Saturday, May 2, 2009

WHO Expecting to Move to Designate Flu Outbreak as Pandemic

The World Health Organization may designate the outbreak of H1N1 influenza as a pandemic by raising its six-stage alert level to its highest step even as many cases of swine flu show symptoms no more severe than seasonal flu, health officials said.

The WHO isn’t seeing sustained community transmission of the virus, known formally as influenza A H1N1, outside of North America, said Michael Ryan, the WHO’s director of global alert and response, at a news conference yesterday in Geneva where the UN health agency is based.

Ireland became the 17th country yesterday to confirm swine flu and the new virus may be spreading in five nations among people unconnected to Mexico, where cases were first reported. The health minister in Mexico said yesterday the country had no new deaths attributed to the virus.

“At this stage we have to expect that phase 6 will be reached; we have to hope that it won’t be reached,” Ryan said. “I would still propose that a pandemic is imminent.”

International health experts said the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century’s three pandemics occurred. The WHO hasn’t had a single phase 6 alert since it introduced the six-level system in 2005. Before this week, the warning had been at phase 3 since 2007, when it was elevated for an outbreak of avian flu, according to the WHO Web site.

Tracked One Week
In little more than a week, world health authorities have tracked the emergence of the flu from an outbreak in Mexico and a few cases in Texas and California to more than 650 confirmed illness in 17 countries across the globe. The virus has shuttered school and offices in Mexico and the U.S., the next hardest hit country, stirred governments to use their treatment stockpiles, and spurred a quest for a vaccine before the beginning of the next flu season.

The virus is already at pandemic level, according to Ira Longini, a researcher at the University of Washington in Seattle who advises the U.S. government on flu.

“The definition of a pandemic is that the new virus has spread to several countries and is transmissible,” Longini said in an interview yesterday. “It’s hard to imagine it’s not going to continue to spread in some form.”

The number of confirmed dead from the H1N1 virus in Mexico is 16, unchanged from May 1, said Mexico’s health minister Jose Cordova at a news conference in Mexico City. Cordova said the number of Mexico’s confirmed cases, including the deaths, rose to 443 from 397.

‘Stabilization Phase’

“We are in a stabilization phase,” Cordova said. “Still, it is too soon to say we are past the most complicated moment.”

The WHO’s statistics, which lag behind those reported by national and local agencies, confirmed 397 cases in Mexico and 658 worldwide. It listed illnesses in the U.S., Canada, the U.K., Austria, Germany, the Netherlands, Denmark, Switzerland, Spain, Israel, Hong Kong, New Zealand, France, South Korea and Costa Rica.

Ireland yesterday confirmed is first case, a man who had recently returned from a trip to Mexico, according to a statement last night from Tony Holohan, chief medical officer of the Department of Heath and Children.

U.S. President Barack Obama spoke about 20 minutes yesterday by telephone with Mexican President Felipe Calderon to share information about their countries’ efforts to limit the spread of the influenza and stress the importance of continuing close cooperation between their governments, according to a White House statement.

Potential Harm

“This is a new strain of the influenza virus, and because we haven’t developed an immunity to it, it has more potential to cause us harm,” Obama said yesterday in his weekly radio and Internet address. “This creates the potential for a pandemic, which is why we are acting quickly and aggressively.”

Obama has asked U.S. lawmakers for $1.5 billion to battle the outbreak and prepare for it to resurface during flu season.

Still, he said the virus hasn’t been as virulent in the U.S. as in Mexico and antiviral treatments have shown to be effective.

The U.K., U.S., Germany, Canada and Spain each confirmed cases in people who didn’t travel to Mexico. The expanding wave of sickness has been similar to seasonal flu, though health authorities are taking no chances with a virus that may flash across the globe, infecting a population with no natural immunity, said the U.S. Centers for Disease Control and Prevention.

Staying Prepared

“Even though we might be seeing only mild cases now, we cannot say what will happen in the future,” Gregory Hartl, a spokesman for the WHO, told reporters on May 1. “If at the end of the day it remains a mild pandemic or if we can somehow avert the worst of the disease or stop the worst of the disease, then that’s fantastic. We will have done our job well.”

The Geneva-based WHO raised its six-tier pandemic alert to 5 on April 29. Stage 6 would signal a pandemic and alert governments to enact plans against the disease.

Canada became the first country to report a case of transmission of the virus from humans to pigs. A farm worker in the province of Alberta, who had recently traveled to Mexico, contracted the virus and probably is the source of the infection in the pig herd, Brian Evans, executive vice president of the Canadian Food Inspection Agency, told reporters yesterday.

More Cases

Canada also reported an increase of confirmed cases to 85 from 51 though most patients have reported mild symptoms, said David Butler-Jones, Canada’s chief public health officer.

New York officials said they suspect more than 1,000 cases, so many that the government has stopped testing all but the sickest there.

Evidence suggests “transmission is widespread, and that less severe illness is common,” the Atlanta-based CDC said in a report May 1. In Mexico “a large number of undetected cases of illness might exist in persons seeking care in primary-care settings or not seeking care at all,” the CDC report said.

In the U.S., at least 433 schools had closed in 17 states, leaving parents to find other arrangements for 245,449 students, according to the Education Department. Five colleges closed, the department said in an e-mail.

The CDC raised its flu count yesterday to 160 cases in 21 states, including the only U.S. fatality, a 22-month-old child who died April 27 at a Houston hospital. The Boston Globe reported that New Hampshire became the 22nd U.S. state with an illness after authorities yesterday confirmed its first H1N1 infection, which had been reported April 30 as probable.
Higher U.S. Tally

The new influenza strain, a conglomeration of genes from swine, bird and human viruses, poses the biggest threat of a flu pandemic since 2003, when the H5N1 strain killed millions of birds and hundreds of people, William Schaffner, an influenza expert at Vanderbilt University School of Medicine in Nashville, Tennessee, said in a May 1 interview.

“In Nashville, we are getting the sense that out in our community there is a lot of relatively mild influenza illness among children and increasing among their parents -- much of this is suspected to be H1N1,” Schaffner said. “By now our usual influenza season is over by weeks, but that’s clearly not the case.”

The 2003 avian flu killed more than half of the people who got it. It didn’t spread from person to person and only infected 421 people. The Spanish flu of 1918, another version of bird flu, killed as many as 50 million people in one of history’s deadliest outbreaks.

Vaccine Production

Batches of seed virus are being developed for potential vaccine production, according to WHO. Paris-based Sanofi-Aventis SA, Baxter International Inc. of Deerfield, Illinois, and GlaxoSmithKline Plc of London are talking with world health authorities about producing shots, the agency said.

“It seems most likely that the manufacturers will proceed and we will certainly support them,” Marie-Paule Kieny, WHO’s vaccine director, told reporters in Geneva.

Production of vaccines against the new H1N1 influenza will be completed “in parallel with or after the seasonal vaccine is produced,” Nancy Cox, chief of the flu division at the CDC’s Center for Immunization and Respiratory Disease, said at a news conference in Atlanta on May 1.

The three main seasonal flu strains -- H3N2, H1N1 and type- B -- cause 250,000 to 500,000 deaths a year globally, according to WHO. The new flu’s symptoms are similar, including fever and coughing, nausea and vomiting, according to the CDC.

Authorities advised hand-washing, hygiene and staying home if sick as the most effective ways to control the outbreak.