ACUTE RESPIRATORY DISEASE - MEXICO, SWINE VIRUS SUSPECTED

[1]
Date: Thu 23 Apr 2009
Source: El Manana [in Spanish, trans. Mod. TY, edited]
<http://www.elmanana.com.mx/notas.asp?id=117125>


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

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

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

[Byline: Imelda Garcia]

--
communicated by:
a healthcare consultant who requested anonymity

******
[2]
Date: Thu 23 Apr 2009
Source: Canada.com [edited]
<http://www.canada.com/story_print.html? id=1527347&tab=PHOT&sponsor=1527>


Warning to travelers
--------------------
Public health officials are on alert for flu-like symptoms among Canadians
who recently travelled to Mexico, following the outbreak of an illness in
that Latin American country that has killed 20 people. However, Ontario's
chief medical officer, Dr David Williams, told a news conference in Toronto
Thursday [23 Apr 2009] that no Canadians have been affected by the illness,
which has surfaced in south and central regions of the vacation hot spot.
"(Canada) hasn't had any cases directly tied to it yet, but it doesn't mean
we won't be vigilant looking for it," Williams said. "We will continue to
look, in case it has any remote connection. We want to see if we can
connect those dots correctly. As a precaution, public health authorities,
family physicians and hospitals across the country have been placed on high
alert to look for any unusual flu-like symptoms in patients. The
government's pandemic surveillance alert has also been increased to a state
of high vigilance, but Ottawa has not as yet issued a travel ban to Mexico.
It is warning prospective Canadian travellers to be vigilant and to take
precautions.

"There is no evidence as of now, that the illness in Mexico (is) an illness
like SARS," said Dr Danielle Grondin, acting assistant deputy minister at
the Public Health Agency of Canada. "It is serious in Mexico but nothing in
Canada. At this point, there are no clusters of SRI [severe respiratory
illness] in Canada. There are no health concerns for Canadians." According
to Grondin, what is known so far of the illness is that it strikes healthy
people aged 25-44 years, and quickly worsens. A total of 137 people have
been struck by the virus.

A man from Cornwall, Ontario, who returned from Mexico with a mysterious
illness is believed to be one of a handful of people in Ontario who may be
linked to the respiratory ailment, provincial officials say. The 47 year
old man was airlifted to an Ottawa hospital in late March and admitted into
the hospital's intensive care unit, a hospital official said Thursday. He
spent 11 nights in hospital before being released on 9 Apr 2009. During a
news conference in Vancouver, Dr Danuta Skowronski of the British Columbia
(C) Centre for Disease Control said there have been reports of severe
flu-like illness in BC but so far none has been linked to Mexico. "We're
doing our best to keep people informed while our investigation is ongoing,"
added Skowronski, an epidemiologist specializing in influenza and
respiratory illness. The flu-like symptoms include fever, cough, general
aches and pains, and shortness of breath, which quickly progresses to
trouble breathing and severe respiratory illness, she said.

The affected areas of Mexico were Mexico City, San Luis Potosl, Oaxaca and
Baja, Skowronski said. Meanwhile, Dr Arlene King, director general of the
Centre for Immunization and Respiratory Infectious Diseases at the Public
Health Agency of Canada, told the Toronto news conference that one of the
lessons learned from the SARS outbreak in 2003 was the need for effective
communications between various agencies and health care providers. Williams
also stressed that a stringent record of any illnesses that might match the
profile of the respiratory condition should be relayed to the proper
authorities. "We'd rather know more than less . . . we want to know all the
details," he said. "That's why we're engaging our wider medical community
at this time to active surveillance rather than passive surveillance. "For
(Mexico), it's early, and we're pleased they moved so quickly to inform
their partners of what's going on... That's to be applauded and that
probably wouldn't have happened five or seven years ago."

--
communicated by:
HealthMapAlerts
via ProMED-mail
<promed@promedmail.org>

******
[3]
Date: Fri 24 Apr 2009
Source: CNN-cm [edited]
<http://edition.cnn.com/2009/HEALTH/04/24/swine.flu/index.html>


60 dead in Mexico flu outbreak
------------------------------
A flu outbreak in Mexico has killed at least 60 people and sickened nearly
1000, health officials said on Friday [24 Apr 2009]. Swine flu is usually
diagnosed only in pigs or people in regular contact with them. The outbreak
has led health officials in the United States to suspect a connection with
7 known cases of a novel swine flu infection in California and Texas.

As a precaution to avoid further contamination, schools and universities in
Mexico City and the state of Mexico were closed on Friday, said the
national health secretary, Jose Angel Cordova Villalobos. He said the
schools may remain closed for a while. Fifty-seven people have died in
Mexico City, the World Health Organization said on Friday. Another 3 people
have died elsewhere in Mexico, the agency said. Sixteen of the deaths were
from "a new type of influenza virus", Cordova said. Another 45 cases are
"suspicious," he said.

Authorities are investigating the cases of 943 people suffering from a
viral infection, the health minister said. WHO had said 800 people had
fallen ill. Mexican President Felipe Calderon canceled a trip Friday to
northern Mexico so he could remain in Mexico City to monitor the situation,
the state-run Notimex news agency reported. Calderon met with his Cabinet
on Thursday night to discuss the outbreak.

In the United States, 7 cases of a previously undetected strain of swine
flu have been confirmed in humans, the Centers for Disease Control and
Prevention said. All of the patients have recovered, officials said. None
of the patients had direct contact with pigs. Five of the cases were found
in California, and 2 in Texas, near San Antonio, said Dr Anne Schuchat, the
CDC's interim deputy director for science and public health program.

The Mexican samples will be tested at the centers based in Atlanta,
Georgia, spokesman David Daigle told CNN by email. The samples were taken
from an affected area just north of Mexico City. Canada also is testing
samples from Mexico "and has placed a travel alert for travel to Mexico,"
Daigle said. The Public Health Agency of Canada issued a respiratory alert
for Mexico on Wednesday [22 Apr 2009], recommending that health providers
"actively look for cases" in Canada, particularly in people who've returned
from Mexico within the last 2 weeks.

An alert issued on Friday by the International SOS medical and consulting
company said more than 130 cases of a severe respiratory illness have been
detected in south and central Mexico, some of which are due to influenza.
"Public health officials in Mexico began actively looking for cases of
respiratory illness upon noticing that the seasonal peak of influenza
extended into April, when cases usually decline in number," the medical
alert said. "They found 2 outbreaks of illness -- one centered on Distrito
Federal (Mexico City), involving about 120 cases with 13 deaths. The other
is in San Luis Potosi, with 14 cases and 4 deaths." Authorities also
detected one death in Oaxaca, in the south, and 2 in Baja California Norte,
near San Diego, California. There was no indication why the International
SOS tallies did not match the WHO figures.

The majority of cases are occurring in adults between 25 and 44 years of
age. CDC reported on Tuesday that 2 California children in the San Diego
area were infected with a virus called swine influenza A H1N1, whose
combination of genes had not been seen before in flu viruses in humans or
pigs. The 7 patients range from age 9 to 54, the CDC's Schuchat said. "The
good news is that all 7 of these patients have recovered," she said. The
first 2 cases were picked up through an influenza monitoring program, with
stations in San Diego and El Paso, Texas. The program monitors strains and
tries to detect new ones before they spread, CDC said. Other cases emerged
through routine and expanded surveillance.

The human influenza vaccine's ability to protect against the new swine flu
strain is unknown, and studies are ongoing, Schuchat said. There is no
danger of contracting the virus from eating pork products, she said. The
new virus has genes from North American swine and avian influenza; human
influenza; and swine influenza normally found in Asia and Europe, said
Nancy Cox, chief of CDC's Influenza Division. Swine flu is caused by type A
influenza, according to CDC. The virus does not normally infect humans, but
cases have occurred among people, especially those with exposure to pigs.
There also have been cases of one person spreading swine flu to other
people, the CDC said. In 1988, in an apparent swine flu infection among
pigs in Wisconsin, there also was evidence of a patient transmitting the
virus to health workers, CDC said. Experts think coughing, sneezing, and
contaminated surfaces spread the infection among people. From December 2005
to February 2009, 12 human cases of swine flu were documented.

CDC is working with health officials in California and Texas and expects to
find more cases, Schuchat said. There's no need for alarm, but people at
risk -- those who live in or have visited areas where patients live or have
had contact with pigs -- should get tested if they notice symptoms, said Dr
William Short at the division of infectious diseases at Thomas Jefferson
University Hospital in Philadelphia, Pennsylvania.

A pandemic is defined as: a new virus to which everybody is susceptible;
the ability to readily spread from person to person; and the capability of
causing significant disease in humans, said Dr Jay Steinberg, an infectious
disease specialist at Emory University Hospital Midtown in Atlanta. The new
strain of swine flu meets only one of the criteria: novelty. History
indicates that flu pandemics tend to occur once every 20 years or so, so
we're due for one, Steinberg said. "I can say with 100 per cent confidence
that a pandemic of a new flu strain will spread in humans," he said. "What
I can't say is when it will occur."

(by Elizabeth Landau)

--
communicated by:
ProMED-mail <promed@promedmail.org>

******
[4]
Date: Fri 24 Apr 2009
Source: BBC News [edited]
<http://news.bbc.co.uk/1/hi/world/americas/8016909.stm>


Mexico flu outbreak kills dozens
--------------------------------
Dozens of people have died and hundreds of others have been infected in a
viral outbreak in Mexico suspected to have been caused by a strain of swine
flu. WHO thinks the virus may be behind 60 deaths in Mexico since mid-March
[2009]. Mexican authorities have closed schools in affected areas and a
vaccination campaign is being launched. Seven non-fatal cases of a new form
of swine flu have also been confirmed in the southern United States.

A WHO spokesman said 12 out of 18 samples taken from the Mexican victims
showed they died from a virus with the same genetic structure as the one
found in the US. WHO would convene an emergency meeting in the "very near
future" to determine whether the event constituted a "public health event
of international concern", Gregory Hartl told Reuters news agency. The
White House said it was following the US outbreak -- in California and
Texas -- closely.

WHO spokeswoman Fadela Chaib said "unusual end-of-season influenza
activity" was noticed in Mexico starting from the end of March [2009].
Fifty-seven people had died in Mexico City from flu-like symptoms, she
said, and another 3 in San Luis Potosi in central Mexico. There are around
800 suspected cases, she said.

Health minister Jose Angel Cordova said the virus had "mutated from pigs
and then at some point was transmitted to humans". The strain of flu had
been confirmed in at least 16 deaths, with 44 others being tested, the
government said. It urged people to take preventative measures such as not
shaking hands or sharing crockery. All schools and universities in the
capital and in nearby Mexico State have been closed, the BBC's Stephen
Gibbs reports from Mexico City.

In the US, experts say the 7 people who fell ill across two states were
suffering from a new form of swine flu that combined pig, bird, and human
viruses. CDC said none of the 7 victims had been in contact with pigs,
which is how people usually catch swine flu. CDC spokeswoman Anne Schuchat
said that officials did not yet know how widely the virus had spread. But
she pointed out that all 7 victims had recovered. "So far this is not
looking like very very severe influenza," she said.

While the world has been worried over the past few years about the impact
of a pandemic originating from avian flu, the WHO say that swine flu has
been implicated in the emergence of two of the last century's influenza
pandemics, reports BBC science reporter Matt McGrath. Pigs can serve as a
mixing vessel for both human and avian viruses that could combine to create
a more virulent strain, our reporter adds.