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Thread: Is swine flu 'the big one' or a flu that fizzles?

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    Default Is swine flu 'the big one' or a flu that fizzles?

    By MIKE STOBBE, AP Medical Writer Mike Stobbe, Ap Medical Writer Sun Apr 26, 8:03 pm ET

    ATLANTA As reports of a unique form of swine flu erupt around the world, the inevitable question arises: Is this the big one?

    Is this the next big global flu epidemic that public health experts have long anticipated and worried about? Is this the novel virus that will kill millions around the world, as pandemics did in 1918, 1957 and 1968?

    The short answer is it's too soon to tell.

    "What makes this so difficult is we may be somewhere between an important but yet still uneventful public health occurrence here with something that could literally die out over the next couple of weeks and never show up again or this could be the opening act of a full-fledged influenza pandemic," said Michael Osterholm, a prominent expert on global flu outbreaks with the University of Minnesota.

    "We have no clue right now where we are between those two extremes. That's the problem," he said.

    Health officials want to take every step to prevent an outbreak from spiraling into mass casualties. Predicting influenza is a dicey endeavor, with the U.S. government famously guessing wrong in 1976 about a swine flu pandemic that never materialized.

    "The first lesson is anyone who tries to predict influenza often goes down in flames," said Dr. Richard Wenzel, the immediate past president of the International Society for Infectious Diseases.

    But health officials are being asked to make such predictions, as panic began to set in over the weekend.

    The epicenter was Mexico, where the virus is blamed for 86 deaths and an estimated 1,400 cases in the country since April 13. Schools were closed, church services canceled and Mexican President Felipe Calderon assumed new powers to isolate people infected with the swine flu virus.

    International concern magnified as health officials across the world on Sunday said they were investigating suspected cases in people who traveled to Mexico and come back with flu-like illnesses. Among the nations reporting confirmed cases or investigations were Canada, France, Israel and New Zealand.

    Meanwhile, in the United States, there were no deaths and all patients had either recovered or were recovering. But the confirmed cases around the nation rose from eight on Saturday morning to 20 by Sunday afternoon, including eight high school kids in New York City a national media center. The New York Post's front page headline on Sunday was "Pig Flu Panic."

    The concern level rose even more when federal officials on Sunday declared a public health emergency a procedural step, they said, to mobilize antiviral medicine and other resources and be ready if the U.S. situation gets worse.

    U.S. Centers for Disease Control and Prevention officials say that so far swine flu cases in this country have been mild. But they also say more cases are likely to be reported, at least partly because doctors and health officials across the country are looking intensively for suspicious cases.

    And, troublingly, more severe cases are also likely, said Dr. Richard Besser, the CDC's acting director, in a Sunday news conference.

    "As we continue to look for cases, we are going to see a broader spectrum of disease," he predicted. "We're going to see more severe disease in this country."

    Besser also repeated what health officials have said since the beginning they don't understand why the illnesses in Mexico have been more numerous and severe than in the United States. In fact, it's not even certain that new infections are occurring. The numbers could be rising simply because everyone's on the lookout.

    He also said comparison to past pandemics are difficult.

    "Every outbreak is unique," Besser said.

    The new virus is called a swine flu, though it contains genetic segments from humans and birds viruses as well as from pigs from North America, Europe and Asia. Health officials had seen combinations of bird, pig and human virus before but never such an intercontinental mix, including more than one pig virus.

    More disturbing, this virus seems to spread among people more easily than past swine flus that have sometimes jumped from pigs to people.

    There's a historical cause for people to worry.

    Flu pandemics have been occurring with some regularity since at least the 1500s, but the frame of reference for health officials is the catastrophe of 1918-19. That one killed an estimated 20 to 50 million people worldwide.

    Disease testing and tracking were far less sophisticated then, but the virus appeared in humans and pigs at about the same time and it was known as both Spanish flu and swine flu. Experts since then have said the deadly germ actually originated in birds.

    But pigs may have made it worse. That pandemic began with a wave of mild illness that hit in the spring of 1918, followed by a far deadlier wave in the fall which was most lethal to young, healthy adults. Scientists have speculated that something happened to the virus after the first wave one theory held that it infected pigs or other animals and mutated there before revisiting humans in a deadlier form.

    Pigs are considered particularly susceptible to both bird and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of deadly, easily spread flu, scientists believe.

    Such concern triggered public health alarm in 1976, when soldiers at Fort Dix, N.J., became sick with an unusual form of swine flu.

    Federal officials vaccinated 40 million Americans. The pandemic never materialized, but thousands who got the shots filed injury claims, saying they suffered a paralyzing condition and other side effects from the vaccinations.

    To this day, health officials don't know why the 1976 virus petered out.

    Flu shots have been offered in the United States since the 1940s, but new types of flu viruses have remained a threat. Global outbreaks occurred again in 1957 and 1968, though the main victims were the elderly and chronically ill.

    In the last several years, experts have been focused on a form of bird flu that was first reported in Asia. It's a highly deadly strain that has killed more than 250 people worldwide since 2003. Health officials around the world have taken steps to prepare for the possibility of that becoming a global outbreak, but to date that virus has not gained the ability to spread easily from person to person.

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    WHO raises its pandemic alert level on swine flu
    AP

    By E. EDUARDO CASTILLO and PAUL HAVEN, Associated Press Writers E. Eduardo Castillo And Paul Haven, Associated Press Writers – 7 mins ago

    MEXICO CITY – The swine flu epidemic entered a dangerous new phase Monday as the death toll climbed in Mexico and the number of suspected cases there and in the United States nearly doubled. The World Health Organization raised its alert level but stopped short of declaring a global emergency.

    The United States advised Americans against most travel to Mexico and ordered stepped up border checks in neighboring states. The European Union health commissioner advised Europeans to avoid nonessential travel both to Mexico and parts of the United States.

    The virus poses a potentially grave new threat to the U.S. economy, which was showing tentative early signs of a recovery. A widespread outbreak could batter tourism, food and transportation industries, deepening the recession in the U.S. and possibly worldwide.

    The suspected number of deaths rose to 149 in Mexico, the epicenter of the outbreak with nearly 2,000 people believed to be infected.

    The number of U.S. cases doubled to 42, 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. Worldwide there were 73 cases, including six in Canada, one in Spain and two in Scotland.

    While the total cases were still measured in hundreds, not thousands, Mexican Health Secretary Jose Angel Cordova said the epidemic was entering an extremely dangerous phase, with the number of people infected mushrooming even as authorities desperately ramped up defenses.

    "We are in the most critical moment of the epidemic. The number of cases will keep rising, so we have to reinforce preventative measures," Cordova said at a news conference.

    The WHO raised the alert level to Phase 4, meaning there is sustained human-to-human transmission of the virus causing outbreaks in at least one country.

    Its alert system was revised after bird flu in Asia began to spread in 2004, and Monday was the first time it was raised above Phase 3.

    "At this time, containment is not a feasible option," as the virus has already spread to several other countries, said WHO Assistant Director-General Keiji Fukuda.

    Putting an alert at Phases 4 or 5 signals that the virus is becoming increasingly adept at spreading among humans. That move could lead governments to set trade, travel and other restrictions aimed at limiting its spread.

    Phase 6 is for a full-blown pandemic, characterized by outbreaks in at least two regions of the world.

    It could take 4-6 months before the first batch of vaccines are available to fight the virus, WHO officials said.

    Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus amid global fears of a pandemic, an epidemic spread over a large area, either a region or worldwide.

    President Barack Obama said the outbreak was reason for concern, but not yet "a cause for alarm."

    Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said that so far the virus in the United States seems less severe than in Mexico. Only one person has been hospitalized in the U.S.

    "I wouldn't be overly reassured by that," Besser told reporters at CDC headquarters in Atlanta, raising the possibility of more severe cases in the United States.

    "We are taking it seriously and acting aggressively," Besser said. "Until the outbreak has progressed, you really don't know what it's going to do."

    U.S. customs officials began checking people entering U.S. territory. Millions of doses of flu-fighting medications from a federal stockpile were on their way to states, with priority given to the five already affected and to border states. Federal agencies were conferring with state and international governments.

    "We want to make sure that we have equipment where it needs to be, people where they need to be and, most important, information shared at all levels," said Janet Napolitano, head of the Homeland Security Department.

    "We are proceeding as if we are preparatory to a full pandemic," Napolitano said.

    She said travel warnings for trips to Mexico would remain in place as long as swine flu is detected.

    Mexico canceled school at all levels nationwide until May 6, and the Mexico City government said it was considering a complete shutdown, including all public transportation, if the death toll keeps rising. Labor Secretary Javier Lozano Alarcon said employers should isolate anyone showing up for work with fever, cough, sore throat or other signs of the flu.

    Amid the warnings, the Mexican government grappled with increasing criticism of its response. At least two weeks after the first swine flu case, the government has yet to say where and how the outbreak began or give details on the victims.

    The health department lacked the staff to visit the homes of all those suspected to have died from the disease, Cordova said.

    Cordova said 1,995 people have been hospitalized with serious cases of pneumonia since the first case of swine flu was reported April 13. The government does not yet know how many were swine flu.

    He said tests show a 4-year-old boy contracted the virus before April 2 in 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 half 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 flu in its herd or its employees working anywhere in Mexico.

    As if the country did not have enough to deal with, Cordova's comments were briefly interrupted by a 5.6-magnitude earthquake in southern Mexico that rattled already jittery nerves and sent mask-wearing office workers into the streets of the capital.

    Aside from the confirmed cases, 13 are suspected in New Zealand, and one is suspected in both France and Israel.

    European Union Health Commissioner Androulla Vassiliou advised Europeans to avoid nonessential travel to Mexico and parts of the United States, although Besser said that including the U.S. in the advisory seemed unwarranted at this time.

    State Department spokesman Robert A. Wood said Vassiliou's remarks were his "personal opinion," not an official EU position, and therefore the department had no comment.

    "We don't want people to panic at this point," Wood said.

    The U.S. stepped up checks of people entering the country by air, land and sea, and the State Department warned U.S. citizens to avoid nonessential travel to Mexico. It said those who live in Mexico should avoid hospitals or clinics there unless they have a medical emergency.

    The best way to keep the disease from spreading, Besser said, is by taking everyday precautions such as frequent handwashing, covering up coughs and sneezes, and staying away from work or school if not feeling well. He said authorities are not recommending that people wear masks at work because evidence that it is effective "is not that strong."

    Besser said about 11 million doses of flu-fighting drugs from a federal stockpile have been sent to states in case they are needed. That's roughly one quarter of the doses in the stockpile, he said.

    There is no vaccine available to prevent the specific strain now being seen, he said, but some antiflu drugs do work once someone is sick.

    If a new vaccine eventually is ordered, the CDC already has taken a key preliminary step — creating what's called seed stock of the virus that manufacturers would use.

    Many of the cases outside Mexico have been relatively mild. Symptoms include a fever of more than 100, coughing, joint aches, severe headache and, in some cases, vomiting and diarrhea.

    European and U.S. markets bounced back from early losses as pharmaceutical stocks were lifted by expectations that health authorities will increase stockpiles of anti-viral drugs. Stocks of airlines, hotels and other travel-related companies posted sharper losses.

    WHO spokesman Peter Cordingley singled out air travel as an easy way the virus could spread, noting that the WHO estimates that up to 500,000 people are on planes at any time.

    Governments in Asia — with potent 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.

    In Malaysia, health workers in face masks took the temperatures of passengers as they arrived on a flight from Los Angeles.

    China said anyone experiencing flu-like symptoms within two weeks of arrival had to report to authorities.

    China, Russia and Ukraine were among countries banning imports of pork and pork products from Mexico and three U.S. states that have reported swine flu cases, while other countries, such as Indonesia, banned all pork imports.

    The CDC says people cannot get the flu by eating pork or pork products.

    Germany's leading vacation tour operators were skipping stops in Mexico City as a precaution. The Hannover-based TUI said trips through May 4 to Mexico City were being suspended, including those operated by TUI itself and also through companies 1-2 Fly, Airtours, Berge & Meer, Grebeco and L'tur.

    Japan's largest tour agency, JTB Corp., suspended tours to Mexico through June 30. Russian travel agencies said about a third of those planning to travel to Mexico in early May had already canceled.

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    Worst case scenario underlies US pandemic plan

    By RICARDO ALONSO-ZALDIVAR and EILEEN SULLIVAN, Associated Press Writers Ricardo Alonso-zaldivar And Eileen Sullivan, Associated Press Writers – Tue Apr 28, 7:11 am ET

    WASHINGTON – Two million dead. Hospitals overwhelmed. Schools closed. Swaths of empty seats at baseball stadiums and houses of worship. An economic recovery snuffed out. We're nowhere close to what government planners say would be a worst-case scenario: a global flu pandemic. But government leaders at all levels, and major employers, have spent nearly four years planning for one in series of exercises.

    Their reports, reviewed by The Associated Press, and interviews with participants paint a grim picture of what could happen if the swine flu gets severely out of control.

    A full-scale pandemic — if it ever comes — could be expected to claim the lives of about 2 percent of those infected, about 2 million Americans.

    The government estimates that a pandemic like the 1918 Spanish flu would sicken 90 million Americans, or about 30 percent of the population. Of those, nearly 10 million would have to be admitted to a hospital, and nearly 1.5 million would need intensive care. About 750,000 would need the help of mechanical ventilators to keep breathing.

    No one would be immune from the consequences, even those who don't get sick, according to worst-case exercises run by local and national agencies.

    Schools would be closed to try to block the spread of illness, for example, but school buses might be used to take flu victims to alternative clinics rather than overcrowded hospitals.

    A 2006 report on the Washington region found both Maryland and Virginia would run out of hospital beds within two weeks of a moderate outbreak.

    People who got sick would be isolated, and their relatives could be quarantined.

    But even if families weren't required to stay home, many would do so to take care of sick relatives, or because they were afraid of getting sick themselves.

    Hotels, restaurants and airlines would face loss of business as business travel and meetings would be replaced by teleconferences.

    In the cities, commuters who do go to work might bike or walk instead of using mass transit.

    People would avoid movie theaters and rent DVDs instead.

    In 1918, authorities even called on churches to cancel services, to the chagrin of some pastors.

    Society as a whole would go into a defensive crouch, and that would deliver a shock to the economy.

    The Trust for America's Health, an independent public health group, estimated in 2007 that a severe pandemic would shrink U.S. output by about 5.5 percent.

    Take a breath. Even if the new swine flu from Mexico turns out to be especially aggressive, the worst consequences could be averted.

    Although some states are less prepared than others, the nation has made strides in stockpiling antiviral medicines, speeding the production of vaccines and laying down basic public health guidelines.

    Homeland Security Secretary Janet Napolitano said Monday that the U.S. is preparing as if the swine flu outbreak were a full pandemic. It is not at that stage and may never reach it.

    Disease detectives are following a series of outbreaks, of varying severity, all of which appear to be related to Mexico. A pandemic would spread throughout the world with explosive speed.

    The government got serious about worst-case planning during the 2005 bird flu scare, as the lessons of Hurricane Katrina loomed large.

    "We have a playbook that was developed and is being followed," said Michael Leavitt, who as secretary of Health and Human Services oversaw pandemic planning for President George W. Bush. "It's a substantially better picture than what we faced three years ago."

    ___

    On the Net:

    U.S. information on swine flu: PandemicFlu.gov

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    WHO has raised the alert level for an influenza A/H1N1 pandemic from 4 to 5, indicating a pandemic is imminent. The move is partly based on sustained human-to-human transmission in the United States.


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    Fortunately, the swine flu does not appear to have anything close to virulence of the spanish flu of 1918. I am not an expert on the subject, but it seems like the kill rate of the swine flu is not even in the ballpark of the kill rate of other pandemics. Really not that many deaths have been attributed to the swine flu. Plus it does not appear to be killing young, healthy adults like the spanish flu did. Every year, influenza is a major killer of the elderly, infants, and compromised. I hope that this is just another example of being overly cautious.

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    I met with one of the member of CDC, USA...he is representative to india..he told me that they asked WHO to raise alert from 4 to 5 for just some internal reasons(Some Politics which i cannot explain here)...he also told that indian subcontinent population is somewat resistent to flu...they suffer but mortality is very very low...

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    Default WHO official says world edging towards pandemic

    Reuters



    By Laura MacInnis and Stephanie Nebehay Tue Jun 2, 1:59 pm ET

    GENEVA (Reuters) The spread of H1N1 flu in Australia, Britain, Chile, Japan and Spain has nudged the world closer to a pandemic, the World Health Organisation said on Tuesday.

    The newly-discovered strain had caused more infections than seasonal influenza at the start of Chile's flu season, raising concern about how it would spread in the southern hemisphere, according to Keiji Fukuda, the WHO's acting assistant director-general.

    The virus has mainly affected people aged below 60 and caused 117 deaths worldwide, including some otherwise healthy people, he said. For now, the WHO's pandemic scale remained at the second-highest level but the threshold may soon be crossed.

    "Globally we believe that we are at Phase 5 but we are getting closer to Phase 6," Fukuda told journalists. "The future impact of this infection has yet to unfold."

    He added: "It is probably fair to call the situation something like moderate right now. We do have some hesitation to call the situation mild."

    The new flu, a mixture of swine, bird, and human viruses, remains most prevalent in North America but has infected nearly 19,000 people in 64 countries, according to the U.N. agency's latest toll, which tends to lag behind national figures but is considered more secure.

    Fukuda said that, while many countries had reported only a small number of infections linked to people traveling to the disease epicenters of Mexico and the United States, others were starting to see more sustained patterns of infection in schools, offices and neighborhoods.

    "There are a number of countries that appear to be transition, moving from travel-related cases to more established community types of spread," he said, citing Australia, Britain, Chile, Japan and Spain as examples.

    "We still are waiting for evidence of really widespread community activity in these countries. It is fair to say that they are in transition and are not quite there yet which is why we are not in Phase 6 yet," Fukuda said.

    PANDEMIC PATTERNS

    Experts say it is nearly impossible to gauge how widespread the H1N1 flu has become because many patients suffer only mild symptoms and are not formally diagnosed, treated and documented.

    "We don't know the full number of people who are infected across the entire spectrum. So right now it appears that the number of severe illnesses appears relatively limited, but again we don't have a perfectly good handle on the numerator and the denominator of what we are seeing," Fukuda said.

    In Chile, which is just entering its normal flu season, Fukuda said the H1N1 variety appeared to be eclipsing other strains in circulation.

    "Most of the influenza viruses that they are seeing so far are the new influenza A-H1N1 viruses," he said. "They are seeing many fewer of the normal seasonal influenza viruses and the majority of viruses are the H1N1.

    "We need to see whether this pattern holds up in other countries," Fukuda continued. "This is one of the patterns that have been seen with earlier pandemics so I think it bears very close watching."

    The WHO consulted more than 30 public health experts from 23 countries on Monday about how to revamp its pandemic alert scale to reflect both the severity of the flu and its geographic spread, as many governments have asked it to do.

    One idea, Fukuda said, was to add three severity notches to the highest marker of 6, so the overall level could reach the peak even if the flu's effects remained moderate, and be adjusted later if the virus caused more serious health problems.

    "All pandemics are not the same. Some pandemics can be mild, other pandemics can be more severe," he said, also stressing that the same virus could have drastically different effects in different countries and regions, for instance posing greater risks in poor or disease-stricken communities.

    Radical actions imposed in immediate response to the outbreak, including quarantines, trade bans and the culling of swine "certainly didn't make people safer" and caused undue concern about the safety of animals and food, Fukuda said.

    "Some of the things that we would like to do is improve how we are able to communicate information, how we are able to provide guidance on what can be done in this situation so that actions which are really unnecessary and potentially anxiety provoking and unhelpful can really be modified or curtailed."

    (Additional reporting by Jonathan Lynn; editing by Andrew Dobbie)

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    Default WHO on verge of declaring H1N1 flu pandemic

    By Stephanie Nebehay Tue Jun 9, 1:54 pm ET

    GENEVA (Reuters) The World Health Organization (WHO) is on the verge of declaring the first influenza pandemic in more than 40 years, but wants to ensure countries are well prepared to prevent a panic, its top flu expert said on Tuesday.

    Keiji Fukuda, acting WHO assistant director-general, voiced concern at the sustained spread of the new H1N1 strain -- including more than 1,000 cases in Australia -- following major outbreaks in North America, where it emerged in April.

    Confirmed community spread in a second region beyond North America would trigger moving to phase 6 -- signifying a full-blown pandemic -- from the current phase 5 on the WHO's 6-level pandemic alert scale.

    "The situation has really evolved a lot over the past several days. We are getting really very close to knowing that we are in a pandemic situation, or I think, declaring that we are in a pandemic situation," Fukuda told a teleconference.

    Fukuda said a move to phase 6 would reflect the geographic spread of the new disease.

    "It does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers or higher rates than they are right now," he said.

    A decision to declare a pandemic involved more than simply making an announcement, he said. The United Nations agency had to ensure that countries were able to deal with the new situation and also handle any public reaction.

    "One of the critical issues is that we do not want people to 'over-panic' if they hear that we are in a pandemic situation. That they understand, for example, that the current assessment of the situation is that this is a moderate level," Fukuda said.

    The WHO and its 193 member states are working hard to prepare for a pandemic, for instance developing vaccines and building up supplies of anti-viral drugs, he said.

    The disease, which has infected over 26,500 people in 73 countries, with 140 deaths, has been most severe in Mexico, which has reported the highest number of fatalities, more than 100. These include infections in otherwise healthy young people.

    PRESSURE ON HOSPITALS

    A very real danger after declaring a pandemic was that hospitals could be overwhelmed by people seeking help when they did not really need it, while other patients requiring emergency treatment risked being neglected, according to Fukuda.

    "In earlier pandemics, in earlier outbreaks, we have often seen that people who are in the category of being worried but who are not particularly sick, have overrun hospitals," he said.

    Since the new flu strain first appeared, many people have stopped eating pork, pigs have been culled in some countries, trade bans on meat imposed, travelers quarantined, and some countries have discussed closing borders.

    "These are the kinds of potential adverse effects that you can have if you go out without making sure people understand the situation as well as possible," Fukuda said.

    Combining human, avian and swine viruses, the new strain has been dubbed 'swine flu', although scientists say this is misleading and stress there is no risk from eating pig meat.

    The world is better prepared but also more vulnerable to the adverse effects of a flu pandemic since the last one occurred in 1968, due to the speed and volume of international travel.

    An H3N2 virus caused an estimated 1-4 million deaths at the time, and became known as Hong Kong flu. But Fukuda said the WHO would not name the new disease after a country or animal to avoid misleading stigmas.

    He voiced concern that Canadian Inuits had suffered disproportionately in the current outbreak, often needing hospitalization. It was not clear if this was due to higher levels of underlying chronic disease, genetics or poverty.

    "Inuit populations were very severely hit in some of the earlier pandemics. This is why these reports raise such concerns to us," he said.

    (For a WHO note on its pandemic alert scale go to:

    [HIDE]http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf )[/HIDE]

    (Additional reporting by Jonathan Lynn; Editing by Mark Trevelyan)

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    Default WHO declares first 21st century flu pandemic

    By Jonathan Lynn Fri Jun 12, 11:11 am ET

    GENEVA (Reuters) The World Health Organization declared an influenza pandemic on Thursday and advised governments to prepare for a long-term battle against an unstoppable new flu virus.

    The United Nations agency raised its pandemic flu alert to phase 6 on a six-point scale, indicating the first influenza pandemic since 1968 is under way.

    "With today's announcement, WHO moves from an emergency to a longer-term response. Based on past experience, this pandemic will be with us for some months, if not years, to come," WHO Director-General Dr. Margaret Chan said in a letter to staff, a copy of which was obtained by Reuters.

    People aged 30-50, pregnant women or people suffering from chronic conditions such as asthma, diabetes or obesity are at highest risk, Chan told a news conference.

    The virus has killed 109 people in Mexico, where it was first detected in April before spreading to the rest of the world, prompting the Mexican government to temporarily shut schools and businesses in an effort to slow its spread.

    Countries from Australia to Chile to the United States are reporting that the new swine flu virus is "crowding out" seasonal flu, becoming the predominant influenza strain, she said.

    For now the virus was "pretty stable," but Chan warned that it could still change into a more deadly form, perhaps mixing with the H5N1 bird flu virus circulating widely in poultry.

    "So it is incumbent on WHO and all members to stay vigilant and alert for the next year or two or even beyond," she said.

    Mexican health minister Jose Angel Cordova said on Thursday the virus was under control in Mexico but warned there could be a new spike in cases later this year.

    There is also a risk the swine flu could mix with its seasonal H1N1 cousin, which has developed resistance to the main antiviral flu drug Tamiflu, made by Roche AG and Gilead Sciences Inc, Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention told a briefing.

    The United States has been operating on pandemic status for weeks, with hundreds of thousands of cases and at least 1,000 hospitalizations, Schuchat said.

    GUARDING AGAINST 'RASH' ACTIONS

    The virus disproportionately makes younger people sick. Some 57 percent of U.S. cases were among people aged 5 to 24, and 41 percent of those hospitalized were in this younger age group.

    H1N1 is active in all 50 states and there are so many cases now that in some areas, patients with specific flu-like symptoms -- a fever above 104 degrees F (40 degrees C), cough or other respiratory symptoms -- are presumed to have the new virus.

    WHO reiterated its advice to its 193 member countries not to close borders or impose travel restrictions to halt the movement of people, goods and services, a call echoed by U.N. Secretary-General Ban Ki-moon.

    "We must guard against rash and discriminatory actions such as travel bans or trade restrictions," Ban told a news conference at U.N. headquarters.

    The move to phase 6 reflects the fact that the disease, widely known as swine flu, is spreading geographically, but does not indicate how virulent it is.

    Widespread transmission of the virus in Australia, signaling that it is entrenched in another region besides North America, was one of the key triggers for moving to phase 6.

    "We are satisfied that this virus is spreading to a number of countries and it is not stoppable," Chan said.

    "Moving to pandemic phase 6 level does not imply we will see an increase in the number of deaths or very severe cases. Quite on the contrary. Many people are having mild disease, they recover without medicines in some cases and it is good news," she said.

    "Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems," she added.

    Canadian health officials said they were concerned about reports of more severe symptoms in some aboriginal communities, but said it was too soon to say for sure.

    "To make conclusions based on a couple of communities that this is somehow a disease that is worse in a particular ethnic group. It's much too early to make any of those kinds of conclusions or presumptions," said Dr. David Butler-Jones, Canada's chief public health officer.

    VACCINE DEVELOPMENT UNDERWAY

    Chan said WHO would start distributing a further donation of 5.65 million courses of Tamiflu from Roche.

    WHO recommended drugmakers stay on track to complete production of seasonal influenza vaccine for the Northern Hemisphere's next winter. Each year, normal flu kills up to 500,000 people and infects millions.

    Work on developing an H1N1 vaccine is already under way at leading companies, whose factories will be ready to switch to making a pandemic shot in around two weeks' time, when normal season flu vaccine production is complete.

    Seasonal flu affects mainly the elderly and causes severe illness in millions, so a premature switch in vaccine production to cope with the new strain could put many people at risk.

    "So our recommendation is they need to finish the seasonal vaccine and then move over," Chan said.

    Chan said the Geneva-based agency would work with regulatory authorities to help fast-track approval of new pandemic vaccines that are safe and effective so that they can be made available as soon as possible.

    In any case, the first doses would only be available in September, she added.

    A pandemic could cause enormous disruption to business as workers stay home because they are sick or to look after family members and authorities restrict gatherings of large numbers of people or movement of people or goods.

    World markets shrugged off the pandemic, as investors focused on possible global economic recovery.

    The strain has spread widely, with 28,774 infections confirmed in 74 countries to date, including 144 deaths, according to WHO's latest tally of laboratory-confirmed cases. The United States has said tests only turn up a fraction of the true number of cases.

    (For the full text of Chan's remarks at a press conference, go to: [HIDE]http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html)[/HIDE]

    (Additional reporting by Laura MacInnis in Geneva, Michael Kahn in London, Agustin Jimenez in Mexico City, and Maggie Fox in Washington, editing by Philip Barbara)

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    drchinx are there any news regarding the 144 deaths due to AH1N1? if they did die solely on AH1N1 and not on other medical conditions?
    thanks

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