Monday, April 27, 2009
WHO ups pandemic alert as Mexico flu deaths climb
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MEXICO CITY (AP) - Ominous developments Monday in the swine flu epidemic - a jump to 149 deaths and more signs that the virus can jump repeatedly from human to human - prompted the World Health Organization to raise its pandemic alert level, and governments around the world were taking tougher measures.
The virus has already spread to at least a half-dozen countries and half of Mexico. Trying to eliminate crowds, the Mexican government canceled school nationwide and considered closing the capital's subway system. Health Secretary Jose Angel Cordova said 20 deaths have been confirmed to be from swine flu and test results were pending on the others.
"We are the most critical moment of the epidemic. The number of cases will keep rising so we have to reinforce preventive measures," Cordova said at a news conference that was briefly shaken by an earthquake centered in southern Mexico.
WHO said the new phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country, signaling a significant increase in the risk of a global epidemic, according to Mexico health department spokesman Carlos Olmos. Phase 4 doesn't mean a pandemic is inevitable, but many experts think it may be impossible to contain a flu virus already spreading in several countries.
Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since mid-April, of whom 1,070 have been released. The government does not yet know how many were swine flu.
Cordova also suggested an earlier timeline for documented swine flu cases inside Mexico. The first death confirmed by the government involved a woman who succumbed from swine flu on April 13 in southern Oaxaca state. But Cordova said tests now show that a 4-year-old boy contracted the disease at least two weeks earlier in neighboring Veracruz state, where a community has been protesting pollution from a large pig farm.
The farm is run by Granjas Carroll de Mexico, a joint venture 50 percent owned by Virginia-based Smithfield Foods, Inc. Spokeswoman Keira Ullrich said the company has found no clinical signs or symptoms of the presence of swine influenza in its swine herd or its employees working at its joint ventures anywhere in Mexico.
But local residents are convinced they were sickened by air and water contamination from pig waste.
There was a widespread outbreak of a particularly powerful respiratory disease in the area early April, and some people reported being sick as early as February. Local health workers intervened in early April, sealing off the town of La Gloria and spraying to kill off flies they said were swarming through their homes.
Cordova said the community was suffering from ordinary influenza - not swine flu. But only one sample was preserved - that of the boy. It was only after U.S. and Canadian epidemiologists discovered the true nature of the virus that Mexico submitted the sample for international testing, and discovered what he suffered from.
The boy has since recovered and Cordova said there have been no new cases detected in the town, but epidemiologists want to take a closer look at pigs in Mexico as a potential source of the outbreak.
Juan Lubroth, an animal health expert at the U.N. Food and Agriculture Organization in Rome, said a team of veterinarians was flying to Mexico. They will examine what surveillance systems are in place to detect swine flu, and review historical data on previous viruses identified in the country. Farmers will be interviewed.
Lubroth said there have been no reports of sick or dying swine in Mexico, but warned that fears surrounding the outbreak could have a devastating effect on the pork industry.
"Although the virus is reported to have a swine origin, it may have been several years ago, and it's only now that it has shown up in humans as a clinical problem that is spreading," he said.
The Mexican government has yet to say where and how the epidemic began or give details on the victims.
Cordova said the health department lacked the staff to visit the homes of all those suspected to have died from the disease. But he assured that the country had enough medicine to treat the ill.
Meanwhile, Mexico suspended all schools nationwide until May 6, extending an order already in place in Mexico City and five of the country's 32 states, and urged people to stay home if they feel sick.
Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other symptoms. And the Mexico City government was considering shutting down all public transportation if the death toll keeps rising. Mayor Marcelo Ebrard said surgical masks were being distributed at subway and bus stops across the city.
The disease has hit hardest in the capital, but life was disrupted from Tijuana to Acapulco, a lucrative Pacific resort town where night clubs and bars were ordered closed until further notice. Acapulco Mayor Manuel Anorve Banos said he was worried about tourists from Mexico City spreading the disease.
Some city dwellers headed to the beach, taking advantage of the closed schools. But those who live day-to-day worried about making ends meet if the city completely shuts down.
"We're going to have to stop working," said Raul Alvarez Torres, who relies on the subway to get from his gritty suburb to his shoe shining stand in an upscale Mexico city neighborhood each day. "If people have no transport, getting around is impossible."
Even as Mexican officials urged those with flu symptoms to seek medical help, some complained of being turned away.
In Toluca, a city west of the capital, one family said health authorities refused to treat a relative Sunday who had full-blown flu symptoms and could barely stand. The man, 31-year-old truck driver Elias Camacho, was even ordered out of a government ambulance, his father-in-law told The Associated Press.
Paramedics complained that Camacho - who had a fever, was coughing and had body aches - was contagious, Jorge Martinez Cruz said.
Family members took him by taxi to a public hospital, but a doctor there denied Camacho was sick and told the trio to leave, Martinez said.
"The government told us that if we have these symptoms, we should go to these places, but look how they treat us," Martinez said. Camacho was finally admitted to the hospital - and placed in an area marked "restricted" - after a doctor at a private clinic notified state health authorities, Martinez said.
Jose Isaac Cepeda, who has had fever, diarrhea and joint pains since Friday, said he was turned away from two hospitals - the first because he isn't registered in the public health system, and the second "because they say they're too busy."
The virus has already spread to at least a half-dozen countries and half of Mexico. Trying to eliminate crowds, the Mexican government canceled school nationwide and considered closing the capital's subway system. Health Secretary Jose Angel Cordova said 20 deaths have been confirmed to be from swine flu and test results were pending on the others.
"We are the most critical moment of the epidemic. The number of cases will keep rising so we have to reinforce preventive measures," Cordova said at a news conference that was briefly shaken by an earthquake centered in southern Mexico.
WHO said the new phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country, signaling a significant increase in the risk of a global epidemic, according to Mexico health department spokesman Carlos Olmos. Phase 4 doesn't mean a pandemic is inevitable, but many experts think it may be impossible to contain a flu virus already spreading in several countries.
Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since mid-April, of whom 1,070 have been released. The government does not yet know how many were swine flu.
Cordova also suggested an earlier timeline for documented swine flu cases inside Mexico. The first death confirmed by the government involved a woman who succumbed from swine flu on April 13 in southern Oaxaca state. But Cordova said tests now show that a 4-year-old boy contracted the disease at least two weeks earlier in neighboring Veracruz state, where a community has been protesting pollution from a large pig farm.
The farm is run by Granjas Carroll de Mexico, a joint venture 50 percent owned by Virginia-based Smithfield Foods, Inc. Spokeswoman Keira Ullrich said the company has found no clinical signs or symptoms of the presence of swine influenza in its swine herd or its employees working at its joint ventures anywhere in Mexico.
But local residents are convinced they were sickened by air and water contamination from pig waste.
There was a widespread outbreak of a particularly powerful respiratory disease in the area early April, and some people reported being sick as early as February. Local health workers intervened in early April, sealing off the town of La Gloria and spraying to kill off flies they said were swarming through their homes.
Cordova said the community was suffering from ordinary influenza - not swine flu. But only one sample was preserved - that of the boy. It was only after U.S. and Canadian epidemiologists discovered the true nature of the virus that Mexico submitted the sample for international testing, and discovered what he suffered from.
The boy has since recovered and Cordova said there have been no new cases detected in the town, but epidemiologists want to take a closer look at pigs in Mexico as a potential source of the outbreak.
Juan Lubroth, an animal health expert at the U.N. Food and Agriculture Organization in Rome, said a team of veterinarians was flying to Mexico. They will examine what surveillance systems are in place to detect swine flu, and review historical data on previous viruses identified in the country. Farmers will be interviewed.
Lubroth said there have been no reports of sick or dying swine in Mexico, but warned that fears surrounding the outbreak could have a devastating effect on the pork industry.
"Although the virus is reported to have a swine origin, it may have been several years ago, and it's only now that it has shown up in humans as a clinical problem that is spreading," he said.
The Mexican government has yet to say where and how the epidemic began or give details on the victims.
Cordova said the health department lacked the staff to visit the homes of all those suspected to have died from the disease. But he assured that the country had enough medicine to treat the ill.
Meanwhile, Mexico suspended all schools nationwide until May 6, extending an order already in place in Mexico City and five of the country's 32 states, and urged people to stay home if they feel sick.
Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other symptoms. And the Mexico City government was considering shutting down all public transportation if the death toll keeps rising. Mayor Marcelo Ebrard said surgical masks were being distributed at subway and bus stops across the city.
The disease has hit hardest in the capital, but life was disrupted from Tijuana to Acapulco, a lucrative Pacific resort town where night clubs and bars were ordered closed until further notice. Acapulco Mayor Manuel Anorve Banos said he was worried about tourists from Mexico City spreading the disease.
Some city dwellers headed to the beach, taking advantage of the closed schools. But those who live day-to-day worried about making ends meet if the city completely shuts down.
"We're going to have to stop working," said Raul Alvarez Torres, who relies on the subway to get from his gritty suburb to his shoe shining stand in an upscale Mexico city neighborhood each day. "If people have no transport, getting around is impossible."
Even as Mexican officials urged those with flu symptoms to seek medical help, some complained of being turned away.
In Toluca, a city west of the capital, one family said health authorities refused to treat a relative Sunday who had full-blown flu symptoms and could barely stand. The man, 31-year-old truck driver Elias Camacho, was even ordered out of a government ambulance, his father-in-law told The Associated Press.
Paramedics complained that Camacho - who had a fever, was coughing and had body aches - was contagious, Jorge Martinez Cruz said.
Family members took him by taxi to a public hospital, but a doctor there denied Camacho was sick and told the trio to leave, Martinez said.
"The government told us that if we have these symptoms, we should go to these places, but look how they treat us," Martinez said. Camacho was finally admitted to the hospital - and placed in an area marked "restricted" - after a doctor at a private clinic notified state health authorities, Martinez said.
Jose Isaac Cepeda, who has had fever, diarrhea and joint pains since Friday, said he was turned away from two hospitals - the first because he isn't registered in the public health system, and the second "because they say they're too busy."
Labels: epidemic, hot trends 2009, mexico, pandemic, swine flu
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Friday, April 24, 2009
Mexico swine flu deaths spur global epidemic fears
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MEXICO CITY - A unique strain of swine flu is the suspected killer of dozens of people in Mexico, where authorities closed schools, museums, libraries and theaters in the capital on Friday to try to contain an outbreak that has spurred concerns of a global flu epidemic.
The worrisome new virus - which combines genetic material from pigs, birds and humans in a way researchers have not seen before - also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.
"We are very, very concerned," World Health Organization spokesman Thomas Abraham said. "We have what appears to be a novel virus and it has spread from human to human ... It's all hands on deck at the moment."
The outbreak caused alarm in Mexico, where more than 1,000 people have been sickened. Residents of the capital donned surgical masks and authorities ordered the most sweeping shutdown of public gathering places in a quarter century. President Felipe Calderon met with his Cabinet Friday to coordinate Mexico's response.
The WHO was convening an expert panel to consider whether to raise the pandemic alert level or issue travel advisories.
It might already be too late to contain the outbreak, a prominent U.S. pandemic flu expert said late Friday.
Given how quickly flu can spread around the globe, if these are the first signs of a pandemic, then there are probably cases incubating around the world already, said Dr. Michael Osterholm at the University of Minnesota.
In Mexico City, "literally hundreds and thousands of travelers come in and out every day," Osterholm said. "You'd have to believe there's been more unrecognized transmission that's occurred."
There is no vaccine that specifically protects against swine flu, and it was unclear how much protection current human flu vaccines might offer. A "seed stock" genetically matched to the new swine flu virus has been created by the U.S. Centers for Disease Control, 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.
Authorities in Mexico urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection. They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks. At Mexico City's international airport, passengers were questioned to try to prevent anyone with flu symptoms from boarding airplanes and spreading the disease.
Epidemiologists are particularly concerned because the only fatalities so far were in young people and adults.
The eight U.S. victims recovered from symptoms that were like those of the regular flu, mostly fever, cough and sore throat, though some also experienced vomiting and diarrhea.
U.S. health officials announced an outbreak notice to travelers, urging caution and frequent handwashing, but stopping short of telling Americans to avoid Mexico.
Mexico's Health Secretary Jose Angel Cordoba said 68 people have died of flu and the new swine flu strain had been confirmed in 20 of those deaths. At least 1,004 people nationwide were sick from the suspected flu, he said.
The geographical spread of the outbreaks also concerned the WHO — while 13 of the 20 deaths were in Mexico City, the rest were spread across Mexico — four in central San Luis Potosi, two up near the U.S. border in Baja California, and one in southern Oaxaca state.
Scientists have long been concerned that a new flu virus could launch a worldwide pandemic of a killer disease. A new virus could evolve when different flu viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Still, flu experts were concerned but not alarmed about the latest outbreak.
"We've seen swine influenza in humans over the past several years, and in most cases, it's come from direct pig contact. This seems to be different," said Dr. Arnold Monto, a flu expert with the University of Michigan.
"I think we need to be careful and not apprehensive, but certainly paying attention to new developments as they proceed."
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.
Cordoba said Mexico has enough Tamiflu to treat 1 million people, but the medicine will be strictly controlled and handed out only by doctors.
Mexico's government had maintained until late Thursday that there was nothing unusual about the flu cases, although this year's flu season had been worse and longer than past years.
The sudden turnaround by public health officials angered many Mexicans.
"They could have stopped it in time," said Araceli Cruz, 24, a university student who emerged from the subway wearing a surgical mask. "Now they've let it spread to other people."
The city was handing out free surgical masks to passengers on buses and the subway system, which carries 5 million people each day. Government workers were ordered to wear the masks, and authorities urged residents to stay home from work if they felt ill.
Closing schools across Mexico's capital of 20 million kept 6.1 million students home, as well as thousands of university students. All state and city-run cultural activities were suspended, including libraries, state-run theaters, and at least 14 museums. Private athletic clubs closed down and soccer leagues were considering canceling weekend games.
The closures were the first citywide shutdown of public gathering places since millions died in the devastating 1985 earthquake.
Mexico's response brought to mind other major outbreaks, such as when SARS hit Asia. At its peak in 2003, Beijing shuttered schools, cinemas and restaurants, and thousands of people were quarantined at home.
In March 2008, Hong Kong ordered more than a half-million students to stay home for two weeks because of a flu outbreak. It was the first such closure in Hong Kong since the outbreak of SARS, or severe acute respiratory syndrome.
"It's great they are taking precautions," said Lillian Molina, a teacher at the Montessori's World preschool in Mexico City, who scrubbed down empty classrooms with Clorox, soap and Lysol between fielding calls from worried parents.
U.S. health officials said the outbreak is not yet a reason for alarm in the United States. The five people sickened in California and three in Texas have all recovered.
It's unclear how the eight, who became ill between late March and mid-April, contracted the virus because none were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.
CDC officials described the virus as having a unique combination of gene segments not seen before in people or pigs. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. It may be completely new, or it may have been around for a while and was only detected now through improved testing and surveillance, CDC officials said.
The most notorious flu pandemic is thought to have killed at least 40 million people worldwide in 1918-19. Two other, less deadly flu pandemics struck in 1957 and 1968.
By MARK STEVENSON, Associated Press Writer
The worrisome new virus - which combines genetic material from pigs, birds and humans in a way researchers have not seen before - also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.
"We are very, very concerned," World Health Organization spokesman Thomas Abraham said. "We have what appears to be a novel virus and it has spread from human to human ... It's all hands on deck at the moment."
The outbreak caused alarm in Mexico, where more than 1,000 people have been sickened. Residents of the capital donned surgical masks and authorities ordered the most sweeping shutdown of public gathering places in a quarter century. President Felipe Calderon met with his Cabinet Friday to coordinate Mexico's response.
The WHO was convening an expert panel to consider whether to raise the pandemic alert level or issue travel advisories.
It might already be too late to contain the outbreak, a prominent U.S. pandemic flu expert said late Friday.
Given how quickly flu can spread around the globe, if these are the first signs of a pandemic, then there are probably cases incubating around the world already, said Dr. Michael Osterholm at the University of Minnesota.
In Mexico City, "literally hundreds and thousands of travelers come in and out every day," Osterholm said. "You'd have to believe there's been more unrecognized transmission that's occurred."
There is no vaccine that specifically protects against swine flu, and it was unclear how much protection current human flu vaccines might offer. A "seed stock" genetically matched to the new swine flu virus has been created by the U.S. Centers for Disease Control, 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.
Authorities in Mexico urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection. They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks. At Mexico City's international airport, passengers were questioned to try to prevent anyone with flu symptoms from boarding airplanes and spreading the disease.
Epidemiologists are particularly concerned because the only fatalities so far were in young people and adults.
The eight U.S. victims recovered from symptoms that were like those of the regular flu, mostly fever, cough and sore throat, though some also experienced vomiting and diarrhea.
U.S. health officials announced an outbreak notice to travelers, urging caution and frequent handwashing, but stopping short of telling Americans to avoid Mexico.
Mexico's Health Secretary Jose Angel Cordoba said 68 people have died of flu and the new swine flu strain had been confirmed in 20 of those deaths. At least 1,004 people nationwide were sick from the suspected flu, he said.
The geographical spread of the outbreaks also concerned the WHO — while 13 of the 20 deaths were in Mexico City, the rest were spread across Mexico — four in central San Luis Potosi, two up near the U.S. border in Baja California, and one in southern Oaxaca state.
Scientists have long been concerned that a new flu virus could launch a worldwide pandemic of a killer disease. A new virus could evolve when different flu viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Still, flu experts were concerned but not alarmed about the latest outbreak.
"We've seen swine influenza in humans over the past several years, and in most cases, it's come from direct pig contact. This seems to be different," said Dr. Arnold Monto, a flu expert with the University of Michigan.
"I think we need to be careful and not apprehensive, but certainly paying attention to new developments as they proceed."
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.
Cordoba said Mexico has enough Tamiflu to treat 1 million people, but the medicine will be strictly controlled and handed out only by doctors.
Mexico's government had maintained until late Thursday that there was nothing unusual about the flu cases, although this year's flu season had been worse and longer than past years.
The sudden turnaround by public health officials angered many Mexicans.
"They could have stopped it in time," said Araceli Cruz, 24, a university student who emerged from the subway wearing a surgical mask. "Now they've let it spread to other people."
The city was handing out free surgical masks to passengers on buses and the subway system, which carries 5 million people each day. Government workers were ordered to wear the masks, and authorities urged residents to stay home from work if they felt ill.
Closing schools across Mexico's capital of 20 million kept 6.1 million students home, as well as thousands of university students. All state and city-run cultural activities were suspended, including libraries, state-run theaters, and at least 14 museums. Private athletic clubs closed down and soccer leagues were considering canceling weekend games.
The closures were the first citywide shutdown of public gathering places since millions died in the devastating 1985 earthquake.
Mexico's response brought to mind other major outbreaks, such as when SARS hit Asia. At its peak in 2003, Beijing shuttered schools, cinemas and restaurants, and thousands of people were quarantined at home.
In March 2008, Hong Kong ordered more than a half-million students to stay home for two weeks because of a flu outbreak. It was the first such closure in Hong Kong since the outbreak of SARS, or severe acute respiratory syndrome.
"It's great they are taking precautions," said Lillian Molina, a teacher at the Montessori's World preschool in Mexico City, who scrubbed down empty classrooms with Clorox, soap and Lysol between fielding calls from worried parents.
U.S. health officials said the outbreak is not yet a reason for alarm in the United States. The five people sickened in California and three in Texas have all recovered.
It's unclear how the eight, who became ill between late March and mid-April, contracted the virus because none were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.
CDC officials described the virus as having a unique combination of gene segments not seen before in people or pigs. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. It may be completely new, or it may have been around for a while and was only detected now through improved testing and surveillance, CDC officials said.
The most notorious flu pandemic is thought to have killed at least 40 million people worldwide in 1918-19. Two other, less deadly flu pandemics struck in 1957 and 1968.
By MARK STEVENSON, Associated Press Writer
Labels: hot trends 2009, influenza, new virus, pandemic, swine flu
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