants to discuss the severity of the situation and provide guidance to countries to help tailor their plans to meet the current situation.

"Our biggest concern is whether actions taken by countries are what is needed right now in terms of information and vaccines," he said. "We are focusing on the critical public health actions. We feel pretty comfortable that these critical actions are being taken."

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