WHO: Swine flu could spread globally

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http://edition.cnn.com/2009/HEALTH/04/25/swine.flu/#cnnSTCOther1

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Swine flu crisis 'near pandemic', hits United States

MEXICO CITY - A new swine flu strain that has killed as many as 68 people and sickened more than 1,000 across Mexico has "pandemic potential," the World Health Organisation chief said today, and it may be too late to contain the sudden outbreak.

Cases have now been confirmed in the United States.

This morning (NZ time) the Kansas Department of Health and Environment has confirmed two cases of swine flu in the state.

New York City officials earlier announced that eight students at a high school in Queens probably have swine flu, but they're unsure of the strain type. The symptoms in the New York cases have all been mild and no students have been hospitalised, officials said.

Samples had been sent to the US Centres for Disease Control and Prevention in Atlanta for more testing. Results were expected last today.

The disease has already reached Texas and California, and with 24 new suspected cases reported this morning (NZ time) in Mexico City alone, schools were closed and all public events suspended in the capital until further notice - including more than 500 concerts and other gatherings in the metropolis of 20 million.

A hot line fielded 2,366 calls in its first hours from frightened city residents who suspected they might have the disease. Soldiers and health workers handed out masks at subway stops, and hospitals dealt with crowds of people seeking help.

Authorities urged people to stay home if they feel sick and to avoid shaking hands or kissing people on the cheeks.

Outside Hospital Obregon in the capital's middle-class Roma district, a tired Dr. Roberto Ortiz, 59, leaned against an ambulance and sipped coffee Saturday on a break from an unusually busy shift.

"The people are scared," Ortiz said. "A person gets some flu symptoms or a child gets a fever and they think it is this swine flu and rush to the hospital."

He said none of the cases so far at the hospital had turned out to be swine flu.

Jose Donasiano Rosales, 69, got nervous on the subway and decided to get out one stop early.

"I felt I couldn't be there for even one more station," Donasiano said as he set up a rack to sell newspapers on a busy thoroughfare. "We're in danger of contagion. ... I'm worried."

The local Roman Catholic Church recommended that priests shorten Mass; place communion wafers in worshippers' hands, instead of their mouths; and ask parishioners to avoid kissing or shaking hands during the rite of peace. The Archdiocese also said Catholics could fulfill their Mass obligation by radio.

Ahued, the capital's health secretary, said Mexico City may not be the epicenter of the outbreak - and could be appearing to the brunt simply because it is home to the most sophisticated medical centers.

"The country's best health care facilities are concentrated in the city," he said. "All the cases here get reported, that's why the number is so high."

The same virus also sickened at least eight people in Texas and California, though there have been no deaths north of the border, puzzling experts at the US Centers for Disease Control and Prevention.

A "seed stock" genetically matched to the new swine flu virus has been created by the CDC, said Dr. Richard Besser, the agency's acting director. If the government decides vaccine production is necessary, manufacturers would need that stock to get started.

The CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.

Mexico's Health Secretary Jose Angel Cordova said the country has enough Tamiflu to treat 1 million people - only one in 20 people in greater Mexico City alone - and that the medicine will be strictly controlled and handed out only by doctors.

http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=10568705

The World Health Organisation's director-general, Margaret Chan, said the outbreak of the never-before-seen virus is a very serious situation and has "pandemic potential." But she said it is still too early to tell if it would become a worldwide outbreak.

"The situation is evolving quickly," Chan said in a telephone news conference in Geneva. "A new disease is by definition poorly understood."

This virus is a mix of human, pig and bird strains that prompted WHO to meet to consider declaring an international public health emergency - a step that could lead to travel advisories, trade restrictions and border closures. Spokesman Gregory Hartl said a decision would not be made just yet.

Scientists have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. Another reason to worry is that authorities said the dead so far don't include vulnerable infants and elderly.

The Spanish flu pandemic, which killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults.

This swine flu and regular flu can have similar symptoms - mostly fever, cough and sore throat, though some of the US victims who recovered also experienced vomiting and diarrhea. But unlike with regular flu, humans don't have natural immunity to a virus that includes animal genes - and new vaccines can take months to bring into use.

But experts at the WHO and the US Centers for Disease Control and Prevention say the nature of this outbreak may make containment impossible. Already, more than 1,000 people have been infected in as many as 14 of Mexico's 32 states, according to daily newspaper El Universal. Tests show 20 people have died of the swine flu, and 48 other deaths were probably due to the same strain.

The CDC and Canadian health officials were studying samples sent from Mexico, and airports around the world were screening passengers from Mexico for symptoms of the new flu strain, saying they may quarantine passengers.

But CDC officials dismissed the idea of trying that in the United States, and some expert said it's too late to try to contain spread of the virus.

They noted there had been no direct contact between the cases in the San Diego and San Antonio areas, suggesting the virus had already spread from one geographic area through other undiagnosed people.

"Anything that would be about containing it right now would purely be a political move," said Michael Osterholm, a University of Minnesota pandemic expert.

Mexican President Felipe Calderon said his government only discovered the nature of the virus late Thursday, with the help of international laboratories. "We are doing everything necessary," he said in a brief statement.

But the government had said for days that its growing flu caseload was nothing unusual, so the sudden turnaround angered many who wonder if Mexico missed an opportunity to contain the outbreak.

"Why did it break out, where did it break out? What's the magnitude of the problem?" pizzeria owner David Vasquez said while taking his family to a movie Friday night, despite warnings to stay out of theaters.

Beginning in late March, when the flu season usually starts to taper off, health officials began recording a spike in cases - three times the normal number.

On April 16, Assistant Health Secretary Mauricio Hernandez noted "an unusual transmission period" of regular, seasonal flu.

Starting two days later, health teams were sent to hospitals looking for patients with severe flu or pnuemonia-like symptoms. They noticed something strange: The flu was killing people aged 20 to 40, though flu victims are either infants or the elderly.

This Wednesday, Hernandez said testing was being carried out in Mexican labs, and hospitals were alerted to watch out for cases. But testing at Mexican labs did not alert doctors to the new strain - even though US authorities had detected cases in California and Texas by April 19.

Mexico City Health Secretary Dr. Armando Ahued said it wasn't until mid-afternoon Thursday that authorities received a call "from the United States and Canada, the most important laboratories in the field, telling us this was a new virus."

"That was what led us to realize it wasn't a seasonal virus ... and take more serious preventative measures," federal Health Secretary Jose Cordova said.

Across Mexico's capital, residents reacted with fatalism and confusion, anger and mounting fear at the idea that their city may be ground zero for a global epidemic.

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Influenza-like illness in the United States and Mexico

24 April 2009 -- The United States Government has reported seven confirmed human cases of Swine Influenza A/H1N1 in the USA (five in California and two in Texas) and nine suspect cases. All seven confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported.

The Government of Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of ILI starting 18 March. The number of cases has risen steadily through April and as of 23 April there are now more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of ILI, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.

Of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.

The majority of these cases have occurred in otherwise healthy young adults. Influenza normally affects the very young and the very old, but these age groups have not been heavily affected in Mexico.

Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern.

The Swine Influenza A/H1N1 viruses characterized in this outbreak have not been previously detected in pigs or humans. The viruses so far characterized have been sensitive to oseltamivir, but resistant to both amantadine and rimantadine.

The World Health Organization has been in constant contact with the health authorities in the United States, Mexico and Canada in order to better understand the risk which these ILI events pose. WHO (and PAHO) is sending missions of experts to Mexico to work with health authorities there. It is helping its Member States to increase field epidemiology activities, laboratory diagnosis and clinical management. Moreover, WHO's partners in the Global Alert and Response Network have been alerted and are ready to assist as requested by the Member States.

WHO acknowledges the United States and Mexico for their proactive reporting and their collaboration with WHO and will continue to work with Member States to further characterize the outbreak.

For more information, please contact:
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 2979
E-mail: bhatiaseviap@who.int

http://www.who.int/csr/disease/swineflu/en/index.html

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In response to cases of swine influenza A(H1N1), reported in Mexico and the United States of America, the Director-General convened a meeting of the Emergency Committee to assess the situation and advise her on appropriate responses.

The establishment of the Committee, which is composed of international experts in a variety of disciplines, is in compliance with the International Health Regulations (2005).

The first meeting of the Emergency Committee was held on Saturday 25 April 2009.

After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses.

The Committee advised that answers to several specific questions were needed to facilitate its work.

The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.

Based on this advice, the Director-General has determined that the current events constitute a public health emergency of international concern, under the Regulations.

Concerning public health measures, in line with the Regulations the Director-General is recommending, on the advice of the Committee, that all countries intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.

The Committee further agreed that more information is needed before a decision could be made concerning the appropriateness of the current phase 3.

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That level should bve at 6...

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Swine influenza questions and answers [pdf 79kb]

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CDC says too late to contain U.S. flu outbreak 24 Apr 2009 19:35:16 GMT
Source: Reuters

WASHINGTON, April 24 (Reuters) - The U.S. Centers for Disease Control and Prevention said on Friday it was too late to contain the swine flu outbreak in the United States.

CDC acting director Dr. Richard Besser told reporters in a telephone briefing it was likely too late to try to contain the outbreak, by vaccinating, treating or isolating people.

"There are things that we see that suggest that containment is not very likely," he said.

He said the U.S. cases and Mexican cases are likely the same virus. "So far the genetic elements that we have looked at are the same." But Besser said it was unclear why the virus was causing so many deaths in deaths in Mexico and such mild disease in the United States.

http://www.alertnet.org/thenews/newsdesk/N24443479.htm

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New flu has spread widely, cannot be contained-CDC
25 Apr 2009 17:45:00 GMT

Source: Reuters

WASHINGTON, April 25 (Reuters) - An unusual new flu virus has spread widely and cannot be contained, the U.S. Centers for Disease Control and Prevention confirmed on Saturday.

"It is clear that this is widespread. And that is why we have let you know that we cannot contain the spread of this virus," the CDC's Dr. Anne Schuchat told reporters on a conference call.

The strain of swine flu is suspected of killing as many as 68 people in Mexico and infecting more than 1,000 more, including eight in the United States. (Reporting by Maggie Fox, editing by Patricia Zengerle)

http://www.alertnet.org/thenews/newsdesk/N25473389.htm

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WHO to say swine flu outbreak a concern-official
25 Apr 2009 18:25:07 GMT

Source: Reuters

WASHINGTON, April 25 (Reuters) - The World Health Organization is set to declare the swine flu outbreak in Mexico and the United States a "public health event of international concern," a global health official said on Saturday.

The health official said a formal statement by the WHO's emergency committee headed by WHO director-general Dr. Margaret Chan will be issued shortly under international health regulations.

http://www.alertnet.org/thenews/newsdesk/N25474808.htm


Will keep an eye out for updates to this and post them here....

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Swine Flu is Public Health Emergency, With New U.S. Cases

The World Health Organization declared a deadly new strain of swine flu to be a "public health emergency of international concern," as health officials identified possible new cases in two additional U.S. states and called the disease widespread.

Several children at a school in the New York City borough of Queens may have been infected, and two people were confirmed with the disease in Kansas, according to reports from local health departments. The U.S. Centers for Disease Control and Prevention said it expects to find more cases soon throughout the country.

http://online.wsj.com/article/SB124069763075656299.html#mod=rss_whats_news_us

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Swine Flu Case Now Suspected in Minnesota

Story Updated: Apr 25, 2009 at 5:39 PM CDT



A new strain of flu... Dubbed swine flu has hit the U.S. after killing dozens in Mexico.

The list of people testing positive for the virus is growing here in the U.S., and so is the list of states... including here in Minnesota.

Kansas, Massachusetts, New York, Texas, and California also have confirmed or suspected cases.

The Centers for Disease Control says the virus spreads like other flu viruses, through contact and coughing and sneezing.

U-S health officials are warning people who may have recently traveled, or have flu-like symptoms to get checked by a doctor and take precautions.

http://www.northlandsnewscenter.com/news/local/43699217.html


This is moving fucken fast.........

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Suspected case in the UK

By Avril Ormsby LONDON, April 25 (Reuters) - A British Airways cabin crew member was taken to a London hospital as a precaution after developing flu-like symptoms on a flight from Mexico City, the airline said on Saturday. It was the first such reported precautionary measure in Britain since the emergence of a new flu strain that has killed up to 68 people in Mexico. It has also infected at least 11 people in the United States.

The man has undergone tests, but the results are not expected back until Sunday. No other crew members or passengers on the BA242 flight into Heathrow airport were detained. "He has flu-like symptoms and is responding well to treatment," a hospital spokesman said in a statement. "The patient was admitted directly to a side room and the hospital is scrupulously following infection control procedures to ensure there is no risk to any other individual in the hospital." A Health Protection Agency (HPA) spokesman said in a statement: "We are aware of a patient admitted to a London hospital with reported travel history to Mexico. "As a precautionary measure the patient is being tested for a range of respiratory and other illnesses in line with UK health guidance. "At present there have been no confirmed cases of human swine flu in the UK or anywhere in Europe." The new flu strain -- a mixture of swine, human and avian flu viruses -- is still poorly understood and the situation is evolving quickly, the World Health Organisation said.

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San Antonio school closed amid swine flu outbreak

SAN ANTONIO — A Texas high school where two students are confirmed to have swine flu is temporarily closing after a new possible case of swine flu was identified there, state health officials announced Saturday.

Carrie Williams, a state Department of Health Services spokeswoman in Austin, confirmed Saturday that another student in Guadalupe County near San Antonio is now believed to have the illness.

Williams said lab tests have not confirmed the potential case.

Because of the outbreak, Williams said officials were temporarily closing Byron Steele High School in Cibolo for classes next week. She did not give any other details.

The illness sickened two high school students at the school and a 10-year-old boy from San Diego who visited Dallas before his diagnosis. All three have recovered and are fine.

As many as 68 people in Mexico have died of swine flu, while more than 1,000 others have become ill.

Gov. Rick Perry announced Saturday that because of the outbreak he was asking the Centers for Disease Control and Prevention to give Texas 37,430 courses of antiviral medications from the Strategic National Stockpile to prevent the spread of swine flu.

More

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Britain placed on swine flu alert

The UK is on health alert following a deadly outbreak of swine influenza in Mexico and the US.

The World Health Organisation has warned all nations to keep a look out for unusual flu cases.

Its director-general Margaret Chan said the outbreak constituted a "public health emergency of international concern" and had "pandemic potential".

The H1N1 strain of swine flu usually associated with pigs has spread to humans, causing symptoms including fever and fatigue.

More than 60 people have died of pneumonia in Mexico after contracting a flu-like virus and many others - including children in a New York school - have been made ill.

Health authorities were monitoring the situation as tests were carried out to assess the potential of the virus to spread.

On Saturday night, a man on a flight from Mexico City to London's Heathrow Airport was taken to a London hospital with "flu-like symptoms".

The UK Health Protection Agency said it was keeping a close eye on the situation.

An HPA spokesman said: "No cases of swine flu have been identified in the UK or anywhere in Europe. The reported events in the US and Mexico are unusual and warrant further investigation and vigilance on the part of other countries."

Britons are not currently being advised to avoid travelling to affected areas of Mexico and the US, although anyone visiting those destinations or who has recently returned should consult a doctor if they experience flu-like symptoms.

http://www.loughboroughecho.net/news/national-news/2009/04/25/britain-placed-on-swine-flu-alert-73871-23474068/


Having problems keeping up - this is moving really fast....

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Press Briefing Transcripts

CDC Briefing on Public Health Investigation of Human Cases of Swine Influenza
April 24, 2009, 2:30 p.m. EST (today about 40 min ago - that's in US time)

GLENN (ph):  I’m a chief of media relations here at the Center for Disease Control Prevention, and we’re here to give an update on human swine food investigation and cases.  With us today is Dr. Richard Besser.  Dr. Besser is the acting director at the Centers for Disease Control and Prevention, and I will turn the microphone over to Dr. Besser.

RICHARD BESSER, ACTING DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION:  Thanks very much, Glenn (ph). 

I want to welcome you to today’s update on the human swine flu situation.  As with yesterday, our goal today is to provide an update on what we know as well as some of the important initial public health actions we’re taking with respect to the recently identified cases of human infection with swine influenza. 

Before I talk about the cases and specific actions, I want to recognize some initial guiding concepts.  First I want to recognize that people are concerned about this situation.  We hear from the public and from others about their concern, and we are worried, as well.  Our concern has grown since yesterday in light of what we’ve learned since then. 

I want to acknowledge the importance of uncertainty.  At the early stages of an outbreak, there’s much uncertainty, and probably more than everyone would like.  Our guidelines and advice our likely to be interim and fluid, subject to change as we learn more.  We’re moving quickly to learn as much as possible and working with many local state and international partners to do so.

I want to recognize that while we’re moving fast, it’s very likely that this will be more of a marathon than a sprint.  I want to acknowledge change.  Our recommendations, advice, approaches will likely change as we learn more about the virus and we learn more about its transmission.

I want to acknowledge that we’re likely to see local approaches to controlling the spread of this virus, and that’s important; that can be beneficial; that can teach us things that we want to use in other parts of the country and that other people in other places may find useful.  Because things are changing, because flu viruses are unpredictable and because there will be local adaptation, it’s likely that any given moment there will be confusing – or may be confusing or conflicting information available.  We are very committed to minimizing and that where we find that, clearing up any of that misconception.

So on to today’s update.  The United States Government is working with the World Health Organization and other international partners to ensure early detection and warning and to respond as rapidly as possible to this threat in order to lessen its potential health and socioeconomic impact.  We’re committed to sharing any new information with our international partners and with the public as it becomes available.  We do not know whether this swine flu virus or some other influenza virus will lead to the next pandemic; however, scientists around the world continue to monitor the virus and take its threat seriously.  The Government of the United States strongly supports the International Health Regulation, which establish a framework for effective international cooperation in monitoring, reporting, and responding to public health emergencies of international concern.

To on today’s update of confirmed cases.  Yesterday we reported we had confirmed a total of seven cases in the United States.  Today, we’ve confirmed one additional case in California, bringing the total number of U.S. confirmed cases to eight.  The most recently confirmed case involved a child in the San Diego area, who has recovered.  Today, Mexico’s Minister of Health confirmed that they have cases of swine influenza in people and that they believe some of the people who were infected died from swine influenza. 

While we are now working with health officials in Mexico, we’re very early on in those efforts.  We’ve only tested a very limited number of samples from Mexico, and we do not have enough information to fully assess the health threat posed by this swine flu virus.  We’ve tested 14 samples from Mexico, and seven of those tested positive.  We also only had eight confirmed cases in the United States, which makes it hard to draw conclusions about the full spectrum of the clinical picture.  We need more comprehensive laboratory analyses and a better understanding of what’s really going on with respect to the number of people who experience influenza-like illness in Mexico.  We still do not have enough information to give us any sense of the extent of spread of this virus, and the illness spectrum is not currently known.

I want to go over some of the CDC and other public health agency actions that have been taken.  We’re working very closely with state and local officials in California, Texas as well as with health officials in Mexico, Canada and the World Health Organization.  CDC has sent teams to California and will be sending a team to Texas to assist state and local health officials in identifying people who are potentially infected, contacting people who lived with or were in extended close contact with confirmed cases and helping on laboratory work.  CDC expects to send people to Mexico to assist in the public health efforts there.

In terms of our travel recommendations, at this time there are no recommendations for U.S. travelers to change, restrict or alter their travel plans to Texas, California or Mexico.  CDC will be issuing today an outbreak notice for American travelers to Central Mexico and Mexico City.  A CDC outbreak notice is designed to inform travelers of an increased health risk due to an outbreak in a limited geographic area.  Outbreak notices also get reminders about standard or enhanced recommendations for the region.  In this case, we’re reminding travelers about our standard recommendation.  Based on the currently available information, CDC is not recommending any additional precautions for travelers to California, Texas or Mexico.  Our standard recommendations, however, do remain in place.  Cover your cough or your sneeze, wash your hands frequently and see your doctor if you have fever, cough, sore throat, body aches, headache, chills and fatigue, and we do want people to realize that some people have reported diarrhea and vomiting associated with the swine flu.

Some other specific CDC actions include posting of another MMWR health dispatch.  That will be up later this afternoon.  This puts forth our latest recommendations, and as we’ve noted before, these include that clinicians should consider swine flu in the differential diagnosis of patients with febrile respiratory illness who live in San Diego in and Imperial County in California and Guadalupe County in Texas or have traveled to these areas or been in contact with ill persons from these areas on the seven days before their illness onset. 

CDC requests that state public health laboratories and all influenza specimens that cannot be subtyped to the CDC Influenza Division (borrows) surveillance and diagnostics branch laboratory.  And as a precautionary step, the CDC is working to develop vaccine seed strains specific to these recent swine influenza viruses in humans.  This is also something we often initiate when we encounter a new influenza virus that has the potential to cause significant human illness. 

We’ve created a web page with information and updates.  We encourage the public and the media to visit this web site for information.  It’s cdc.gov/flu/swine.  But you can get it from our main web site; there’s a link there.  We also have a CDC information line that’s set up, and that’s 1-800-CDC-INFO.

I’d now like to open it up to questions.  We’ll begin with some questions in the room, and then we’ll move on to some from the – from the phone bridge.

UNIDENTIFIED PARTICIPANT:  Our first question.

UNIDENTIFIED PARTICIPANT:  (INAUDIBLE) here in Atlanta you talked a little bit about today you’re growing more concerned.  Tell us a little bit about why more concerned today.

BESSER:  Well, what we’ve learned from yesterday when we spoke with you and today is that the cluster of cases that we’re seeing in Mexico is being attributed to the swine flu virus.  What we are seeing here in the United States so far are eight cases of swine flu, primarily mild disease.  All have recovered.  Only one of the eight has been hospitalized.  It’s really critically important we learn more about what’s going on in Mexico because reports from Mexico are raising concerns about much more severe disease, and in that – in Mexico individuals who have died.  We do know or have heard from the health officials in Mexico that there are other influenza viruses that are circling there.  They are other viruses – respiratory viruses circulating, and so sorting out what is caused potentially by the swine flu virus, what is caused by other or what could be caused by co-infection, those are important public health questions.

LAURIE DANIEL, NBC NEWS:  Hi.  Laurie Daniel, NBC News.  Can you reconfirm is there a travel domestic restrictions that there is Mexico restrictions?

BESSER:  We don’t have restrictions for travel domestically or to Mexico.  What we’ve posted is something that we do all the time, and that’s an outbreak notice so that individuals who may be traveling to that area will be aware that there is an outbreak of respiratory infection and can decide for themselves whether to travel, and if they travel what precautions to take.

Let me go to the phone for a question, then we’ll go back and forth.  We’ll take the next question from the phone bridge, please.

OPERATOR:  The question is from Helen Branswell (ph).  Your line is open.

HELEN BRANSWELL (ph):  Hi, Dr. Besser.  Thanks so much for doing this.  I’m wondering if you can tell me, the samples that you’ve tested from Mexico that tested positive, has any at least preliminary sequencing of the virus isolates been done?  Can you say anything about how closely related they are to the isolates you have from the California cases, and also I’m wondering if you are talking to vaccine manufacturers about potentially ceasing production of seasonal flu vaccine for next fall and starting up production of a swine flu vaccine?

BESSER:  Thanks, Helen (ph).  As I said, the analyses of the – of the virus are preliminary.  We’ve been looking at one part of the virus, and what we’re seeing in that part of the virus is similarity.  But the more detailed analysis of the whole genome has not taken place.

In terms of the scale up for vaccine, what we have done is created a feed stock for this virus which is something we do whenever we see a new novel strain of influenza that cause disease, and then as part of that we would need to explore with the manufacturers what it would take to be able to scale up vaccine production.  At this point we have not made any decisions regarding the need for manufacturing of vaccine, but we thought it was prudent to develop that feed stock.

BRANSWELL (ph):  Can I ask a follow-up question?

BESSER:  Sure.

BRANSWELL (ph):  What pandemic threat level are we actually at today?

BESSER:  So far there has not been any change in the pandemic threat level.  The World Health Organization will be looking at the situation that’s occurring in Mexico and will be convening – most likely convening their group of experts to address that situation.  As Dr. Shook (ph) had talked about yesterday, there are really three things we want to look for when we’re thinking about whether a virus is causing a new pandemic.  One is is it new?  In order to cause a pandemic, you need a virus to which the majority of the population does not have protection or immunity.  Does it cause severe disease?  There are probably new viruses that appear all the time that don’t cause severe disease, but with an influenza virus, one of the factors we look at is the severity of disease.  And then the third factor is whether it’s easily transmissible and sustainable in a population.  So those are the three factors that WHO would be considering when they look at the threat level.

In the room.  We’ll go back to the phone bridge, please.

OPERATOR:  The next is from David Brown, Washington Post.  Your line is open.

DAVID BROWN, WASHINGTON POST:  Yes, thanks.  Acknowledging that the investigation is still under way, can you give us some sense of what you have heard about the number of cases and the number of deaths in Mexico, because it’s been – there’s been some reports of 60 deaths, hundreds of cases, and it would be nice to know what sort of order of magnitude we’re talking about.

BESSER:  Yes, you know I think that that’s a really important question, and we look forward to understanding more about the numbers from Mexico.  I’d refer you to the Mexican Government for that as well as the World Health Organization, which will be starting to report on cases reported to them.  We’re not in a position here to report on the number of cases and severity going on in Mexico.  We are offering support to the Mexican Government in terms of epidemiologists and laboratory scientists to help with their investigation.

BROWN:  OK, can I ask a follow-up?  There’s also been a report that their – the attack rate and severity is greater in sort of young adults, you know the kind of 19, 18 picture, young adults, teenagers rather than children and the elderly.  Have you heard that also?

BESSER:  Yes, I think that exploring the epidemiology, understanding who is getting sick in Mexico is critically important, and it’s premature to comment on that, but with a pandemic one of the things that you frequently see is infection in younger adults, a population that usually doesn’t get as severe disease from a seasonal flu outbreak.

In the room?  Yes.

JOHN CATER (ph), WXI 11 (ph):  John Cater (ph) from WXI 11 (ph), a live news out of Atlanta.  Just wondering is there a common thread that the patients in the cases that you’ve seen in the United States and Texas and California that each one of these people had?

BESSER:  That’s a great question, and that’s what we’re looking for.  So far we’ve not been able to identify that.  We’ve not been able to identify a common exposure or a common behavior that they’ve had, and when you’re doing an outbreak investigation, that’s what you’re looking for because that can give you a window into how can you potentially control – how is the virus spread and how can you potentially control the spread.  The number of cases we’ve identified in the United States, eight, is not very many, and so we are doing intensive looking to see are there cases out there that have gone undiagnosed, looking both in the clinic setting as well as in hospitals.  Are there patients in hospitals with pneumonia where a diagnosis wasn’t made who may, in fact, have this infection.  So far we haven’t identified any.

Phone line?

OPERATOR:  The next is from Rob Spine (ph), Washington Post.  Your line is open.

ROB SPINE (ph), WASHINGTON POST:  Yes, hi.  Thanks very much for taking this.  I just was hoping you could elaborate a little bit more on the analysis of the strains you’ve gotten from Mexico.  You said you analyzed 14, and 7 tested positive for the swine flu, and you see it looks like there’s a match.  So are all seven of those who tested positive, did they match the strains in the United States?

BESSER:  Yes, all seven isolates were matched based on the genetic component we analyzed it matched the strains that we've seen here in the United States. 

UNIDENTIFIED PARTICIPANT:  Great, thanks very much.  And so do you have any sense of why there is such a difference in illness that it’s causing?  Mild illness in this country and apparently severe illness in Mexico?

BESSER:  That's one of the analysis that both the laboratory will be working on and see are there any factors related to (INAUDIBLE) related to various disease that differ between the strains.  As well as something that we'll be looking at as part of the epidemiologic investigation to see are there other factors that would give us an answer as to why they're seeing more severe disease in Mexico. 

In the room?  We'll go back to the phone bridge.

OPERATOR:  The next is from Betsy McKay, Wall Street Journal, your line is open. 

BETSY MCKAY, WALL STREET JOURNAL:  Hi, Dr. Besser.  Thank you.  Just to follow-up on the previous question about the seven strains do you know who those seven strains are from?  In other words are any of these I mean of these seven samples are any of them from people who died in Mexico?  That's the first question. 

And secondly do you have any information on what links the U.S. cases may have to Mexico or were they Mexican-Americans, have they traveled or been in contact with family who traveled to and from Mexico? 

BESSER:  Thanks, Betsy, the first question was…?

MCKAY:  The seven…

BESSER:  Yes…

MCKAY:  Are any of them connected – are any of them from people who died?

BESSER:  We have not received detailed case information on the seven patients.  We do understand that they were taken from individuals with severe disease.  But we're looking to get more detailed information about that in terms of their ages and the clinical course. 

In terms of your second question, yes…

MCKAY:  (INAUDIBLE).

BESSER:  We’re in the process of working on those case investigations.  My understanding is that one of the cases in San Diego had traveled to Mexico.  Having lived in San Diego myself traveling to Mexico is a very common behavior and so, you know, it's hard to put any risk on that from what we know so far. 

Question in the room?  Back to the phone bridge. 

OPERATOR:  The next is from Daniel DeNoon, WebMD.  Your line is open. 

DANIEL DENOON, WEBMD:  Thanks very much, Dr. Besser so we hope this is going to be limited in Mexico and nothing is going to happen but can you walk me through what the scenario might be that would trigger a higher level of concern? 

In other words what might we see happen that would get CDC to move on?  And can you tell me if we did move on to a higher level of preparedness what that would look like and how we would proceed exactly?

BESSER:  There has been extensive planning across the federal government, across federal, state and local governments within the private sector, in schools.  Our communities have been planning for pandemic influenza for many, many years. 

We don’t know that this strain will develop into a pandemic strain.  But the level of planning that has taken place in this country in unprecedented.  And I think will allow us to respond in ways that we would not have been able to respond had this occurred 10 years ago. 

At this point we don’t know what actions will need to be taken.  There is a lot of work that's been going on around community control of a pandemic virus and what needs to take place.  The type of activities that need to take place depend on the severity of the virus.  And, you know, I’d refer you to our Web site on pandemic flu planning to see the detailed guidance around those types of steps. 

Again, though in terms of this situation and this swine flu we are not at the point and WHO is not at the point of declaring a pandemic.  We are at the point of trying to learn more about this virus and understand the transmission and how to control it. 

Another question from the phone bridge? 

OPERATOR:  Richard Knox, National Public Radio your line is open. 

RICHARD KNOX, NATIONAL PUBLIC RADIO:  It seems as though from what has been reported that it's likely – more likely than not that the conditions may be met to raise the level of pandemic alert to level four; novel virus, severe disease and fairly efficient or widespread (INAUDIBLE) transmission. 

When do you think you'll have enough information and WHO is likely to have enough information to make that determination?  And I have a follow-up too if I may. 

BESSER:  You know, we are working very closely with the World Health Organization.  We've been in direct contact with the Director General, Dr. Chan and the Deputy Director of PAHO having discussions around those questions as well as general control questions for this particular virus.  And they convene an expert panel to look at the conditions to determine whether or not we should elevate the status. 

When we look at what actions we take though we look at actions on the ground.  And so what you're seeing is a lot of activity around San Diego, a lot of activity in one part of Texas, a lot of activity in certain parts of Mexico.  And that's because that’s where we're seeing disease occurring.  What we expect to be seeing is that people start thinking about their own preparedness. 

What would they do if there were a pandemic?  What would they do if there were a new disease in their community?  It's all about general preparedness and I'd refer you to our Web site to get ideas as to what people could do as part of general preparedness. 

There has been a lot of business planning going on around if there were a pandemic what would businesses do?  School planning around what would they do.  This is the time for people to be thinking about that.  And, again, it's not because we have information that this will develop into a pandemic strain but it's a time where there is a teachable moment and people can take some action around preparedness. 

KNOX:  So, you're not prepared now to say how long it's likely to be before we know whether those conditions will be satisfied or not? 

BESSER:  No, but, you know, my initial comments that we're moving quickly.  That we are being very aggressive in our approach.  We are taking this very seriously.  That applies not just to our activities here at the Centers for Disease Control and Prevention but that goes for the thinking at the World Health Organization. 

So, I expect that each day we're going to be evaluating the situation and making decisions. 

UNIDENTIFIED PARTICIPANT:  If you went to Mexico would you do exactly the same thing that you would do in Mexico as you’re doing here on the ground or would you, you know, be following Mexican officials or…?

BESSER:  In terms of assistance?  CDC has a long history of providing assistance on outbreak investigations domestically and globally.  And so the same sort of things that we are assisting folks in California and Texas, the things that they're doing on the ground, trying to identify who was sick, looking to see who was in contact and whether those individuals get sick. 

That gives you an idea as to whether the virus can spread, collecting samples and trying to understand the disease transmission, is there – what did the spectrum of disease look like?  Those are very important things to help us determine whether the conditions for a pandemic will be met. 

UNIDENTIFIED PARTICIPANT:  Other countries like Mexico are usually happy to have you guys come. 

BESSER:  The CDC has personnel all around the globe and our interactions with Mexico are very strong in this area. 

UNIDENTIFIED PARTICIPANT:  And should people outside of Texas and California, how concerned should they really be about them?

BESSER:  Well, you know, I think that it's very important that people are paying attention to what's going on.  The situation has been developing quickly.  As I said at the beginning, this is something we are worried about and we are treating very seriously. 

I think that’s important that people are paying attention to what's going on.  At this point, all we have in terms of cases is in those two areas in Texas and in California but it is worth people thinking about this. 

On the phone?

OPERATOR:  The next is from Maggie Croux (ph) of Reuters.  Your line is open. 

Maggie Croux:  Dr. Besser, you say you got strong interactions with Mexico but are CDC personnel in Mexico and has Mexico officially asked CDC help.  And can I ask you if anyone is talking about trying to contain this virus. 

BESSER:  We are, we have not sent a team to Mexico yet.  We're still in discussions with Mexico but we anticipate that we will have folks there very soon.  In terms of the issue of containment, you know, there are things that we see that suggest containment is not very likely and that we're seeing cases in Texas and we're seeing cases in San Diego without any connection between them which makes us think that there has been transmission from person to person through several cycles. 

You know, the idea of containment with a new infection we think about when it's limited to a focus, a well defined geographic area and that’s not something that we have seen here. 

UNIDENTIFIED PARTICIPANT:  OK.  When you talk about spreading from person to person through several cycles, tell me what you mean by that. 

BESSER:  Yes.  Thinking there – if you have an individual who's sick and you have another individual who's sick and you can find no connection between them.  So it hasn’t gone from one individual to another family member to another person that family member had contact with. 

That would in a sense a two step move.  Here we're not seeing any linkages at all between the cases in Texas and those in California.  But again it's really early in the investigation.  As more information comes to light, we could see connections that haven't shown up so far. 

CROUX:  Is the Canada Mexico connection, why does Canada evaluate Mexico viruses?

BESSER:  You know, many countries provide support to other countries through bilateral relations.  And just as we provide support and other countries provide support to us.  So there is a relationship between Canada and Mexico that lead to that taking place. 

On the phone?

OPERATOR:  The next is from Mike Stobbe, Associated Press.  Your line is open. 

Mike Stobbe, Assoicated Press:  Hi, doctor.  Thanks for taking the question.  So, 14 samples from Mexico, seven positive.  I'm going to add a fault to this but can we say in a simple statement that it’s the same virus in Mexico as in California and Texas?

BESSER:  I think that you would be safe in saying that.  From everything we know to date, the virus appears to be the same.  You know, again, my earlier comments that information is changing and as we find more information, we'll share that with you. 

So far, the genetic elements we've looked at are the same. 

Stobbe:  OK.  As a follow-up, what were the other seven that came back?  What did they turn out to be.  Also you mentioned one person from San Diego had been to Mexico.  Which person was that?  The 10 -year-old boy? 

BESSER:  The other samples came up negative and so we can't really say anything about those specimens.  And I'm sorry your second question?

Stobbe:  One person had been to Mexico, somebody from San Diego.  Which individual was that?  Was it the 10-year-old boy or the father or was it the teenage daughter or –

BESSER:  I'm going to need to refer to the folks in San Diego on that.

Stobbe:  OK.  Thank you. 

BESSER:  Yes.

Stobbe:  One more question on air travel, maybe in a little bit different kind of context.  My understanding is that some of the local authorities in a press conference in Texas suggested that folks who may be suffering flu like symptoms perhaps ought to consider staying off of airplanes type spaces, circulated air. 

Is that something that you all would recommend?

BESSER:  Well, that’s the general recommendation.  You know, it’s a good idea, if you're sick and you have the flu, you should stay home whether you're planning to go on a plane for travel or you're planning to go to work. 

We know that influenza, seasonal flu, is spread person to person.  And staying home allows you to rest and recover but it also allows you to not spread your infection to your coworker or the person sitting next to you on a plane. 

So that’s a general recommendation that we have but if you're sick with fever and aches and flu like symptoms, you shouldn’t be getting on a plane.  On the phone?

OPERATOR:  The next is from Mike Lees, San Diego Union Tribune.  Your line is open. 

Mike Lees, San Diego Union Tribune:  Thank you and thank you for taking the call.  I'm looking for a couple of things here.  One is some details on the newest case in San Diego, the City of Residents, whether the patient was hospitalized, and I believe you said the person has recovered. 

And then secondly, I'm looking at what the geographic area is that you're asking doctors to test specimens from patients with flu like symptoms?

BESSER:  Yes.  The newest case in San Diego, I'll need to refer you to the health department there.  I don't have those specific details.  I know that the child recovered and I believe was not hospitalized. 

In terms of the areas that we're looking at, in terms of doctors doing testing, we're looking at patients in the areas where we've seen cases so far, which is in San Diego County and Imperial County and Guadalupe County in Texas. 

But it's important that clinicians have a high index of suspicion.  As I said at the beginning, we're just starting to learn here about this virus and about transmission and so having a high index of suspicion is a good idea. 

Travel histories are useful.  If you have a patient who has traveled to Mexico to a part of that country that’s been affected, it's really important that you do the proper testing.  Other questions in the room.  I have time for two more questions.  One in the room and one on the phone.  OK, two from the phone. 

OPERATOR:  The next is from Jeffrey Wise, Dallas Morning News.  Your line is open. 

Jeffrey Wise, Dallas Morning News:  Yes.  A clarification and then a question.  The clarification, the cases in Mexico, do we know if any of those people had contact with swine and then the question is Dallas is one of many cities where there is a lot of travel between Mexico, Mexico City in particular, and Dallas.  Is there anything that local officials should be doing thinking about DFW Airport or at the bus station or other places where people do a lot of travel. 

BESSER:  At this point we don't know about swine contact with cases in Mexico.  We really don't have detailed information on those cases and their exposures.  That’s one of the important reasons to do a detailed investigation. 

In terms of travel screening and at airports or bus stations, there are approximately 400 million crossing at the border between United States and Mexico a year.  I think that the best approach is really encourage people who are sick not to travel.  So if you have the flu you shouldn’t be getting on the bus or getting on the airplane and traveling. 

Thank you very much.  I appreciate your questions and we will be providing regular updates. 

End

[DazzaMc]

WHO sets emergency meeting on swine flu outbreak

GENEVA (Reuters) - The World Health Organisation said on Saturday it will hold an emergency meeting at 3:00 p.m. British time (1400 GMT) to discuss a deadly swine flu strain outbreak in Mexico and the United States.

WHO Director-General Margaret Chan called the "virtual meeting" that will link public health authorities and experts in various parts of the world "to seek their advice and guidance," WHO spokesman Fadela Chaib told Reuters.

Chan will also brief journalists about the outbreak -- which has killed up to 68 people in Mexico and infected 8 in the United States -- on a teleconference before the virtual meeting starts, at 2:00 p.m. British time (1300 GMT).

The experts will not necessarily issue firm recommendations on Saturday. Once more details are clear about the virus and its risks, the emergency panel could recommend a change in the WHO's pandemic alert level -- currently at 3 on a scale of 1 to 6 -- or recommend travel advisories to control the flu's spread.

http://uk.reuters.com/article/UKNews1/idUKTRE53O1AD20090425


We find out more at around 3pm I guess.
 

[sickofpollies]

A guy at work nailed what the next big scare would be. He said it was time for another influenza pandemic scare. I'm pretty sure he even guessed it would be pigs, though he said it in jest.

[DazzaMc]

Yep - it's past time for another.
Not sure if this will be it or not but we watch and learn as we go...

H5N1 is still trying it's hardest as well.

[DazzaMc]

Oh - the piggies are the perfect cross over bridge to human DNA.
It would almost be a safe bet to say the next lot will come from piggies...

 

[DazzaMc]

Google Map of current outbreaks - Live Data

[DazzaMc]

UPDATE 2-WHO chief says swine flu has pandemic potential


* WHO emergency committee to advise on changing alert level
* All countries urged to be vigilant for unusual cases
* Premature to issue travel advisories, WHO head says
* Too soon to switch to production of new flu vaccine

GENEVA, April 25 (Reuters) - Outbreaks of swine flu in Mexico and the United States have the potential to cause a worldwide pandemic but it is too early to say whether they will, the head of the World Health Organisation said on Saturday.

WHO director-general Margaret Chan urged health authorities in all countries to be on high alert for unusual patterns of disease and any rise in severe flu or pneumonia cases.

"This is clearly an animal strain of the H1N1 virus and it has pandemic potential because it is infecting people," Chan said on a teleconference.

"However, we cannot say on the basis of currently available laboratory, epidemiological, and clinical evidence whether or not it will indeed cause a pandemic."

The United Nations health agency has warned for several years that a new virus strain could spark a human influenza pandemic that could sweep around the globe and kill millions.

The new H1N1 flu strain -- a mixture of swine, human and avian flu viruses which has killed up to 68 people among 1,004 suspected cases in Mexico and infected eight in the United States -- is still poorly understood and the situation is evolving quickly, Chan said.

There were currently no indications of similar outbreaks elsewhere in the world, she said.

"It would be prudent for health officials within countries to be alert to outbreaks of influenza-like illness or pneumonia, especially if these occur outside in months outside the usual peak influenza season," added Chan, a former health director of Hong Kong.

Health officials worldwide should also be alert to large incidences of severe or fatal flu-like illness in groups other than young children and the elderly, the ages usually at highest risk from normal seasonal flu, she said.

Most of the dead in Mexico were aged between 25 and 45.

WHO experts have been deployed in Mexico to help health authorities with disease surveillance, laboratory diagnosis and clinical management of cases.

The WHO stood ready with antivirals to combat the outbreaks in Mexico. But authorities have a sizeable supply of Tamiflu, known generically as oseltamivir, and made by Switzerland's Roche Holding (ROG.VX), which has proved effective against the new virus, according to the WHO.



"NOTORIOUSLY UNPREDICTABLE"

"Influenza viruses are notoriously unpredictable and full of surprises, as we are seeing right now," Chan said.

"We need to know how the virus is spread, what is the transmission pattern and whether or not it is going to cause severe disease and in what age group," she said.

An emergency committee of 15 experts was meeting on Saturday to advise her about any "temporary measures" to protect international health or whether to recommend a change in the WHO's pandemic alert level, currently 3 on a scale of 1 to 6.

It was "too premature at this stage" for the WHO to announce any travel advisories, as better analysis of the cases and other clinical data was required, she said. But the experts would address the issue of travel advisories.

"We do not yet have a complete picture of the epidemiology or the risk, including possible spread beyond the currently affected areas," Chan said.

"Nonetheless, in the assessment of WHO, this is a serious situation which must be watched very closely."

It was also too soon for the U.N. agency to advise drugmakers to switch to producing a new vaccine -- to be derived from the new virus -- from their traditional production of seasonal influenza vaccines, she said. (For other stories on swine flu click on [nFLU]) (For WHO information on swine flu go to: here ) (Editing by Mark Trevelyan)

http://www.reuters.com/article/wtUSInvestingNews/idUSLP31018720090425?sp=true

[DazzaMc]

Nearer to home....

Ministry monitoring swine flu pandemic

The Ministry of Health is monitoring a new flu virus after the World Health Organisation (WHO) warned it could start a global epidemic.

More than 80 people in Mexico are believed to have died and over 1300 are sick as a result of catching swine flu which has led to the closure of schools in Mexico city.

There have also been cases of the swine flu reported in New York, California and Kansas and a British Airways pilot has been hospitalised in London with flu symptons after returning from Mexico .

The WHO has declared the outbreaks a "public health event of international concern" and said they could cause a pandemic -- a global epidemic of serious disease.

Normal border control procedures were in place, and the WHO has asked all countries to "intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia".

The ministry here said it continued to be in contact with the WHO and was liaising with Australia over its response at this stage was. "We are implementing the early stages of our pandemic response plan," a spokesman said.

"However at this stage there is no indication that this will be needed.,"


http://nz.news.yahoo.com/a/-/top-stories/5523371/ministry-monitoring-swine-flu-pandemic/

[DazzaMc]

Australia issues warning after swine flu outbreak

Australian health authorities have urged travellers who have recently returned from Mexico with flu-like symptoms to visit a doctor.

The Department of Health and Ageing says it is aware of the recent outbreak of illness in Mexico which has killed at least 60 people and infected hundreds more.

The World Health Organisation (WHO) today declared the swine flu outbreak an international public health emergency.

The deadly strain has been found in three Mexican cities and in the US border states of California and Texas, but new reports suggest it may also have reached as far as Kansas and New York.

Australian authorities are liaising with the WHO, the US Centres for Disease Control and Prevention (CDC) and other relevant public health experts, and say they will maintain a watching brief on the virus.

The department warned that anyone who has returned from Mexico with flu-like symptoms since March this year should seek advice from a general practitioner.

More

[DazzaMc]

Strict Monitoring Of Swine Flu In Place
Sunday, 26 April 2009, 1:38 pm
Press Release: NZ Ministry of Health 


All Media


Media Release
26 April 2009

Strict Monitoring Of Swine Flu In Place

The Ministry of Health is continuing to monitor updates from the World Health Organisation concerning an outbreak of swine influenza (H1N1) in Mexico and the western United States.

Normal border control procedures are in place, and the WHO has asked all countries to "intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia". 

The Ministry continues to be in contact with the WHO and is liasing with Australia in terms of what their response at this stage is.  We are implementing the early stages of our pandemic response plan, however at this stage there is no indication that this will be needed.

An updated statement will be issued as soon as more information is available. 

The WHO statements can be found by following this link:
http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/index.html

WHO questions and answers concerning swine influenza:
http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/index.html

ENDS

[DazzaMc]

The latest from here in New York:  Two more schools as well as a daycare center now being investigated.  Symptoms include "high fevers" of 101 degrees, and also vomiting with the usual coughing, etc.