Bleak News of the Day

Situation Update No. 1
On 2009-04-23 at 12:33:27 [UTC]

Event: Epidemic Hazard
Location: USA State of California San Diego and Imperial Counties

Infected: 2 persons

Situation

Health officials alerted doctors Tuesday to a unique type of swine flu diagnosed in two California children, but it’s unclear whether many people will be susceptible to the infection. The children were diagnosed last week. One was a 10-year-old boy in San Diego County, and the other a 9-year-old girl in neighboring Imperial County. Both recovered. U.S. Centers for Disease Control and Prevention officials said there’s no reason for the public to take unusual measures against it. “CDC is concerned, but that’s our job,” said CDC spokesman Tom Skinner. Health officials have long feared the emergence of a deadly form of flu. They have not noted a spike in flu cases or a rash of severe illnesses. But they are continuing to investigate the genetics of the virus and track down and test people who may have been in contact with the children. Both children became sick in late March and experienced fever and cough. The boy also vomited. The two had not been in contact with each other, CDC officials said. The boy’s mother and brother also had a flu-like illness recently, as did a brother and a cousin of the girl. None of those relatives were tested for flu at the time of their illness. The San Diego County boy and his 8-year-old brother flew from California to Dallas in early April and are currently with relatives in Texas. Health officials also are trying to contact the plane’s flight crew and two children who sat near the boys, CDC officials said.

In the past, CDC received reports of approximately one human swine influenza virus infection every one or two years. But more than a dozen cases of human infection with swine influenza have been reported since late 2005. Most cases occur in people who were exposed to pigs. Neither child had touched a pig, according to their families, although the girl had been at an Imperial County agricultural fair four weeks before she got sick. The jump in cases in the past few years could be because of technological improvements and expansion of public health laboratories, which have improved testing capacity. But genetic mutations could also play a role. The new flu contains a unique combination of gene segments that have not been seen in swine or human flu viruses before, CDC officials said. The same virus has not been detected in any California pigs. “But we don’t test every pig for influenza, so we don’t know all the strains that are circulating,” said Dr. Gil Chavez, California’s state epidemiologist. Early tests indicate this type of flu is resistant to amantadine and rimantadine, two common antiviral medications. It is not unique in that respect — a more common virus that’s been infecting people this flu season also is resistant to those drugs. Health officials think the current seasonal flu vaccine may not protect against it.

Swine flu is an infamous disease in public health circles. In 1976, health officials were frightened by unusual cases of swine flu in soldiers at Fort Dix, N.J. The virus appeared to be similar to a deadly flu that killed millions around the world in 1918 and 1919. Federal officials vaccinated 40 million Americans during a national campaign. The pandemic never materialized, but thousands who got the shots filed injury claims, saying they suffered a paralyzing condition and other side effects from the vaccinations. The government is more sophisticated now in how it diagnoses and tracks diseases, said Dr. Lyn Finelli, a CDC epidemiologist.

Situation Update No. 3
On 2009-04-24 at 03:23:13 [UTC]

Event: Epidemic Hazard
Location: USA MuntiStates States of California, Texas

Infected: 7 persons

Situation

Nevada state health officials are on heightened alert after a federal agency confirmed seven cases of swine flu in people who appear to have had no contact with pigs. A 10-year-old boy and a 9-year-old girl in Southern California were first diagnosed with an “unusual” strain of swine flu last week, the Centers for Disease Control and Prevention, based in Atlanta, said during a teleconference today. Since then five other cases, including two in Texas that were confirmed this morning, have been found, officials said. Typically, the swine flu virus was transmitted to people who had contact with pigs, but in the latest cases, no such connection to the animals has been discovered, officials said. Although there have been no swine flu cases reported in Nevada, the state Health Division is preparing a technical bulletin for doctors around the state, Martha Framsted, spokeswoman for the health division, said.

State health investigators with epidemiologists are staying in contact with the CDC daily, said Framsted. The technical bulletin will be posted to the state Health Division’s Web site probably as soon as Friday, Framsted said. Like typical influenza, swine flu can be prevented by washing hands thoroughly, staying home if coughing, sneezing or diarrhea is occurring and by receiving a flu vaccine annually, Framsted said. Four different segments of influenza strains have been found in the cases of swine flu discovered so far, including the North American, the North American avian, human and swine strains from Asia and Europe, CDC officials said. These swine flu strains combined have not been seen before in any laboratory. A total of five swine flu cases have been confirmed in California from San Diego County and the Imperial Valley, CDC officials said. A father and his daughter contracted the flu there. In Texas two 16-year-old boys, classmates in San Antonio, were diagnosed with the same strain. Ages of the people who have had this swine flu range from 9 years of age to 54, CDC said. It is unknown how the virus is spreading, as a 10-year-old boy traveled from California to Dallas, but none of that particular flu strain has been found in Dallas, CDC said. All of the cases have recovered. One was hospitalized, but has since recovered. As the typical influenza season winds down, CDC officials said, it is unusual for swine flu to arise.

Situation Update No. 4
On 2009-04-24 at 18:27:03 [UTC]

Event: Epidemic Hazard
Location: USA MuntiStates States of California, Texas

Infected: 7 persons

Situation

The World Health Organization said on Friday it was calling an emergency committee to advise whether outbreaks of swine flu in humans in the United States and Mexico constituted an international public health threat. A deadly strain of swine flu never seen before has broken out in Mexico, killing as many as 60 people and raising fears of a possible spread across North America. “WHO will convene, sometime in the very near future, an emergency committee under the International Health Regulations, which will consider whether or not this event constitutes a public health event of international concern,” WHO spokesman Gregory Hartl told Reuters in Geneva. Hartl also said that 12 of 18 samples taken from victims in Mexico showed the virus had a genetic structure identical to that of a swine flu virus found in California. But more epidemiological information was needed before any change to the WHO’s pandemic alert level, currently at ‘3′ on a scale of 1 to 6, he said. “The technical people in our organization are saying that before we know how pandemic a virus can be, we need to know how efficiently it is transmitting and how widespread it is,” Hartl said.

Situation Update No. 5
On 2009-04-24 at 18:29:10 [UTC]

Event: Epidemic Hazard
Location: USA MuntiStates States of California, Texas

Infected: 7 persons

Situation

Disease trackers are asking U.S. hospitals to help follow a new strain of swine flu and are trying to determine whether it’s related to hundreds of illnesses and 57 deaths in Mexico. A previously unseen variant of H1N1 swine influenza has sickened at least seven people in California and Texas, the Atlanta-based U.S. Centers for Disease Control and Prevention said yesterday. The World Health Organization said 57 people died among more than 800 in the Mexico City region who developed flu-like symptoms in the past month. Global health experts are studying whether the U.S. and Mexico illnesses pose a threat of pandemic, according to the European Centre for Disease Prevention and Control. U.S. hospitals today were asked to collect samples from patients with flu-like symptoms, said William Schaffner, a flu expert at Vanderbilt University School of Medicine in Nashville, Tennessee. “This has a sense of urgency about it,” Schaffner, chief of preventive medicine at Vanderbilt, said in a telephone interview today. “They are asking us who work in hospitals to go to our emergency rooms and our pediatric wards to gather specimens and start testing them.” Investigators haven’t found a link between the California and Texas cases, indicating the virus may be circulating elsewhere, Schaffner said. CDC disease experts will continue investigating whether the outbreaks have a common source, he said. The agency also will host a conference call today with experts, he said.

Threat of Pandemic

Flu can spread quickly when a new strain emerges, because no one has natural immunity. The so-called 1918 Spanish Flu pandemic, which may have killed as many as 50 million people, began when an avian flu virus jumped to people, experts said. “We are taking this very seriously,” Gregory Hartl, spokesman for WHO, the Geneva-based United Nations agency, said in a telephone interview today. “We have to get laboratory confirmation of what it is. We need to know how widespread it is.” The Mexico illnesses are affecting “otherwise healthy adults,” Hartl said.

Pandemic Potential

“The infection of humans with a novel influenza-A virus infection of animal origins, as has happened here, is of concern because of the risk, albeit small, that this could represent the appearance of viruses with pandemic potential,” the European Centre for Disease Prevention and Control, based in Stockholm, said in a statement. There’s no evidence a pandemic strain is evolving in the U.S., the European agency said. The CDC reached the same conclusion. “We don’t think this is a time for major concern,” Anne Schuchat, CDC’s director of respiratory diseases, told reporters on a conference call yesterday. Authorities in Mexico asked the Public Health Agency of Canada to help identify what’s causing the lung infection that has also spread to five health-care workers, the Ottawa-based agency said in an e-mail yesterday. Mexico Health Minister Jose Cordova canceled classes in Mexico City today and recommended citizens avoid public places. Canada’s National Microbiology Lab received 51 specimens from Mexico on April 22 and will test them for pathogens. Tests in Mexico found patients had the H1N1 and type-B influenza strains and the parainfluenza virus, the agency said.

Pigs Susceptible

Three main human flu strains — H3N2, H1N1 and type-B — cause 250,000 to 500,000 deaths a year globally, according to the World Health Organization, a United Nations agency. Pigs also are susceptible to flu, including the H1N1 subtype. “It will be critical to determine whether the strains of H1N1 isolated from patients in Mexico are also swine flu,” Donald Low, an infectious diseases specialist at Toronto’s Mount Sinai Hospital, told the Canadian Press. The CDC is discussing its cases and viruses with Mexico and the Pan American Health Organization, Schuchat said. “At this point, we do not have any confirmation of swine influenza in Mexico,” Schuchat said. Symptoms of the illnesses in Mexico include high fever, headache, eye pain, shortness of breath and extreme fatigue with rapid progression of symptoms to severe respiratory distress in about five days, the Canadian agency said. A “high proportion” of cases require mechanical respiration, it said.

U.S. Sickness

The four males and three females in San Diego County and Imperial County, California, and in San Antonio, diagnosed with swine flu had mild flu-like symptoms. The patients, 9 to 54 years old, included a father-daughter pair and two boys attending the same Texas school. The virus is contagious and spreading from human to human, the CDC said in a statement on its Web site. The patients began feeling sick from March 28 to April 19. All have recovered and only one was hospitalized, according to the CDC. None had direct contact with pigs. “That’s unusual,” Schuchat said. “We don’t know yet how widely it’s spreading and we certainly don’t know the extent of the problem.” As precaution, CDC is preparing the virus as a vaccine seed strain that could be used to make immunizations, she said. The swine flu virus contains four different gene segments representing both North American swine and avian influenza, human flu and a Eurasian swine flu, CDC said.

Not Seen Before

“We haven’t seen this strain before, but we haven’t been looking as intensively as we are these days,” Schuchat said. “It’s very possible that this is something new that hasn’t been happening before.” Swine influenza is a respiratory disease of pigs caused by type-A influenza that regularly causes outbreaks among the animals, according to the CDC. Swine flu doesn’t normally infect people, though human infections do occur and cases of human-to- human spread of swine flu viruses have been documented. Infection in pigs is regarded as especially problematic because of the risk of “reassortment” to produce a new virus, the European Centre for Disease Prevention and Control said. “These mild U.S. cases infected with a novel influenza are not reflecting the emergence of a pandemic strain, but they at least raise the possibility that there has been limited human- to-human transmission,” the health agency said.