Penumbra Pandemia

WHO: Swine flu count rises to 154, raises specter of level 6 pandemic
April 30th, 2009 Posted: 06:35 AM ET
GENEVA, Switzerland (CNN)
http://cnnwire.blogs.cnn.com/2009/04/30/who-swine-flu-count-rises-to-154-raises-specter-of-level-6-pandemic-2/
"The number of confirmed swine flu cases worldwide has risen to 154, with six additional cases reported in Spain, the World Health Organization said Thursday.
Until now, the country had four confirmed cases.
Of the 10 total cases of the 2009 H1N1 virus in Spain, nine were found in people who had returned from Mexico.
But authorities are troubled about the 10th case which they say is a case of community transmission, spread from one person in the community to another, said WHO spokesman Dick Thompson.
If Spain now sees more such cases of community transmission, the world body may have to elevate its pandemic alert another notch to its highest level.
Phase 6 is the pandemic phase and is characterized by a community-level outbreak in another country in a different WHO region."

Initial Test Results Today on Finland's First Suspected Case of Swine Flu
YLE
published Wednesday 29 April 2009 01:52 PM, updated Thursday 30 April 2009 01:28 PM
"Initial test results will be released later on Thursday on the first suspected case of swine flu in Finland An elderly woman was admitted to a hospital in Lahti complaining of flu symptoms after returning from a visit to Mexico earlier this week..
Laboratory tests were carried out and initial results results will be available on Thursday afternoon. A final analysis of further tests will be announced next week.
The patient’s symptoms are in line with national guidelines issued for swine flu infection. However, her symptoms remain mild and she is in no danger. Those who came into contact with the patient have been informed and given Tamiflu anti-viral medication. However, they show no signs of influenza.
The patient is being cared for in an isolation ward."

Sikainfluenssaepäilystä luvassa lisätietoa iltapäivällä
YLE Uutiset
julkaistu Thursday 30 April 2009 klo 12:29, päivitetty tänään klo 13:10
http://yle.fi/uutiset/kotimaa/2009/04/sikainfluenssaepailysta_luvassa_lisatietoa_iltapaivalla_714645.html
"Lahdessa sikainfluenssaepäilyn vuoksi hoidettavana olevan naisen tila on säilynyt hyvänä. Päijät-Hämeen alueella ei ole myöskään todettu uusia sikainfluenssaepäilyjä.
Meksikosta palannut nainen otettiin Päijät-Hämeen keskussairaalaan eristyshoitoon viikonloppuna alkaneiden oireiden vuoksi. Kyseessä on Suomen ensimmäinen influenssaepäily.
Naiselta on otettu laboratorionäytteitä, joiden alustavat tulokset valmistuvat tänään kello 16:een mennessä. Näytteet on lähetetty jatkotutkimuksiin Helsinkiin. Täysin varma tieto taudinkuvasta saadaan ensi viikolla.
Naisen lähikontakteilla on aloitettu varmuuden vuoksi ehkäisevä Tamiflu-lääkitys, mutta heillä ei toistaiseksi ole ilmaantunut influenssan kaltaisia oireita. Heitä on kehotettu pysymään kotona, kunnes sairaudesta saadaan lisätietoa. Heidän vapaaehtoinen karanteeninsa päättyy muutaman päivän sisällä, kun laboratoriokokeista saadaan alustavia tuloksia.
Meksikosta viikko sitten palanneella naisella ilmenneet oireet täyttävät kansallisten ohjeiden kriteerit sikainfluenssaepäilystä. Naisella nousi viikon kuluttua Suomeen palaamisen jälkeen 38,5 asteen kuume ja hänellä ilmaantui särkyjä ja tulehdusoireita.
Päijät-Hämeen alueella ei ole torstaihin mennessä ilmennyt uusia tartuntaepäilyjä. Lahden kaupungin viranomaiset ovat kuitenkin ohjeistaneet kaupunkilaisia sikainfluenssasta, mitenkä tulee toimia, jos epäilee saaneensa tartunnan."
*************

Briefly in English:
Probable TexMex virus in Lahti, Finland. A woman that came back to Finland from Mexico is now in Päijät-Häme central hospital in quarantine. She began to have influenza symptoms in last weekend. Her condition has been stable good all the time. This is the first TexMex virus suspect in Finland. The preliminary lab test results will be ready today at 16 pm. The confirmation tests will be due in the weekend.
The infection contacts of the woman are receiving oseltamivir (Tamiflu), but they haven't got any influenza symptoms this far. They have been told to stay home until there is more information of the illness of the index case. Their voluntary quarantine will end in a few days, after the lab test results are available.
The index case came back to Finland from Mexico a week ago. After that she got temperature 38,5 C, pains and inflammation symptoms.
There haven't been new infection suspects in the Päijät-Häme region. The authority in Lahti town have given population instructions about how to react if someone presumes to have got an infection.

*********
Editor note: In Finland media the instruction is: Suspect swine flu only if you have influenza symptoms AND you came back from Mexico during latest week. Hopefully people in Lahti region alert doctors also in case got influenza symptoms even though have not been traveling to Mexico... ;)

Swine Flu Source Apparently Not Pigs, Says FAO
The Chosun Ilbo
VOA News / Apr. 30, 2009 10:38 KST
http://english.chosun.com/site/data/html_dir/2009/04/30/2009043000765.html
"The UN Food and Agriculture Organization (FAO) is responding to the swine flu outbreak by sending out emergency assessment teams and monitoring whether any evidence appears that the disease is actually affecting pigs and not just humans.
Joseph Domenech, the FAO's chief veterinary officer spoke to VOA about what actions the agency is taking. "The FAO is doing, as a technical agency... alerting all the countries and governments through people in the field through very active rumor tracking of anything which could happen in pigs," he said. "One is to confirm that pigs are not the origin of the human crisis. And second, to be ready to detect and respond if there is an infection of pigs from this new virus coming from humans."
An FAO assessment team is heading for Mexico, along with experts from the World Health Organization and the U.S. Centers for Disease Control. "We have mobilized funds to assist our country members to strengthen their surveillance system in pig production," Domenech said.
Clarifying the apparent lack of evidence of pig involvement, he added "Today, all the processes we are working on are based on the fact that the crisis is human to human without intervention of pigs. It's a pure contagious human to human (transmission) and there is no declaration, there is no rumor, there is no identification of flu in pigs. Of course, this has also to be carefully investigated more than it was before... We hope that it will be confirmed."
Domenech has taken the lead for the FAO in efforts to track the spread and control avian flu. Asked to compare avian flu and swine flu, he said, "It's totally different in the sense that the avian flu was and still is an avian problem of the poultry sector with millions of dead and killed animals."
The big fear has been a mutant strain of bird flu causing a human pandemic. That has not happened. As for swine flu, he said, "In this case it's totally the contrary. It's human and pigs are, for the moment, not involved."
The FAO will step up efforts to support member countries in carefully monitoring the pig population. "Obviously, if pigs become infected this could be a problem for pig program and for humans because it will contribute to the epidemiological cycle," he says."

"WHO Confirms Sustained Swine H1N1 Transmision in Humans
Recombinomics Commentary 23:53
April 29, 2009
Apr 27, 2009 (CIDRAP News) – The World Health Organization (WHO) today raised its official pandemic alert level from the current phase 3 to phase 4 on its 6-phase scale, saying the newly identified swine influenza virus has made a pandemic more likely but not inevitable.

The above comments describe the phase increase from 3 to 4, which left little doubt that the phase would be raised to 6 within a few days because of the spread of H1N1 swine flu out of Mexico (see updated map). The earlier definitions used sustained transmission as the definition of phase 6. This change was due in part to limited human to human transmission of H5N1. The repeated reports of smaller clusters dictated a change from 3 to 4, but such a change was linked to significant increases in pandemic preparedness.
The new definition, that required sustained transmission, made it clear that the progress of phases from 4 to 6 would just be a matter of days as noted in yesterday’s lengthy interview.
The pandemic is quite predictable, as detailed in the video above, has much in common with the 1918 outbreak, including the start in the late spring as a mild infection, the targeting of previously healthy adults, and the origin as swine H1N1. Over the summer the swine H1N1 will proliferate in the southern hemisphere and recombine with H1N1 seasonal flu, leading to a much more virulent H1N1 in the fall.
Active surveillance and the developing a vaccine that targets the predicted product is critical. Tamiflu resistance will almost certainly develop in swine H1N1, leading to a heavy reliance on a well matched vaccine.
The CDC has been quickly released swine H1N1 in humans. Similar release of seasonal flu H1N1 in the southern hemisphere, as well as the private swine sequence database maintained by WHO consultants should also be made public immediately
Phase 6 should be announced within the next few days.
It is time for serious vaccine targeting of emerging sequences."

"Girl, 12, among England's first three swine flu victims as virus kills two-year-old in U.S.
By Daily Mail Reporter
Last updated at 3:07 PM on 29th April 2009
http://www.dailymail.co.uk/news/article-1174110/Girl-12-Englands-swine-flu-victims-virus-kills-year-old-U-S.html
A 12-year-old girl who is one of England's first three cases of swine flu was on the same flight from Mexico as the Scottish newlyweds who have fallen ill with the virus.
Gordon Brown told the Commons that the girl's school in Torbay, Devon, had been closed and all 2,300 pupils offered anti-viral drugs.
England's first cases of the virus emerged as it was revealed that a two-year-old American child had become the first person outside Mexico to die from the virus.
The first non-Mexican death will dramatically raise fears of a global pandemic and experts have warned that it is likely that many more people will die from the virus.
Mr Brown revealed that the 12-year-old girl from Torbay, Devon and two adults - a 41-year-old man from Birmingham and a 22-year-old man from south London - had all recently travelled to Mexico.
But worried parents at the girl's school have complained that they were not told about the outbreak until after the Prime Minister's announcement today.
All three had mild symptoms and were responding well to treatment, the Prime Minister said.
---
The Health Protection Agency in Devon has identified that the girl had been in close contact with 50 fellow pupils and others.
'The school had not told us about it, and my son said the pupils were told around 1pm today. Right now we just don't know what to think. Obviously it's a worry.'
Another parent, Michelle Buswell, who has a 13-year-old daughter called Emma Thorpe, said it was 'a shame' that parents appeared to be some of the last to know.
---
'Flu is a very serious infection and each virus is unique so it's hard to know what we're going to be seeing, but given what we've seen in Mexico we have expected that we would see more severe infections and we would see deaths.'
In Britain, doctors have warned that a lack of anti-viral drugs and facemasks could leave parts of the population without protection from the virus.
The Government has been forced to order 32 million face masks as thousands of panic-stricken Britons rush to buy swine flu protection on the internet.
Today, the Prime Minister said the Government was increasing the order of anti-virals from 35 million to 50 million doses.
The fears emerged as as a health expert warned hundreds of Britons can expect to be struck down with swine flu within weeks.
---
Professor Neil Ferguson warned that up to 40 per cent of the British population, or 24 million people - could become ill if the outbreak dragged on until the winter and became a pandemic.
---
The Government last night announced that it would be sending leaflets to every household in Britain providing information about the virus and 'preventative messages'.
---
Yesterday, Professor Ferguson, of London's Imperial College, told the BBC's Today programme: We don't really know what size epidemic we will get over the next couple of months.
'It is almost certain that, even if it does fade away in the next few weeks - which it might - we will get a seasonal epidemic in the autumn.
'We might expect up to 30 to 40 per cent of the population to become ill in the next six months if this truly turns into a pandemic.
---
Eleven cases have been confirmed in New Zealand and one in Israel - meaning the disease has now spread across four continents (Europe, North America, Asia and Australasia)."

More nations report flu
WIRE REPORTS
Published: April 29, 2009
http://www.timesdispatch.com/rtd/news/world/article/FLUU29_20090428-213806/264437/
Isolated outbreaks of swine flu continue to be confirmed, with new cases reported yesterday in Canada, Israel, France, New Zealand, Costa Rica and South Korea. California Gov. Arnold Schwarzenegger proclaimed a state of emergency, and the White House asked Congress for an additional $1.5 billion to fight the outbreak.
Authorities said hundreds of students at a New York school have fallen ill, and federal officials said they expected to see U.S. deaths from the virus.

Cuba suspended flights to and from Mexico except in "exceptional cases," becoming the first country to impose a travel ban to the epicenter of the epidemic. Argentina announced a five-day ban on flights arriving from Mexico.

The mayor of Mexico City cracked down further on public life, closing gyms and swimming pools in the capital and ordering restaurants to limit service to takeout.

Swine flu is believed to have killed more than 150 people in Mexico, and the Centers for Disease Control and Prevention said the U.S. has 68 confirmed cases in five states, with 45 in New York, one in Ohio, one in Indiana, two in Kansas, six in Texas and 13 in California. "I fully expect we will see deaths from this infection," said Richard Besser, acting director of the CDC.
(Snip)
Keiji Fukuda, assistant director-general of the World Health Organization, warned against jumping to the conclusion that the virus has become firmly established in the United States.
(Snip)
Vaccine: Scientists hope to have a key ingredient for a vaccine ready in early May, but it still will take a few months before any shots are available for the first required safety testing. Using samples of the flu taken from people who fell ill in Mexico and the U.S., scientists are engineering a strain that could trigger the immune system without causing illness." Continued:
http://www.timesdispatch.com/rtd/news/world/article/FLUU29_20090428-213806/264437/

"Nokia: Älä matkusta Meksikoon
http://www.kauppalehti.fi/5/i/talous/uutiset/etusivu/uutinen.jsp?oid=2009/04/21562
Kauppalehti, Bloomberg
Maanantai 27.04.2009 klo 18:44
"Matkapuhelinyhtiö Nokia ohjeistaa työntekijöitään lykkäämään matkustusta Meksikoon sikainfluenssaepidemian vuoksi.
Nokian tiedottaja Tapani Kaskinen kertoi uutistoimisto Bloombergille, että kännykkäjätti neuvoo työntekijöitään lykkäämään kaikkia ei-välttämättömiä matkoja Meksikoon.
Sen sijaan Nokian myyntikonttori Mexico Cityssä ja Reynosassa sijaitseva tehdas toimivat normaalisti. Matkapuhelinyhtiöllä on 3559 työntekijää Meksikossa.
Myös muut suomalaisyhtiöt ovat tänään antaneet henkilöstölleen matkustusohjeita sikainfluenssan vuoksi.
Ylen uutisten mukaan esimerkiksi konepajakonsernit Wärtsilä ja Metso kehottavat henkilöstöään välttämään matkustamista Meksikoon. Myös UPM seuraa tarkasti tilanteen kehittymistä.
Myös ulkoministeriö kehottaa Meksikoon matkustavia välttämään joukkotilaisuuksia ja kosketusta toisiin ihmisiin.
Nina Broström"

ProMED-mail
26 April 2009
http://www.promedmail.org/pls/otn/f?p=2400:1001:2064395877097825::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,77215

"WHO declares health emergency
Date: Sat 25 Apr 2009
Source: Associated Press [edited]
http://www.philly.com/philly/wires/ap/news/nation_world/20090425_ap_whodeclaresswineflucrisisahealthemergency.html

WHO declares swine flu crisis a health emergency
------------------------------------------------
GENEVA: The World Health Organization has declared the swine flu outbreak
in North America a "public health emergency of international concern". The
decision means countries around the world will be asked to step up
reporting and surveillance of the disease implicated in dozens of human
deaths in Mexico and at least 8 non fatal cases in the US. WHO fears the
outbreak could spread to other countries and is calling for a coordinated
response to contain it.

WHO director-general Margaret Chan made the decision late on Saturday after
consulting influenza experts during an emergency meeting. She earlier told
reporters the outbreak had "pandemic potential." But her agency held off
raising its pandemic alert level, citing the need for more information.

"It would be prudent for health officials within countries to be alert to
outbreaks of influenza-like illness or pneumonia, especially if these occur
in months outside the usual peak influenza season," Chan told reporters by
telephone from Geneva, where she convened an emergency meeting of influenza
experts. "Another important signal is excess cases of severe or fatal
flu-like illness in groups other than young children and the elderly, who
are usually at highest risk during normal seasonal flu," she said. Several
Latin American and Asian countries have already started surveillance or
screening at airports and other points of entry.

At least 62 people have died from severe pneumonia caused by a flu-like
illness in Mexico, WHO says. Some of those who died are confirmed to have a
unique flu type that is a combination of bird, pig, and human viruses. The
virus is genetically identical to one found in California. US authorities
said 8 people were infected with swine flu in California and Texas, and all
recovered. So far, no other countries have reported suspicious cases,
according to WHO. But the French government said suspected cases are likely
to occur in the coming days because of global air travel. A French
government crisis group began operating Saturday. The government has
already closed the French school in Mexico City and provided French
citizens there with detailed instructions on precautions.

Chilean authorities ordered a sanitary alert that included airport
screening of passengers arriving from Mexico. No cases of the disease have
been reported so far in the country, deputy health minister Jeanette Vega
said, but those showing symptoms will be sent to a hospital for tests. In
Peru, authorities will monitor travelers arriving from Mexico and the US
and people with flu-like symptoms will be evaluated by health teams, Peru's
Health Ministry said. Brazil will "intensify its health surveillance in all
points of entry into the country," the Health Ministry's National Health
Surveillance Agency said in a statement. Measures will also be put in place
to inspect cargo and luggage, and to clean and disinfect aircraft and ships
at ports of entry.

Some Asian nations enforced checks Saturday on passengers from Mexico.
Japan's biggest international airport stepped up health surveillance, while
the Philippines said it may quarantine passengers with fevers who have been
to Mexico. Health authorities in Thailand and Hong Kong said they were
closely monitoring the situation. Asia has fresh memories of an outbreak of
severe acute respiratory syndrome, or SARS, which hit countries across the
region and severely crippled global air travel. Indonesia, China, Thailand,
Vietnam and other countries have also seen a number of human deaths from
H5N1 bird flu, the virus that researchers have until now fingered as the
most likely cause of a future pandemic.

The Dutch government's Institute for Public Health and Environment has
advised any traveler who returned from Mexico since April 17 and develops a
fever over 101.3 degrees Fahrenheit (38.5 Celsius) within four days of
arriving in the Netherlands to stay at home. The Polish Foreign Ministry
has issued a statement that recommends that Poles postpone any travel plans
to regions where the outbreak has occurred until it is totally contained.
The Stockholm-based European Center for Disease Prevention and Control said
earlier Saturday it shared the concerns about the swine flu cases and stood
ready to lend support in any way possible.

WHO's emergency committee, called together Saturday for the first time
since it was created in 2007, draws on experts from around the world. They
may decide that the outbreak constitutes an international public health
emergency. If so, they will consider whether WHO should recommend travel
advisories, trade restrictions or border closures and raise its pandemic
alert level.
[byline: Maria Cheng]"

BBC
27 April 2009
http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

"MONDAY, 27 APRIL, MEXICO AND SPAIN
I'm a doctor responsible for managing vaccines in the northern Mexican state of Nuevo Leon.
Over the last two weeks we started seeing patients with high fever, muscle aches, sore throats and coughs. Those symptoms seemed a bit odd for us, but we didn't diagnose them with swine flu as we didn't know about it.
On Sunday we had our first death in the area. It was someone who came from Mexico City. But we don't have the means to confirm whether it was as a result of swine flu.
More than anything, we lack equipment and laboratory kits. All we can do is look at the symptoms and make a clinical diagnosis.
In the pharmacies, there is no Tamiflu available. They only have another medication and they don't even have enough of that.
So the vaccines we have are not enough we don't have the medication required. People here are not aware that this flu outbreak can kill people.
On behalf of all the medical community in Nuevo Leon I'd like to ask for help to get the medication, so we can treat people.
We need to have the means to diagnose people and, most importantly, the means to offer them treatment.
Dr Vicente Torres, Monterrey, Nuevo Leon, Mexico
***
Our health minister has just confirmed a positive case in a small town called Almansa, 50 miles from the capital of the province of Albacete, where I live.
There are other suspected cases in the same province. It is very worrying, especially as there are concerns that the numbers of people infected will grow.
The main hospital for the province is here in my town and people will be coming here for treatment.
We have received no further information yet from the authorities, beyond the case being confirmed.
We have just been told to stay calm. Meanwhile, everybody is texting each other asking what next?
Francisco Cebrian, Albacete, Spain
***
SATURDAY, 25 APRIL, MEXICO

I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.
There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.
Antonio Chavez, Mexico City
***

I think there is a real lack of information and sadly, preventative action. In the capital of my state, Oaxaca, there is a hospital closed because of a death related to the porcine influenza. In the papers they recognise only two people dead for that cause. Many friends working in hospitals or related fields say that the situation is really bad, they are talking about 19 people dead in Oaxaca, including a doctor and a nurse. They say they got shots but they were told not to talk about the real situation. Our authorities say nothing. Life goes on as usual here.
Young people are going to schools and universities. Buses and planes go and come from Mexico City as frequently as before. Even with two people dead locally, last night the local baseball stadium was full, mainly with young people. What's really happening? I know vaccines are good for nothing, and if you take care, maybe you won't die, so, why not acknowledge the real situation? I know that the economic situation is not the best, and it will worsen with panic. But panic comes from a lack of information. Many people travel for pleasure or without any real need. Stopping those unjustified trips can help a lot to ease the situation. We must do something!
Alvaro Ricardez, Oaxaca City, Oaxaca, Mexico
***
It's certainly been very quiet where I'm living in the Historic Centre of Mexico City, whereas normally the centre is almost uncomfortably packed at the weekend. Most people also seem to be wearing the face masks being handed out by the army around the city. There always seems to be a healthy mistrust of the government here, but I wouldn't say I'm sensing a great deal of paranoia or panic. It does seem as though the unprecedented actions being taken by the government to contain the virus don't match with the statistics being provided, however, so there is some doubt as to whether they're just being overly cautious or whether things are a lot worse than what they're telling the public.
Randal Sheppard, Mexico City
***
I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.
Yeny Gregorio Dávila, Mexico City ---"

New York: Eight students probably have swine flu. Kansas: Two confirmed cases

Via NECN.com: NYC officials: 8 students probably have swine flu.
http://www.necn.com/Boston/Health/2009/04/25/NYC-officials-8-students/1240692004.html
(via Crofsblog.com http://crofsblogs.typepad.com/h5n1/ )
Excerpt:
Officials in New York City report that about 75 Queens high school students have fallen ill with flu-like symptoms. Testing is underway to rule out the new strain found in Mexico.

Dr. Thomas R. Frieden the commissioner of New York City's Department of Health, gave an update on the flu cases.

He says that at the high school, 200 students were absent presumably because of illness. He says that on Friday evening, the Department of Health was able to receive specimens from nine of those children who were sickened, and sent them to the public health laboratory.

Dr. Frieden says, "today we're confirming that the laboratory has identified eight of those nine specimens, as probable human swine influenza."

This is also on CBC Radio news at 2 pm PST as I write this.

And I have just received an email with a media advisory on a news conference to be held in Topeka this afternoon, announcing two confirmed swine flu cases in Kansas."

WHO: Sikainfluenssa on vakava uhka
julkaistu eilen klo 08:28, päivitetty eilen 25.4.09 klo 22:27
http://yle.fi/uutiset/ulkomaat/2009/04/who_sikainfluenssa_on_vakava_uhka_705079.html

Maailman terveysjärjestön pääjohtaja Margaret Chan varoittaa, että Meksikossa satoja sairastumisia ja kymmeniä kuolemia aiheuttanut sikainfluenssaepidemia on "vakava ilmiö", jolla on edellytykset levitä maailmanlaajuiseksi. Matkustusrajoituksia ei kuitenkaan vielä vaadita.
---
WHO:n asiantuntijaryhmä kokoontui lauantaina arvioimaan Meksikossa ja Yhdysvalloissa leviävän sikainfluenssan vaarallisuutta. Meksikossa uudenlaisen sikainfluenssan on todettu tappaneen 20 ihmistä, mahdollisesti jopa 68. Suomen ulkoministeriö on jo varoittanut Meksikon-matkaajia.
Meksikon terveysministeriön mukaan virus on sairastuttanut noin tuhat ihmistä. Yhdysvaltain puolella Texasissa ja Kaliforniassa potilaita on tiedossa kahdeksan. He ovat kaikki toipuneet.
Meksikon hallitus on ilmoittanut aloittavansa laajan rokotusohjelman sikainfluenssaa vastaan.
---
Meksikon pääkaupungissa ja sen ympäristössä suljettiin varotoimena koulut perjantaina ja kaikki laajat julkiset tapahtumat peruttiin. Ihmisiä kehotetaan välttämään ruuhkaisia paikkoja, kättelyjä ja muuta läheistä koskettelua. Hengityssuojat on paikoin myyty loppuun.
Terveysministeri Jose Angel Cordova kertoi, että virus on muuntautunut ja siirtynyt sioista ihmisiin. ---"

ACUTE RESPIRATORY DISEASE - MEXICO, SWINE VIRUS SUSPECTED
*********************************************************
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[1] Date: Thu 23 Apr 2009
Source: El Manana [in Spanish, trans. Mod. TY, edited]
http://www.elmanana.com.mx/notas.asp?id=117125

At least 500 employees in the health sector in the Federal District have
been infected with influenza virus, announced Antonio Sanchez Arriaga,
secretary general of the National Independent Union of Health Workers. The
infection has now affected employees of the main public hospitals in the
caital, including the Juarez Hospital, the General Hospital and the
National Institute of Respiratory Diseases, and the hospitals in the
Tlalpan area, where the National Institute of Cardiology, the National
Institute of Nurtition and the Manuel Gea Gonzalez, as well as the Polanco
Red Cross, are located.

The union official indicated that the number of infected individuals could
triple this week if the necessary [preventive] health measures are not
taken. "This past Friday [17 Apr 2009] we realized that the disease [was
occurring] and we requested the the representatives in the various
hospitals submit reports of the illnesses, and we found that that the
infection had reached 500 of our fellow workers, " indicated Sanchez
Arriaga. The leader of the union said that the authorities are overwhelmed
by the presence of influenza in the hospitals and only palliative measures
have been implemented to try to prevent further infections.

"Now they are vaccinating us and giving permission for a week off of work
for the employees who are ill, but this has now turned into an epidemic and
we believe that this will continue this week and we could have more than
1500 cases," he said. Sanchez Arriaga declared that it is urgent to
vaccinate personnel who work in the areas of neonatology, pediatrics,
gynecology and respiratory diseases, since they are those who have thee
greatest possibility of spreading the disease in a high risk population.
[Byline: Imelda Garcia]
--
communicated by:
a healthcare consultant who requested anonymity"

Mexico Flu Deaths So Far Not Seen Bird-Flu Related
http://online.wsj.com/article_email/SB124058255179552887-lMyQjAxMDI5NDIwNDUyODQyWj.html
The Wall Street Journal online
APRIL 24, 2009, 10:41 A.M. ET
By MAJA WALLENGREN
"MEXICO CITY -- The death of at least 20 people in Mexico from an unknown strain of influenza hasn't been linked to the dangerous H5N1 strain of bird flu, the World Health Organization said Friday.
'We are still expecting more details but so far we have no indications that this is avian flu,' WHO spokesperson Sari Setiogi told Dow Jones Newswires, speaking by telephone from Geneva.
---
Mexico's season for influenza A normally ends in December, she added.
Mexico's government has ordered all schools in the greater capital area closed Friday amid the growing influenza epidemic and several rumors circulated in the capital late Thursday that this could be a case of the dangerous high-pathogenic strain of bird flu that has led to deaths in humans.
Health Minister Jose Angel Cordova told local press that preliminary test results from scientists in the U.S. and Canada showed it wasn't avian influenza, and has warned citizens to take extreme caution and avoid greeting others by shaking hands, cheek kisses or any other unnecessary physical contact.
The WHO, in a separate report Friday, said hundreds of cases of swine flu have been reported in Mexico and the U.S. in recent weeks including 57 cases of suspected deaths in the capital area, which is home to about 20 million people.
Setiogi said the WHO is "on alert" about the growing influenza outbreak in Mexico and expects the number of cases in both Mexico and other countries in the region to grow in the coming weeks.
"We are right now on alert and monitoring the developments of this unusual influenza activity. We are still gathering information while the Mexican authorities are doing their investigations, but we are expecting more cases to be reported," she said.
Mexico was declared free of the deadly H5N1 strain of avian flu several years ago, but the current influenza outbreak has stirred speculation as to how it emerged in the first place.
Local newspapers reported that at least 20 people have already died from the influenza, while some 120 people have been hospitalized within the greater Mexico City region."

"California and Texas Swine Flu Clusters Raise Concerns
Recombinomics Commentary
07:03, April 24, 2009
http://www.recombinomics.com/News/04240902/H1N1_Swine_CA_TX_Clusters.html
Two of the new cases were among 16-year-olds at the same school in San Antonio 'and there's a father-daughter pair in California,' Schuchat said. The boy whose case was reported on Tuesday had flown to Dallas, but the CDC has found no links to the other Texas cases.

The above comments describe four of the five new swine flu cases (see updated map) recently confirmed by the CDC. The two high school students near San Antonio, Texas were friends and not linked to the San Diego case who flew to Dallas. Similarly there was no indication that the father daughter pair in San Diego Country were linked to the earlier cluster.
The two initial confirmed cases were also linked to clusters, but the relatives were not tested. However, it is almost certain that the two sets of contacts for the first two cases were also infected, creating four distinct clusters. The only individual case was the fifth new case, a female from Imperial County. Thus, of the 11 confirmed or suspect cases, only one was not in a cluster.
This clustering signals efficient transmission, but none of the cases have links to swine or the other clusters. The efficient transmission signals extensive silent transmission. As noted earlier, only two of the six initial cases were tested, and the testing was linked to a border surveillance program.
Thus, without the border surveillance, none if these cases would have been identified, with the possible exception of the hospitalized patient who was on a ventilator. However, the swine flu would have only been identified if the sample was sub-typed. The swine flu would test positive for influenza A, and treatment and symptoms would be the same for seasonal or swine flu.
Although all cases were in locations close to the Mexican border, no cases in Mexico have been confirmed. However, without the border surveillance no case in the United States would have been confirmed.
It is likely that there are swine flu cases in Mexico, and it is likely that the current influenza outbreak includes a high number of swine flu cases. There have been 20 fatalities due to atypical pneumonia, and cases have been unusually high for mid to late April. Samples have been sent to Canada for analysis, and the CDC said they were also investigating. However, there is little doubt that a high percentage of cases in Mexico are swine flu. School closings throughout southern Mexico, affecting millions of students were just announced.
As flu season ends in the northern hemisphere, identifying swine flu cases should be easier. However, the mild nature of the illness will likely lead to spread into the southern hemisphere increasing the frequency of co-infections with H1N1 seasonal flu and acquisition of Tamiflu resistance (H274Y).
Aggressive testing of patients throughout the Americas is warranted, as well as testing in other areas.
The number of flu cases in Mexico, coupled with the high frequency of clusters in California and Texas, raises concerns that the swine flu will spread worldwide and expand into a major pandemic."

***************************

Lyhyesti suomeksi:
San Antonion uusista tautitapauksista kaksi oli samassa koulussa opiskelevilla kuusitoistavuotiailla nuorilla. Lisäksi Kaliforniassa on ollut isä-tytär -sairauspari. Poika, jonka tapaus raportoitiin tiistaina [21.4.09], oli lentänyt Dalasiin, mutta CDC ei ole löytänyt linkkejä muihin Teksasin tapauksiin.
Kaksi San Antonion lähellä olevassa koulussa opiskelevaa nuorta ovat ystävyksiä, eivätkä heillä ole sidosta San Diegon tapaukseen, joka lensi Dallasiin. Myöskään San Diegon isä-tytär -parilla ei ole näyttänyt olevan yhteyttä aiempaan klusteriin. Todennäköisesti USAssa on nyt ollut jo neljä tautiklusteria, joista vain kaksi on saatu varmistettua laboratoriossa.
Sairauden ryvästyminen viittaa tehokkaaseen tarttuvuuteen, mutta millään sairaustapauksista ei ole ollut yhteyttä sikoihin eikä muihin ryvästymiin. Tehokas tarttuminen antaa viitteitä laajamittaisista hiljaisista tartunnoista.
Vain kaksi alkuperäisistä kuudesta tapauksesta testattiin, ja testaukset olivat osa rajaturvallisuustarkastusta.
Niinpä yhtääkään näistä tapauksista ei olisi havaittu ilman rajatarkastusta, lukuunottamatta yhtä potilasta, joka päätyi sairaalaan hengityskoneeseen. Tällöinkin sikainfluenssa olisi löytynyt vain, jos influenssatestauksessa olisi satuttu alatyypittämään influenssanäyte.
Kun nyt influenssakausi pohjoisella pallonpuoliskolla päättyy, sikainfluenssatapausten tunnistaminen tulee helpommaksi. Kuitenkin sairauden liev taudinkuva todennäköisesti johtaa taudin leviämiseen eteläiselle pallonpuoliskolle ja samalla lisää todennäköisyyttä yhteisinfektioihin H1N1-kausi-influenssan kanssa ja Tamiflu-resistenssin (H274Y) saavuttamiseen.

"Canada Issues Alert on Severe Respiratory Disease in Mexico
http://www.recombinomics.com/News/04230901/SRI_Mexico_Alert.html
Recombinomics Commentary 02:22
April 23, 2009

The Public Health Agency of Canada has told quarantine services to be on alert for travellers returning from Mexico after a number of severe respiratory illnesses (SRI) were reported in some regions of the country.
PHAC, in an April 20 report, said Mexican officials informed the Canadian health agency that the 'case-fatality rate was relatively high' and that most cases involved healthy adults between the ages of 25 and 44. A number of health-care workers were also affected.
Although no cause has been confirmed, some samples were positive for influenza A and B.

The above comments on an alert issued by Canada offer some insight into the situation in Mexico. The reports out of Mexico are decidedly mixed. Some reports describe an increase in influenza cases which is attributed to a late spike in influenza B, which when combined with influenza A, gives an abnormally high number of cases this late in the season. Other reports discuss revaccinating at risk groups with the current trivalent vaccine.
Samples have been sent to Canada for a comprehensive analysis.
The increased influenza-like illness and fatalities was announced as the CDC issued an MMWR dispatch on H1N1 swine flu. Two cases have been confirmed in children (9F and 10M) and family members had mild symptoms but were not tested. The precise location of the clusters in southern California has not been released, but one cluster is in San Diego Country, while the other is 100 miles away in Imperial County (see updated map). Additional suspect cases in Imperial County have been noted and it is likely that these cases are near the border with Mexico. Some media reports also note that some contacts have not been interviewed because they were in Mexico.
It remains unclear if these two outbreaks are related. All reported cases in California have been mild, and the two confirmed cases were influenza A positive, but failed to sub-type for seasonal flu. It is unclear if sub-typing failures have led to the confusing reports out of Mexico.
More information on these cases, and results of analysis in Canada, would be useful.
Similarly, a more precise location and number of confirmed and suspect cases in the United States would be useful."

*************
Lyhyesti suomeksi:
Kanadan kansanterveyslaitos (PHAC) on määrännyt karanteeniviranomaiset olemaan valmiustilassa Meksikosta palaavien matkustajien suhteen sen jälkeen, kun useita vaikeita hengitystieinfektioita ilmoitettiin Meksikon eri alueilta. PHAC ilmoitti 22.4.09, että Meksikon viranomaisten mukaan 'tapauskohtainen kuolleisuus [case fatality rate] on suhteellisen suuri, ja että useimmat sairaustapaukset ovat olleet nuorilla ja aiemmin terveillä 25-44 -vuotiailla aikuisilla. Lisäksi sairastuneiden joukossa oli sairaanhoitohenkilökuntaa.
Vaikka yhtään tapausta ei ole [23.4.09] varmistettu, jotkut näytteet olivat positiivisia influenssa A:n ja B:n suhteen.

Meksikosta on julkistettu ristiriitaisia uutisia. Riskiryhmiä kerrotaan aloitetun rokottaa nykyisellä [kausi-influenssan] trivalentilla rokotteella.
Joissakin uutisraporteissa kerrotaan, että osa kahden kalifornialaisen indeksilapsen kontakteista on ollut Meksikossa, ja siksi näitä kontakteja ei ollut haastateltu.

"Swine H1N1 In Southern California Children Raise Concerns
http://www.recombinomics.com/News/04220901/H1N1_CA_Swine.html
Recombinomics Commentary 01:27
April 22, 2009
---
The isolates are similar and have an unusual constellation of genes.
Although all 8 are reported as being swine, the NA and MP sequences are European, while the other 6 gene segments are North American. The HA, NA, and MP sequences of A/California/04/2009 have been placed on deposit at GISAID.
The lack of contact between the two children, as well as a lack of contact with swine, suggests the virus is spreading human to human. Although both children recovered, the presence of swine H1N1 in humans raises concerns of recombination with H1N1 seasonal flu, including the acquisition of H274Y.
Moreover, the 1918 pandemic strain was a recombinant between human H1N1 and swine H1N1.
The likely ability of this swine H1N1 to transmit efficiently in humans is cause for concern."

CDC: Swine flu seen in 2 California children [22 April 2009]
http://edition.cnn.com/2009/HEALTH/04/22/swine.flu.california/index.html
Theresa Tamkins
April 22, 2009 -- Updated 2138 GMT (0538 HKT)
"The Centers for Disease Control and Prevention is investigating two cases of swine flu detected in children in the San Diego, California, area last week.
---
The children were infected with a virus known as swine influenza A H1N1, which has a unique combination of genes not previously seen in flu viruses in either humans or swine - although it shares similarities with a virus that has been circulating in pigs since 1999.
---
Since neither of the two children, a 10-year-old boy and a 9-year-old girl, had contact with pigs, it "increases the possibility that human-to-human transmission of this new influenza virus has occurred," according to a CDC report. The girl did attend an agricultural fair four weeks before becoming sick, she said, but did not have any contact with pigs or other livestock. Family members of both children also had flu-like symptoms, but it's not clear whether they were infected with the same virus since samples weren't taken when they were ill.
Both children had a fever and cough in late March, and one child vomited. The children, who live in the adjacent San Diego and Imperial counties in Southern California but had no known contact with one another, have since recovered.
---
The boy did travel from California to Dallas, Texas, on a trip to visit family members and the CDC is reaching out to crew members on that flight to see whether any other people experienced flu-like symptoms, says Skinner.
---
"He was probably at the tail end of his illness, but yes, he was symptomatic," he says. "We're just reaching out to crew members at this point. Based on what we learn from that initial outreach, if we feel like we need to reach out to other passengers on the plane, we will."
---
The virus seems to be resistant to treatment with the antiviral drugs amantadine and rimantadine. It's not clear yet whether the virus is resistant to other drugs, such as oseltamivir and zanamivir.
---
The most famous outbreak of swine flu in the United States occurred in 1976 in recruits at Fort Dix, New Jersey. The cases triggered fear of a pandemic - largely because the lethal 1918 flu pandemic was thought at the time to be a result of a swine flu mutation - that resulted in more than 40 million people being vaccinated. The program was later criticized when a swine flu pandemic did not materialize and a number of cases of vaccine-related side effects were reported"

"Meksikon tauti on sikainfluenssan uusi muunnos
YLE
julkaistu tänään klo 18:28, päivitetty tänään klo 23:13
http://yle.fi/uutiset/ulkomaat/2009/04/meksikon_tauti_on_sikainfluenssan_uusi_muunnos_704503.html
Maailman terveysjärjestö WHO kutsuu kokoon hätäkomitean arvioimaan Meksikossa ja Yhdysvalloissa leviävän sikainfluenssan vaarallisuutta. Tähän asti tuntemattomaan sikainfluenssan muunnokseen on Meksikossa kuollut WHO:n mukaan jopa 60 ihmistä ja tartuntoja on löydetty lähes tuhat. Myös Yhdysvalloissa on tavattu sikainfluenssaa.
Maailman terveysjärjestö WHO sanoo olevansa hyvin huolissaan uudentyyppisen viruksen ilmaantumisesta ja mahdollisista seurauksista.
---
Tutkimukset ovat vahvistaneet, että ainakin osa Meksikon sairastumisista johtuu viruksesta, joka on geneettisesti samanlainen kuin Kaliforniassa tavattu virus.
Hätäkomitea kokoontuu näillä näkymin lauantaina iltapäivällä.
--
Meksikon päkaupungissa ja sen ympäristössä suljettiin varotoimena koulut perjantaina ja kehotettiin ihmisiä välttämään ruuhkaisia paikkoja, kättelyjä ja muuta läheistä koskettelua.
Meksikon terveysministeri Jose Angel Cordova kertoi, että virus on muuntautunut ja siirtynyt sioista ihmisiin.
WHO on huolissaan Meksikon sairaustapausten lisäksi myös Yhdysvaltain Teksasissa ja Kaliforniassa havaitun uuden sikainfluenssa muunnoksen vuoksi. Yhdysvalloissa sairastuneita on ollut kahdeksan, jotka kaikki ovat toipuneet.
Yhdysvaltain terveysviranomaiset sanovat, että uusi sikainfluenssa on yhdistelmä aiemmin linnuissa, sioissa ja ihmisissä tavatuista influenssaviruksista. Presidentti Barack Obamaa pidetään jatkuvasti ajantasalla tautitilanteen kehittymisestä.
Maailman terveysjärjestö WHO on jatkuvasti yhteydessä Yhdysvaltain, Kanadan ja Meksikon viranomaisiin ja on määrännyt oman operaatiokeskuksensa valmiustilaan sikainfluenssan leviämisen vuoksi.
Reuters, AP,AFP, DPA

"Sixty Swine Flu Fatalities In Mexico Confirm Pandemic Start
http://www.recombinomics.com/News/04240903/H1N1_Swine_Mexico_Pandemic.html
Recombinomics Commentary 13:30
April 24, 2009
A rare outbreak of human swine flu has killed at least 60 people in Mexico and spread to the United States where authorities are on alert, the World Health Organisation said on Friday.
'To date there have been some 800 suspected cases with flu-like illness, with 57 deaths in the Mexico City area,' Chaib added.
Twenty four suspected cases and three deaths were also recorded in San Luis Potosi in central Mexico.

The above comment confirm that the swine H1N1 in southwestern United States (see updated map) is the leading edge of a H1N1 pandemic that appears to be centered in Mexico.
These deaths should increase the pandemic phase to 6.
Release of sequences from fatal cases in Mexico would be useful."

***************************
Lyhyesti suomeksi:
"Harvinainen sikainfluenssaepidemia on tappanut ainakin 60 ihmistä Meksikossa, ja se on levinnyt Yhdysvaltoihin, missä viranomaiset ovat valmiustilassa, sanoi WHO perjantaina.
'Tähän mennessä Mexico Cityn alueella on noin 800 epäiltyä influenssan kaltaista tautitapausta, ja 57 kuolemantapausta' Chaib lisäsi.
Lisäksi Keski-Meksikossa San Luis Potosissa on löytynyt 24 epäiltyä tapausta ja kolme kuolemantapausta.

Edellä oleva kommentti vahvistaa, että sikojen H1N1-epidemia Lounais-USAssa (katso kartta) on ensimmäinen uloke H1N1-pandemiasta, jonka keskipiste näyttäisi olevan Meksikossa.
Näiden kuolemantapausten kuuluisi nostaa pandemiavalmius tasolle kuusi (6).
Meksikon kuolemantapaukset aiheuttaneet virussekvenssit olisi hyödyllistä julkistaa."