Swine Flu Case in Spain May Point to Global Pandemic, WHO Says

By Naomi Kresge and Tom Randall

April 30 (Bloomberg) -- A swine-flu patient in Spain who hadn’t traveled to Mexico may signal a new front of the outbreak, potentially heralding the first influenza pandemic in 41 years.

The World Health Organization raised its six-tier alert to 5, the second-highest, and said a pandemic declaration may come soon. It urged countries to make final preparations to deal with a virus that may sweep across the globe.

The WHO has confirmed 154 cases in nine countries, and hundreds of people are being tested for the virus from Australia to New York. Eight of those known to have had swine flu have died, though many more may be carrying the virus and not getting seriously ill, the WHO said. The case in Spain may signal that the disease is being transmitted easily outside of Mexico, where the outbreak began, officials said.

“It is all of humanity that is under threat during a pandemic,” Margaret Chan, WHO director-general, said at a news conference in Geneva yesterday. “The biggest question right now is this: How severe will the pandemic be? All countries should immediately now activate their pandemic plans.”

Batches of seed virus are being developed for potential vaccine production, according to WHO, the UN health agency in Geneva. Paris-based Sanofi-Aventis SA, Baxter International Inc. and GlaxoSmithKline Plc are talking with world health authorities about how to produce a vaccine.

Vaccine Makers ‘Alert’

“Manufacturers are on the alert,” said U.S. Health and Human Services Secretary Kathleen Sebelius. “Once the testing protocol is done and the dosage protocol is done they are ready to begin production, should that be necessary.”

Baxter will receive a sample of the swine flu virus “in the next couple days,” Chris Bona, a spokesman for the Deerfield, Illinois, company, said yesterday.

“We are in constant discussions with the government about how and if we should go ahead,” said Donna Cary, a spokeswoman for Sanofi’s Sanofi-Pasteur unit in Swiftwater, Pennsylvania. London-based Glaxo and Novartis AG of Basel, Switzerland, also are talking with regulators, spokesmen for the companies said.

Today, a Swiss hospital said a patient tested positive for swine flu, the first confirmed case in Switzerland. In Mexico, where the toll is highest, 159 people may have died from the malady, according to government officials, with eight confirmed by laboratory tests.

U.S. Cases

Ninety-four cases were reported in 11 U.S. states, with one confirmed death, and New York City officials said they suspected hundreds were infected. The WHO’s statistics, which lag behind those reported by national and local agencies, showed confirmed cases in the U.S., Mexico, Canada, Austria, Germany, Israel, Spain, the U.K. and New Zealand.

Disease trackers are trying to determine whether the new H1N1 influenza strain is spreading efficiently in Spain, said Dick Thompson, a spokesman for the WHO in Geneva. The agency needs evidence of sustained human-to-human transmission outside North America to declare the outbreak has become a pandemic.

Among the 10 cases in Spain, nine involve people who had traveled to Mexico, he said today. “The tenth confirmed to us that there’s some community transmission beginning,” he said. “The virus is becoming established in another area. It’s this new single case that is especially worrying.”

The last pandemic, 41 years ago, killed 1 million people and was mild compared with the global outbreak of 1918, which may have killed as many as 50 million.

‘Preemptive’ Measure

President Barack Obama asked Congress for $1.5 billion to battle an outbreak, and said parents should plan for school closings. Texas Governor Rick Perry declared a disaster, a “preemptive” measure to facilitate emergency preparations and seek federal reimbursement. California Governor Arnold Schwarzenegger declared a state of emergency.

“Every American should know that their entire government is taking the utmost precautions and preparations,” Obama said on a televised news conference last night. “This is a cause for deep concern, but not panic.”

Swine flu infections in people aren’t related to exposure to the animals, and properly prepared pork is safe to eat, said Keiji Fukuda, WHO assistant director-general for health security and environment. The disease, spreading like the seasonal flu, is “unlikely” to stop, Fukuda said.

Mexico Severity

“It’s clear that deaths and serious illnesses can occur in other countries, but more are occurring in Mexico,” Fukuda told reporters yesterday in Geneva. “We don’t know the reason for that right now.”

The genetic strains around the world that have been tested are “remarkably consistent and remarkably similar to each other,” he said. The three main seasonal flu strains -- H3N2, H1N1 and type-B -- cause 250,000 to 500,000 deaths a year globally, according to the WHO.

Scientists are trying to determine why swine flu, a respiratory disease caused by a type-A influenza virus, has been more severe in Mexico. The new flu results in symptoms similar to those of seasonal influenza, including fever and coughing, and may also cause nausea and vomiting, according to the CDC. It appears to be causing more diarrhea than seasonal flu, WHO said.

Hospitalizations and Deaths

The U.S. can expect more hospitalizations and deaths, Sebelius said yesterday in her first press conference after being confirmed secretary of Health and Human Services. Hand- washing and hygiene are among the most effective ways to control the outbreak, she said.

The first death in U.S. was a 22-month-old boy from Mexico City who was brought to Texas Children’s Hospital in Houston last weekend and died April 27, the state health department said yesterday in a statement. The boy had “several underlying health problems,” the statement said.

A Marine is recovering after being tested for the illness, and another 37 Marines are being “watched and tested” at a base in 29 Palms, California, Marine Corps Commandant General James Conway said at the Pentagon yesterday. The base, with 15,000 personnel, is located in the desert east of Los Angeles.

Three adults in Maine were confirmed as having the H1N1 swine flu virus, according to a release from Governor John E. Baldacci’s office, making it the 11th U.S. state with such cases.

‘Level of Calmness’

“We need to maintain a level of calmness so we will continue to manage this in a rational manner,” WHO’s Chan said. “Influenza viruses are notorious for rapid mutation and unpredictable behavior.”

WHO raised the level on its current pandemic alert system, adopted in 2005, twice this week. It had been at 3 since 2007, when it was elevated for an outbreak of avian flu.

A stage 5 warning is “a strong signal that a pandemic is imminent” with little time left for preparation, according to the WHO Web site. It’s based on the determination that the disease is established in communities in two countries in the same WHO region.

A pandemic is an unexpected outbreak of a new contagious disease that spreads from person to person across multiple borders. In such cases, almost no one has natural immunity.

“We think that we are in the process of moving toward” phase 6, Fukuda said. “I think at this point it is possible that we will move to seeing established transmission in other countries relatively quickly.”

Stage Six

“We have been preparing all along as if this is going to stage 6,” Janet Napolitano, U.S. Homeland Security secretary, said yesterday at a news conference in Washington. “Our preparations are for a situation in which this does become a full-fledged pandemic.”

Athletic, academic and music competitions were canceled for more than 1 million students in Texas until May 11, according to the Texas University Interscholastic League, the largest inter- school organization of its kind in the world. Maine shut a school and a daycare center, according to a statement from the governor’s office.

The outbreak in Mexico City prompted the local government to order a halt to dining service at all 35,000 restaurants. U.S. officials recommended that nonessential visits to Mexico be avoided and the European Union told travelers to avoid outbreak areas.

French Health Minister Roselyne Bachelot told reporters she would ask European transport ministers to suspend flights to Mexico.

No Travel Limits

WHO doesn’t recommend travel restrictions and said the focus should be on mitigating the outbreak.

U.S. Senate Majority Leader Harry Reid urged calm. He said a vaccine will probably be developed by the time next flu season starts in North America.

If a vaccine is needed, “the goal is to have one ready by September,” said U.S. Representative Peter King, a New York Republican.

An experimental vaccine for swine flu may be tested in people within a couple of months, according to Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. Reference strains for the virus have been distributed and a pre-planned development process is under way, Fauci said at a press conference today in Washington.

Production of influenza vaccine for seasonal outbreaks, which U.S. health officials have said is ineffective against the new flu, should continue, Fukuda said.

Emergency Authorizations

The U.S. Food and Drug Administration signed emergency authorizations April 27 that will permit the CDC to use an unapproved lab test for swine flu and more dosing options than currently recommended for influenza treatments Tamiflu, sold by Swiss drugmaker Roche Holding AG, and Relenza, from Glaxo.

Australia is testing 128 passengers with flu symptoms and has taken steps to prepare for an outbreak, such as tightening quarantine rules. The country also upgraded its travel warning for Mexico, urging people not to visit the Latin American nation.

New Zealand confirmed 14 cases of swine flu as of April 29, the only definite infections in the Asia-Pacific region. Singapore today upgraded its disease outbreak alert to “orange” from “yellow,” saying it will quarantine people with a recent history of travel to Mexico and tighten infection control measures at hospitals.

Egypt ordered the slaughter of as many as 400,000 pigs. South Korea is also suspending imports of live hogs from North America, while China, the world’s top pork consumer, banned imports of swine products from Mexico and parts of the U.S. Indonesia said April 27 it will destroy all imported pork and swine products and fumigate agricultural goods bought from Canada, the U.S. and Mexico as a precaution.

To contact the reporters on this story: Naomi Kresge in Geneva at nkresge@bloomberg.net; Tom Randall in New York at trandall6@bloomberg.net.

Last Updated: April 30, 2009 07:21 EDT