U.S. health officials troubled by new flu pattern

WASHINGTON, 20 may 2009-- The new influenza strain circulating around most of the United States is putting a worrying number of young adults and children into the hospital and hitting more schools than usual, U.S. health officials said on Monday.

The H1N1 swine flu virus killed a vice principal at a New York City school over the weekend and has spread to 48 states. While it appears to be mild, it is affecting a disproportionate number of children, teenagers and young adults.

This includes people needing hospitalization -- now up to 200, said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention.

"That's very unusual, to have so many people under 20 to require hospitalization, and some of them in (intensive care units)," Schuchat told reporters in a telephone briefing.

"We are now experiencing levels of influenza-like illness that are higher than usual for this time of year," Schuchat added. "We are also seeing outbreaks in schools, which is extremely unusual for this time of year."

New York City Health Commissioner Dr. Thomas Frieden agreed with Schuchat.

"We're seeing increasing numbers of people going to emergency departments saying they have fever and flu, particularly young people in the 5 to 17 age group, " Frieden, who has been named by U.S. President Barack Obama as the new CDC director, told a news conference.

About half of all cases of influenza are being diagnosed as the new H1N1 strain, while the rest are influenza B, or the seasonal H1N1 and H3N2 strains. Flu season in the United States is usually almost over by May.

CDC officials say around 100,000 people are likely infected with the new flu strain in the United States and Schuchat said the 5,123 confirmed and probable cases and six deaths in the United States were "the tip of the iceberg."

MORE ILLNESS OVERALL

"We are seeing more reports of influenza-like illness from outpatient visits that we monitor than is typical for this time of year," Schuchat said.

Because doctors usually treat symptoms and only occasionally give flu tests to patients, the CDC must monitor reports of symptoms such as fever, cough and muscle aches to track flu activity. Some centers are doing actual influenza tests to confirm the patterns that are seen.

Influenza is a factor in 36,000 deaths a year in the United States and 250,000 to 500,000 deaths globally, the CDC says.

"Unlike the seasonal flu, we are seeing relatively few cases or hospitalizations in people over 65," Schuchat said. Usually flu kills the elderly and people with chronic diseases.

There is no evidence that a second, bacterial infection is worsening the H1N1 cases, Schuchat said.

When family members are questioned, it seems clear that children and teens are more prone to infection than older adults, Schuchat said. "People under 18 are more likely to have infections when another person in the family is infected," she said.

"One of our working hypotheses is that older adults may have some pre-existing protection against this virus due to their exposure long ago to some virus that may be distantly related," Schuchat said.

An alternative hypothesis is that it just has not had a chance to make its way into the older population yet.

(Editing by Julie Steenhuysen and Xavier Briand)

WHO confirms nearly 1,000 flu cases in 20 countries

GENEVA , 05 may 2009 - The World Health Organization (WHO) said on Monday that its laboratories have identified a total of 985 H1N1 flu infections in 20 countries, including El Salvador and Colombia, and said there have been 25 confirmed deaths in Mexico.

The WHO's toll lags national reports about the virus but is considered more scientifically secure. Its figures about Mexico -- considered the epicenter of the outbreak -- have been rising in recent days because of lab results on previously-collected samples coming in, not because of new infections reported.

Its most recent figures say that 590 people have been infected in Mexico, and 226 people have been infected in the United States, the two countries most affected by the virus widely known as swine flu. There has also been one U.S. death, identified by authorities there as a Mexican infant.

The WHO has also confirmed flu infections, without deaths, in the following countries: Austria (1), Canada (85), Hong Kong - China Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (2), Germany (8), Ireland (1), Israel (3), Italy (1) Netherlands (1), New Zealand (4), South Korea (1), Spain (40), Switzerland (1) and Britain (15).

The WHO is waiting to see evidence of sustained spread of the virus outside of the Americas region before raising its global alert level from 5 to the highest level, 6, and declaring a full pandemic.

Asked on Sunday about the relatively large number of infections confirmed in Spain, WHO spokesman Gregory Hartl said most of those appeared to be "imported" cases involving people returning from Mexico, the disease epicenter, and not a situation where the virus was spreading widely through the Spanish population.

What you need to know about the new swine flu

WASHINGTON, 03 may 2009– As the new swine flu spreads, people have lots of questions about how it affects their day-to-day life. Here are some answers.

Q: How easy is it to catch this virus?

A: It's spreading as easily as regular winter flu, which infects millions each year. Early estimates are that 25 percent to 30 percent of family members are getting sick once a relative brings it home.

Q: How dangerous is it?

A: Nobody knows yet. Genetically, it doesn't share the same traits that made the infamous 1918 pandemic so deadly, nor does it seem as virulent as the bird flu that scientists have tracked for several years. While Mexico reported many deaths, the virus is causing less severe illness in the U.S. In fact, the Centers for Disease Control and Prevention says most cases so far haven't needed medical attention.

Q: Could I have some immunity?

A: Since it's a never-before-seen mix of mostly pig but also human and bird viruses, the CDC has cautioned that's unlikely. But it is a member of the H1N1 family of flu viruses, which circulate widely. Flu specialist John Treanor at the University of Rochester says people born before 1957 spent their childhood repeatedly exposed to H1 viruses. So experts are withholding final judgment on that question.

Q: Is it treatable?

A: Yes, with the standard anti-flu drugs Tamiflu and Relenza. They lessen symptoms if taken within 48 hours of the first symptoms.

Q: Is there a vaccine?

A: No. The government is working to develop one and the earliest shots could roll out would be in the fall, if authorities decide the virus remains enough of a threat to offer those shots. Manufacturers are preparing regular flu shots for the fall, when routine influenza strains will start circulating regardless of swine flu.

Q: Why does CDC stress hand-washing?

A: Flu viruses do spread through the air, so cover coughs and sneezes with a tissue or by sneezing into your elbow rather than your hand. But flu also can spread by touching your mouth or nose with unwashed hands. The viruses can live on surfaces such as doorknobs or handrails for a few hours, or be passed by a handshake.

Q: Do hand gels work better?

A: No, they're just an alternative, says Dr. Richard Besser, the CDC's acting chief. He keeps a bottle in his pocket. The bigger issue is to wash hands well enough to get rid of germs. Sing "Happy Birthday" or "Twinkle, Twinkle, Little Star" to know you've scrubbed long enough, he advises.

Q: How long do I have to worry if I just got back from Mexico?

A: The incubation period is two days to seven days, regardless of where you were exposed.

Q: How long should I stay home if I get the flu?

A: Certainly call your doctor about bad symptoms or if you're at all worried, especially if you have any chronic condition, such as asthma, that makes you more susceptible to any kind of flu. But other than going out for medical care, stay home for seven days or for one day after symptoms end. The CDC also says family members should consider staying home or decreasing their contact with others in case they're incubating the infections.

Q: Why are so many schools closing?

A: It's not clear just how much good school closings do in slowing flu's spread. It doesn't help much if kids then gather at the mall or a friend's house or day care. But because children spread all kinds of viruses easily — they don't wash as well, have close contact in crowded classes, and sometimes are contagious for a few days longer than adults — the CDC has advised schools with cases to consider closing for at least 14 days.

Q: Can pets get sick?

A: Besser says there's no evidence that this flu affects anyone other than humans.

Q: Can flu spread on imported fruits and vegetables from Mexico?

A: No. It doesn't spread through any food, including pork.

Q: Is it safe to fly? How about the subway?

A: Yes, the CDC says. Just don't travel if you're sick — stay home.

Q: Do I need a mask in crowded areas?

A: The CDC hasn't yet recommended that anyone other than health workers use masks.

Q: Why hasn't the U.S. closed the border with Mexico?

A: By the time authorities detected the new virus, it already had spread here. That makes closing the border moot, the Obama administration says.

Q: I have a summer trip planned to a state with lots of cases. Should I cancel?

A: Not yet, just stay tuned, Besser advises. Doctors should know much more about this flu by then.

Q: Why did the government quit using the name "swine flu" this past week?

A: Because of concern that people thought they might catch the virus from pigs or pork — which is wrong. It is spread person to person.

Q: How can I get more information?

A: On the Web, check http://www.cdc.gov/swineflu or call CDC's 24-hour hot line, in English or Spanish, at 1-800-CDC-INFO.

Flu pandemic still likely but Mexico toll drops

MEXICO CITY,03 may 2009- Mexico's flu outbreak appeared to be stabilizing on Saturday but officials warned the unpredictable virus still threatened a global pandemic.

Mexican officials said hospitals were seeing fewer new cases of people with symptoms from the new swine flu virus and cut the estimated death toll from the outbreak.

"It would still be imprudent to say that we're past the worst of it but I do think ... we are in a stage of stabilization," Mexican Health Minister Jose Angel Cordova told reporters.

Costa Rica, Italy, and Ireland confirmed cases of the virus, which has now been found in 18 countries.

In Geneva, the World Health Organization said H1N1 influenza had not spread in a sustained way outside North America, as would be required before the pandemic alert level is raised to its highest level. But it said that would probably happen soon.

"I would still propose that a pandemic is imminent because we are seeing the disease spread," Michael Ryan, WHO director of Global Alert and Response, told a briefing.

Few are ready to take chances with the new virus, widely dubbed swine flu.

In Hong Kong, police quarantined a hotel after a Mexican guest fell ill with the virus, which may have killed more than 100 people in Mexico, the worst-hit country. Mexico called the action "unjustified" and advised its citizens to avoid travel to China.

Mexican authorities cut their suspected death toll to up to 101 from as many as 176 as more test samples came back negative. Fewer patients with severe flu symptoms were checking into hospitals, suggesting a falling infection rate, and no new deaths were reported in Mexico City in the past two days.

REMAIN VIGILANT

The World Health Organization said 15 countries had reported 615 infections, not including the later reports of confirmed cases in Ireland, Italy and Costa Rica.

The United States, the second hardest-hit country, said it had confirmed 160 cases in 21 states.

U.S. officials said they were encouraged by reports from Mexico that the outbreak may be leveling off, although they said it was too early to relax.

"We are remaining vigilant," said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention. "We have seen times where things appear to be getting better and then get worse again. ... I think in Mexico we may be holding our breath for some time."

Almost all infections outside Mexico have been mild. The only death in another country has been a Mexican toddler who was taken to the United States before he fell sick.

President Barack Obama said the United States was responding aggressively to the new flu strain and was closing some schools temporarily and distributing antiviral drug supplies as needed.

The White House said Obama spoke to Mexican President Felipe Calderon on Saturday about U.S.-Mexican cooperation on limiting the spread of the virus.

Scientists are still trying to assess how the new virus behaves and how it compares to regular seasonal flu strains, which kill between 250,000 and 500,000 globally every year.

The outbreak remains tiny compared with other epidemics such as malaria, hepatitis and meningitis. But the WHO hiked its pandemic alert level to 5 from 3 this week -- the last step before a pandemic -- due to its rapid spread and the possibility it could hit hard in poor and disease-prone communities, including among people with HIV.

Ryan said the WHO would send more than 2 million treatment courses of antiviral drugs to poor countries to help them prepare for the virus, which is already causing havoc with a travel industry that flies hundreds of thousands of people to and from Mexico each week.

China suspended flights to Mexico after Hong Kong authorities on Friday confirmed a Mexican man who flew via the Chinese mainland was infected with the flu strain. Hong Kong was hit hard by the 2003 SARS outbreak.

Police in surgical masks quarantined 200 guests and 100 staff inside a Hong Kong hotel where the Mexican, 25, had been staying, saying they would be confined for a week.

"They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man at the hotel told a TV reporter by telephone.

Public hospitals in Mexico have noted a steady drop in patients turning up with fevers, suggesting the infection rate may be declining as people don face masks and use hand gel.

Cordova said of 159 suspected flu deaths, tests showed 58 died of other causes. He said 16 deaths were confirmed as caused by the H1N1 flu and 85 were being tested.

In Mexico City, big parks, museums and zoos were shut and in the sprawling metropolis of 20 million people many were heeding a government call to stay home for a prolonged five day-holiday to try to stem new infections.

Jose Francisco Suarez, 15, said he wanted to get back to school. "We're sick of this situation. A few days off school wouldn't be so bad but now there's nothing to do," he said during a break playing basketball with two friends.

Lower Mexico flu death toll calms nervous world

MEXICO CITY , 03 may 2009- New laboratory data showed fewer people have died in Mexico than first thought from a deadly new influenza strain, a glint of good news for a world rattled by the threat of a flu pandemic.

Mexico cut its suspected death toll from the H1N1 flu to up to 101 from as many as 176, as dozens of test samples came back negative. Fewer patients with severe flu symptoms were also checking into hospitals, suggesting the infection rate of a flu that has spread to Europe and Asia was declining.

South Korea confirmed its first H1N1 case on Saturday, a 51-year-old woman who returned from Mexico in mid-April.

The U.S. Centers for Disease Control and Prevention agreed the outbreak may not be as severe as it looked a few days ago, citing many mild cases that were not immediately noticed.

For Mexicans -- who are spending a second weekend stuck indoors with stores and businesses shuttered across the country and the capital, Mexico City, devoid of its lively restaurants, bars, cinemas and museums -- the data is cheering.

Health Minister Jose Angel Cordova acknowledged the numbers were encouraging but cautioned it was too early to say Mexico had control of a flu that has infected people in 15 countries.

"For now it's unpredictable," Cordova said late on Friday, noting epidemics can peak again after an initial spurt in infections drops off.

"We need more days to see how it behaves and whether there is really a sustained decline so we can conclude that it's going down," he said.

The new virus is only the third infectious disease experts regard as having pandemic potential in the past 10 years.

It has world health experts racing to work on a vaccine and is wreaking havoc with a travel industry that flies hundreds of thousands of people to and from Mexico each week.

China suspended flights to Mexico after Hong Kong authorities on Friday confirmed a Mexican man who flew via the Chinese mainland was infected with the flu strain.

Police in surgical masks quarantined 200 guests and 100 staff inside a Hong Kong hotel where the 25-year-old Mexican had been staying, saying they would be confined for a week.

"They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man at the hotel told a TV reporter by telephone.

The measures taken by the authorities in Hong Kong underscore the concern there about the new flu. Hong Kong was badly hit by the SARS virus in 2003 and has had many episodes of H5N1 bird flu for more than a decade.

ANTIVIRAL DEMAND UP, PANAMA CATCHES RUNAWAY

Various European countries have confirmed cases of the virus.

The United States has been hit with 145 cases in 22 states, sending demand shooting up for antiviral medicine and prompting preventative measures such as a Boston University dropping handshakes for graduating students accepting diplomas.

In Panama, police detained an American who ran away from a hospital that was testing him for the swine flu.

Almost all infections outside Mexico have been mild, however, with only a handful needing hospital treatment. The only death in another country has been a Mexican toddler who was taken to the United States before he fell sick.

Mexico has released a confusing batch of flu data in recent days but public hospitals have noted a steady drop in patients turning up with fevers, suggesting the infection rate may be declining as the nation dons face masks and hand gel.

"There are very few deaths worldwide," said Marcelo Musi, a salesman shopping for vegetables in Mexico City, where residents weary of masks, hand sanitizer and frightening headlines clutched at signs of an end to the crisis.

"If there are no more cases, they say things will get better," said Musi.

President Felipe Calderon ordered non-essential businesses to close for five days from Friday, extending a three-day holiday weekend over Monday and Tuesday.

Analysts say the move will dent already negative economic growth this year as it pinches businesses, but inspectors will fine or forcibly close companies that defy the order.

Countless families were devastated at having their long weekend ruined. Young couples, children and the elderly were mainly stuck indoors as restaurants, bars, playgrounds and parks that hold outdoor "cumbia" dances all stayed closed.

Cordova said that out of 159 files on suspected flu deaths, tests showed 58 died of other causes. He said 16 deaths are confirmed as caused by the H1N1 flu and 85 are being tested.