Pandemic Risk Grows as New Cases Pop Up

Daily News Article   —   Posted on April 28, 2009

(by Betsy McKay and Gautam Naik, WSJ.com) – The swine flu epidemic crossed new borders Tuesday with the first cases confirmed in the Middle East and the Asia-Pacific region, as world health officials said they suspect American patients may have transmitted the virus to others in the U.S.

Most people confirmed with the new swine flu were infected in Mexico, where the number of deaths blamed on the virus has surpassed 150. But confirmation that people have been infecting others in locations outside Mexico would indicate that the disease was spreading beyond travelers returning from Mexico, World Health Organization spokesman Gregory Hartl told reporters on Tuesday in Geneva.

Mr. Hartl said the source of some infections in the U.S., Canada and Britain was unclear. The swine flu has already spread to at least six countries besides Mexico, prompting WHO officials to raise its alert level on Monday.

“At this time, containment is not a feasible option,” said Keiji Fukuda, assistant director-general of the World Health Organization.

The United Nations public-health agency raised its global alert to phase 4 from phase 3. The change recognizes that the new A/H1N1 virus spreads from person to person, and signals that governments should prepare for outbreaks. Phase 6 is a pandemic.

Fifty cases — none fatal and most of them mild — were confirmed in the U.S. Including the New Zealand, Israeli and new Spanish reports, there were 92 confirmed cases world-wide on Tuesday. That included six in Canada, one in Spain and two in Scotland.

New Zealand confirmed that 11 people who recently returned from Mexico contracted the virus, Health Minister Tony Ryall said. Laboratory tests on samples from three of the 11 came back positive and “on that basis we are assuming” the eight others are also infected, he said.

Those infected had suffered only “mild illness” and were expected to recover, Public Health Director Mark Jacobs said.

In the Israeli city of Netanya, hospital officials said a 26-year-old patient recently returned from Mexico was the region’s first confirmed case of swine flu, but didn’t know whether the patient had the same strain as the one that appeared in Mexico. Avinoam Skolnik, Laniado Hospital’s medical director, said Israeli Health Ministry laboratory tests confirmed the virus but the patient has fully recovered and is in “excellent condition.”

Meanwhile, a second case was confirmed Tuesday in Spain, Health Minister Trinidad Jimenez said, a day after the country reported its first case. The 23-year-old student, one of 26 patients under observation, was not in serious condition, Mr. Jimenez said.

The European Union health commissioner suggested that Europeans avoid nonessential travel both to Mexico and parts of the U.S. Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus.

Governments in Asia — with memories of previous flu outbreaks — were especially cautious. Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the 2003 SARS crisis and were checking for signs of fever among passengers from North America. South Korea, India and Indonesia also announced screening.

Teams of doctors, nurses and government officials boarded flights arriving in Japan from Mexico, the U.S. and Canada to check passengers for signs of the flu, Japanese Health Ministry official Akimori Mizuguchi said.

World stock markets fell Tuesday as investors worried that any swine flu pandemic could derail a global economic recovery.

Cases Increase in the U.S.

With the virus spreading, the U.S. prepared for the worst even as President Barack Obama tried to reassure Americans. At the White House, a swine flu update was added to Mr. Obama’s daily intelligence briefing. Mr. Obama said Monday the outbreak is “not a cause for alarm,” even as the U.S. stepped up checks of people entering the country and warned U.S. citizens to avoid nonessential travel to Mexico.

“We are proceeding as if we are preparatory to a full pandemic,” said Homeland Security Secretary Janet Napolitano.

The number of U.S. cases rose to 50, the result of further testing at a New York City school, although none was fatal. Other U.S. cases have been reported in Ohio, Kansas, Texas and California.

The Food and Drug Administration issued emergency guidance that allows certain antiviral drugs to be used in a broader range of the population in case mass dosing is needed to deal with the outbreak. The agency originally approved the use of the antiviral drug Tamiflu for the prevention and treatment of influenza in adults and children age 1 and older. Another antiviral drug, Relenza, was originally approved to treat people 7 years and older and to help prevent flu in those 5 and older.

Late Monday, the FDA said it issued emergency guidance to allow Tamiflu to treat and prevent flu in children under 1 year old and to provide doses other than originally approved in children over 1. The drugs may be distributed to larger segments of the population without complying with the approved label requirements, the FDA said. The agency also authorized a swine flu diagnostic test for testing samples from people with certain flu infections who virus subtypes cannot be identified by currently available tests.

On Monday, the Centers for Disease Control and Prevention raised its number of confirmed cases to 40 people, who ranged in age from 7 years old to 54.

The new cases tallied by the CDC were linked to the outbreak at the St. Francis Preparatory School in Queens, New York, where eight people had been identified earlier. The new cases came after further testing and weren’t new outbreaks, said Richard Besser, the CDC’s acting director.

The new cases in Texas include a 24-year-old, a 7-year-old and a 3-month-old in Dallas County. The Dallas County city of Richardson, where the 7-year-old is enrolled, will close an elementary school for the rest of the week, school-district spokeswoman Liz Morse said.

None of the Richardson students have required hospitalization, Ms. Morse said. She said the district made the decision to close Canyon Creek Elementary School on Monday afternoon after consulting with county health officials. She said parents of all Canyon Creek students, even those without symptoms, should keep their children out of public places to avoid spreading the disease.

“We really want the students to not be in public places, to stay maybe a little secluded so that if they’ve caught it they won’t be spreading it around,” Ms. Morse said.

The flu outbreak comes as the Obama administration seeks a new head of its Department of Health and Human Services, which oversees the CDC. The Senate on Tuesday is expected to begin debating the nomination of Kansas Gov. Kathleen Sebelius as HHS secretary. Democratic and Republican aides in the Senate said they expected Senate approval.

The U.S. government is far better prepared for an outbreak than it was when SARS awakened politicians and the public to the notion that infectious diseases continue to be deadly, even with modern vaccines.

Prodded by SARS and the avian flu scare that followed, President George W. Bush in 2005 issued a pandemic flu preparedness plan. Since 2006, $6.2 billion has been appropriated to stockpile antivirals, step up surveillance and improve vaccine-making and technology.

But state and local health departments — which are often the first to detect new infectious threats — haven’t received federal funds for pandemic flu preparedness since 2006. Many of the agencies have cut staff and services in the recession.

“You can’t stand up to this kind of capacity overnight if you haven’t had resources to keep people on staff,” said Jeffrey Levi, executive director of Trust for America’s Health, a public health advocacy organization.

Investigation Intensifies

Mexico, where the number of deaths believed caused by swine flu rose by 50% on Monday to 152, is suspected to be ground zero of the outbreak. Health officials said they were stumped over why the strain has been so deadly in Mexico, where the number of suspected cases has surpassed 2,000 people.

Amid the alarm, there was a spot of good news. The number of new cases reported by Mexico’s largest government hospitals has been declining the past three days, Mr. Cordova said, from 141 on Saturday to 119 on Sunday and 110 Monday.

In a bid to prevent mass contagion, Mexico canceled school nationwide until May 6, and the Mexico City government is considering a complete shutdown, including all public transportation. The Cinco de Mayo parade celebrating Mexico’s defeat of a French army on May 5, 1862 and Mexico City’s traditional May 1 parade were canceled. More than 100 museums nationwide were closed.

Three games involving Mexico City soccer clubs were played with no spectators over the weekend. Decio de Maria, secretary general of the Mexican soccer federation, said plans for future matches would be announced on Wednesday.

“The idea is to look for the fewest number of games that have to be played behind closed doors,” he said. “If it’s necessary, we’ll play all the matches behind closed doors. We don’t foresee canceling any games.”

Many residents of Mexico City wore blue surgical masks, though the CDC said most masks offer little protection. Many victims have been in their 30s and 40s — not the very old or young who typically succumb to the flu. So far, no deaths from the new virus have been reported outside Mexico.

-Betsy McKay, Gautam Naik, Janet Adamy, Shai Oster, J.R. Wu, Ben Casselman, Jennifer Martinez, Alicia Mundy and Jonathan D. Rockoff contributed to this article.

Write to Betsy McKay at betsy.mckay@wsj.com and Gautam Naik at gautam.naik@wsj.com.

Copyright 2009 Dow Jones & Company, Inc.  All Rights Reserved.  Reprinted here for educational purposes only.  Visit the website at wsj.com.