The Influenza A (H1N1) outbreak, commonly known as swine flu, continues to intensify globally as the number of confirmed human cases jumped to 257 on Thursday (April 30) from a previous 148 cases on Wednesday (April 29), reports from the UN’s World Health Organization (WHO) said. No new deaths were reported today, leaving the worldwide death toll at eight, with seven confirmed in Mexico and one in the US. According to the WHO’s update on Thursday, 11 countries – US (109), Mexico (97), Canada (19), Spain (13), UK (8), Germany (3), New Zealand (3), Israel (2), Austria (1), Netherlands (1) and Switzerland (1) – have reported laboratory confirmed human cases. The Netherlands and Switzerland are the latest countries to confirm swine flu cases. Several media reports have noted Peru confirming its first swine flu case, but it was not among the WHO’s official tally. The UN health agency’s tally of confirmed cases has lagged behind those that individual countries report because it has to wait for formal notification from the affected nation.
In addition to investigating suspected cases in countries already affected by the disease, the WHO is monitoring and awaiting test results in 15 other countries possibly having the virus – Australia, France, Chile, Brazil, Denmark, Colombia, South Korea, Argentina, Guatemala, Costa Rica, El Salvador, South Africa, Finland, Norway and Serbia. The WHO defines “possible” as cases where the patient tested positive for Influenza A, which is the general category of strains that includes the H1N1 swine virus, and needs additional tests to verify whether they are positive for the specific virus. Dr. Keiji Fukuda, assistant director-general of the WHO said the higher totals does not necessarily mean incidence of the disease is increasing, but rather that health investigators are getting through their backlog of specimens. Several thousand samples are being analyzed. Under pressure from meat industry producers and concerned governments, the WHO has decided to refer to the new virus strain as Influenza A (H1N1), not swine flu.
On Wednesday, the WHO raised its pandemic alert for swine flu to Phase 5 in a six-phase preparedness plan created by the WHO. Phase 5 is the second highest alert level, meaning there is a sustained human-to-human spread in at least two countries. In addition, the alert shows that the WHO believes a global outbreak of the disease is imminent. The increased alert level also signals that efforts to produce a vaccine will be increased. No evidence has surfaced that suggests the WHO should raise its pandemic alert to Phase 6, the highest level, due to the outbreak. To move up to Phase 6 would require confirmation that the virus is spreading from human-to-human in a sustained way in a country in another region besides North America. In the US, the situation continued to escalate as additional human infections were confirmed and more cases were suspected. According to the US Centers for Disease Control and Prevention (CDC), the number of laboratory confirmed cases in the US increased to 109, up from 91 cases on Wednesday. The number of states affected grew to 11 as South Carolina confirmed 10 swine flu infections. Within the previously affected states – New York (50), Texas (26), California (14), Kansas (2), Massachusetts (2), Arizona (1), Indiana (1), Michigan (1), Nevada (1) and Ohio (1) – Texas confirmed 10 more cases, while Michigan and Nevada decreased by one case each. Officials from other states have confirmed cases, but they have yet to be confirmed by the WHO. Due to the threat of a possible pandemic, more than 100 US schools have been closed as a precautionary measure. US President Barack Obama on Wednesday called on schools with confirmed or suspected swine flu cases to “strongly consider temporarily closing” to ensure safety to others. In the event a school has a confirmed case, the CDC recommends the closure of the facility for about seven days. On Thursday, about 30 Marines on a Southern California military base were quarantined after one of them became the first US serviceman to have contracted the virus.
In Mexico, the epicenter of the outbreak, the number of confirmed cases increased to 97 from a previously stable 26. The death toll remains at seven, a decrease from 20 after Mexican authorities revised down the number of confirmed swine flu deaths on Tuesday (April 28) following additional testing recommended by the WHO. The other 13 cases have not been confirmed yet. The suspected death toll due to the virus increased to 176 from 159 yesterday. More than 1,300 people were in hospitals out of an estimated total of 2,500 suspected cases. All those suspected to be infected with the swine flu continue to be monitored and treated. Mexican President Felipe Calderon has ordered non-essential government offices and businesses to shut down for five days from Friday (May 1) to try to curb the spread of the virus. Schools nationwide have also been closed until at least May 6.
As of Tuesday, all new confirmed WHO cases had been associated with people who had traveled to Mexico. However, Spain on Wednesday reported the first case of swine flu affecting a person who had not recently visited Mexico, stressing the threat of person-to-person transmission. Another such case of community transmission in Spain could elevate the pandemic alert to its highest level. Ecuador joined Argentina and Cuba in banning travel to or from Mexico, while France continues to seek a European Union ban on flights to Mexico. The US, Canada and the European Union have advised people to avoid non-essential travel to Mexico, but no travel restrictions have been implemented. Additionally, the WHO advised against travel restrictions and border closures, saying such restrictions will not stop the spread of the virus and urging countries to instead boost domestic efforts to contain the spread of the virus. Obama has vowed to do “whatever it takes” to fight the outbreak, but rejected calls to close the US border, saying the move would be pointless with the virus already on US soil.
Meanwhile, Egypt on Thursday began seizing and slaughtering herds of pigs as a precaution against swine flu despite resistance by farmers and UN criticism. Egypt’s plan to cull up to 400,000 pigs is being called “a real mistake” by the UN because the new strain has not been detected in pigs. No cases of the disease have been reported in Egypt. Several countries have established bans on the importing of all pork products, despite the WHO declaring that the virus could not be transmitted by eating pork. The US has increased checks of people entering the country by air, land and sea. The WHO has also recommended that all countries track any suspect cases and ensure medical workers dealing with them guard themselves by wearing protective masks and gloves.
The CDC implemented its emergency response on Wednesday, and on Tuesday issued new interim guidance for clinicians on how to care for children and pregnant women who may become infected with the virus, since they are at high risk of serious complications from seasonal influenza. On Sunday (April 26), US Secretary of the Department of Homeland Security Janet Napolitano declared it a public health emergency in the US, allowing funding to be released to assist the public health response. The CDC has also been working closely with the WHO and with health officials in areas where the virus has been confirmed, sending staff domestically and internationally to provide guidance and technical support in affected areas. In conjunction with officials worldwide, the CDC’s goals include reducing transmission and illness severity and providing information to assist healthcare providers, public health officials and the public in addressing the challenges posed by the newly identified swine influenza. The CDC’s Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, oseltamivir (Tamiflu) and zanamivir (Relenza), personal protective equipment and respiratory protection devices to all 50 states and US territories to help them cope with the escalating outbreak. Laboratory tests have confirmed that influenza A (H1N1) is susceptible to both prescription antiviral drugs, oseltamivir and zanamivir, and they are most effective when taken soon after the onset of symptoms. According to the WHO, Swiss drug maker Roche indicated they were increasing production of Tamiflu to combat the infection. There is no direct vaccine available for the new virus, but the federal government and manufacturers have commenced the process of developing a vaccine against it. However, vaccine makers say it could take months to produce it in large quantities. US President Barack Obama on Tuesday requested US$1.5 billion from Congress to fight the spread of the new virus, help fund a plan to build drug stockpiles and monitor future cases of the disease. In addition, the money will help international efforts to combat the disease. Researchers are also still investigating the origins of the outbreak as it would be key in future prevention. Also, they are trying to understand the virulence of the strain and why it has caused serious illness and deaths in Mexico, but mild symptoms elsewhere.
BACKGROUND
Swine influenza has previously been identified as a contagious respiratory disease that commonly infects pigs and is caused by a type-A influenza. The current strain is a new variation of an H1N1 virus, which is known as a mix of human and animal versions. The dangers of this strain exist when the flu spreads from human to human instead of from animals to humans, as the virus can continue to mutate, making it difficult to treat and combat because people do not have natural immunity. Symptoms are similar to the common flu, causing fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea. Also like the common flu, the virus spreads when an infected person coughs or sneezes around another person. One can also become infected by touching something with the flu virus on it and then touching their mouth, nose or eyes. The CDC recommends taking everyday precautions such as frequent handwashing, covering up coughs and sneezes and staying away from work or school if not feeling well to prevent the disease from spreading. The WHO has recommended all nations “intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia.” Researchers are working to determine how easily transmissible the virus is from person to person.