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Tuesday, May 26, 2009

Swine Flu Spreading Wider than Offical Data Show

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 25 May 2009
Source: Bloomberg News [edited]

Swine flu is spreading wider than official data show (update 2)
Swine flu is spreading more widely than official figures indicate, with
outbreaks in Europe and Asia showing it's gained a foothold in at least 3
regions. One in 20 cases is being officially reported in the US, meaning
more than 100 000 people have probably been infected nationwide with the
new H1N1 flu strain, according to the Centers for Disease Control and
Prevention (CDC). In the UK, the virus may be 300 times more widespread
than health authorities have said, the Independent on Sunday [newspaper]
reported yesterday [Sun 24 May 2009]. Japan, which has reported the most
cases in Asia, began reopening schools at the weekend [23-24 May 2009]
after health officials said serious medical complications had not emerged
in those infected. The virus is now spreading in the community in
Australia, Jim Bishop, the nation's chief medical officer, said yesterday
[24 May 2009]. "I think we will see the number rise," Bishop told the
Australian Broadcasting Corporation radio today after confirming the
nation's 17th case and saying test results are pending on 41 others. "This
is going to be a marathon rather than a sprint."

So far, 46 countries have confirmed 12 515 cases, including 91 deaths,
according to the World Health Organization's latest tally. Almost 4 of
every 5 cases were in Mexico and the US, where the pig-derived strain was
discovered last month [April 2009]. Most of those infected experience an
illness similar to that of seasonal flu. The main difference is that the
new H1N1 strain is persisting outside the Northern Hemisphere winter.

Summer disease?
"While we are seeing activities decline in some areas, we should expect to
see more cases, more hospitalizations and perhaps more deaths over the
weeks ahead and possibly into the summer," Anne Schuchat, CDC's interim
deputy director for science and public health program, told reporters on a
22 May 2009 conference call.

The US has officially reported 6552 probable and confirmed cases, Schuchat
said. "These are just the tip of the iceberg. We are estimating more than
100 000 people probably have this virus now in the US. There have been 9
deaths and more than 300 known hospitalizations," she said. The fatalities
exclude a woman in her 50s who died in New York over the weekend [23-24 May

China reported cases today [25 May 2009] in Shanghai and the eastern
province of Zhejiang, taking its tally of confirmed infections to 12.
Taiwan confirmed the island's 1st domestically transmitted case and
reported 2 imported infections, giving it 9. South Korea confirmed 12 more
cases, bringing its total to 22, while the Philippines confirmed a 2nd
infection today.

Caribbean honeymoon
Russia's health ministry confirmed the country's 2nd case, in a man who
honeymooned in the Dominican Republic. He returned from the Caribbean on 18
May 2009 and was hospitalized 2 days later in the Kaluga region south west
of Moscow, Gennady Onishchenko, head of the ministry's public health
department, said on state television today [25 May 2009]. His wife wasn't
infected. Japan has the most cases outside North America, with 335 as of
yesterday [24 May 1009], according to the health ministry. Chile's tally
reached 74 after 19 cases were recorded yesterday, while Argentina's total
increased by 3 to 5.

Eighteen European countries have confirmed 349 cases, a third of whom were
probably infected in their home country, the Stockholm-based European
Centre for Disease Prevention and Control (ECDC) said in a report yesterday
[24 May 2009]. The UK and Spain have the most reported cases, with 133
each. About 60 per cent of cases in the UK are linked to "in-country"
transmission, the ECDC said. Thousands of people have caught the virus in
the UK and suffered mild symptoms, or none at all, over the past weeks,
John Oxford, professor of virology at the University of London, told the
Independent [newspaper].

Already a pandemic
Community spread of the new virus in a 2nd region means WHO's criteria for
a pandemic has been met, said Michael T Osterholm, director of the Center
for Infectious Disease Research and Policy of the University of
Minneapolis. Britain's health secretary Alan Johnson told WHO
director-general Margaret Chan at the organization's annual meeting last
week [week of 18 May 2009] that disease severity and other determinants
besides geographic spread need to be considered before the pandemic alert
is raised to the highest of WHO's 6-level scale. "The move to phase 6
[would] mean that emergency plans are instantly triggered around the globe,
and in the UK this would mean increased vigilance and activation of the
UK's own inter-pandemic phases," the UK's Department of Health said in an
18 May 2009 statement.

At phase 6, many pharmaceutical companies would switch from making seasonal
flu shots to pandemic-specific vaccine, potentially creating shortages of
an immunization to counter the normal winter flu season, the department said.

"Risk of harm"
WHO is reviewing its pandemic response plans, including the prerequisites
for a pandemic, in the wake of the swine flu threat, said Keiji Fukuda, the
agency's assistant director-general of health security and environment. A
move to phase 6 would "signify a really substantial increase in risk of
harm to people," Fukuda told reporters during a 22 May 2009 briefing.

Some of the guidelines were prepared in anticipation of a pandemic sparked
by the H5N1 strain of avian flu, which killed 61 per cent of 429 people
confirmed to have contracted that virus, Chan told the World Health
Assembly on 18 May 2009. "This has left our world better prepared, but also
very scared," she said. Rather than redefine what constitutes a pandemic,
health officials should help people understand the current threat may
resemble the 1957 or 1968 pandemics, in which fewer than 4 million people
died, rather than the 1918 Spanish flu, blamed for killing about 50
million, said Osterholm at the University of Minneapolis. "The bigger
problem is scientific integrity," he said. "If they want to change the
definition, then go ahead. But don't say that we are not in phase 6 right
now because we don't want to go there."

[byline: Jason Gale]

communicated by:
ProMED-mail rapporteur Mary Marshall

Date: Sat 23 May 2009
Source: Associated Press (AP) [edited]

WHO to consider severity of "sneaky" swine flu
WHO said on Friday [22 May 2009] that it will change the rules for
declaring a swine flu pandemic, a virus the agency's chief called "sneaky"
because of its ability to spread quickly from person to person and
potentially mutate into a deadlier form.

Under political pressure from many of its 193 members to consider factors
other than just the spread of the disease before announcing a global
epidemic, WHO's flu chief said "course corrections" were being made. "What
we will be looking for is events which signify a really substantial
increase in risk of harm to people," Keiji Fukuda told reporters in Geneva.

So far the virus has been mild, sickening 11 168 people and causing 86
deaths, most of them in Mexico, according to WHO. But experts worry it
could evolve into a more deadly strain or overwhelm countries unprepared
for a major flu outbreak. Many countries fear a pandemic declaration would
trigger mass panic, and be economically and politically damaging. For
developed countries that already have activated their pandemic preparedness
plans, a pandemic declaration would change little in their response strategies.

Earlier this week [week of 18 May 2009], Britain and other countries urged
WHO to reconsider its pandemic definition. WHO hastily responded to these
concerns, as Fukuda said the agency would revise the conditions needed to
move from the current phase 5 to the highest level, phase 6, which makes it
a pandemic. "The countries are telling us now that moving from phase 5 to 6
is not so helpful," Fukuda said. He said the alert phases were developed
before the outbreak hit, and now need to be adjusted to the reality of the
situation. The virus' lethality could become one of the required criteria
before a pandemic is declared, Fukuda said.

Fukuda's comments echoed those of WHO director-general Margaret Chan, who
told governments she would heed their call to caution in declaring a
pandemic. At the same time, Chan warned against complacency. "This is a
subtle, sneaky virus," she said at the close of the weeklong meeting. "It
does not announce its presence or arrival in a new country with a sudden
explosion of patients seeking medical care or requiring hospitalization. We
expect it to continue to spread to new countries and continue to spread
within countries already affected," Chan said.

Countries taking part in the Geneva meeting agreed on Friday [22 May 2009]
to delay efforts to finalize a deal on sharing flu viruses, instead
instructing Chan to find a solution by early next year [2010]. Developing
countries lobbied hard to ensure they would benefit from any drugs created
using their virus samples. Against that, the United States and the European
Union called for samples to be shared without restriction, arguing that
this was in the best interest of science and global efforts to combat
disease. Both sides agreed Chan should form a task force to investigate
unresolved questions, including whether countries should have to share
samples and resulting drugs could be patented. They also want the task
force to consider whether doses of any new pandemic flu vaccine should be
reserved for developing countries, and to report back to members in January
[2010] with recommendations.

[byline: Frank Jordans]

communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

[If as suggested in part [1] the ratio of inapparent to apparent infections
is of the order of 20:1, the discussion of the appropriate pandemic alert
level is becoming rather irrelevant. The communities currently at risk may
be rapidly acquiring a significant level of immunity. - Mod.CP]

[see also:
Influenza A (H1N1) - worldwide (44): case counts 20090525.1945
Influenza A (H1N1) - worldwide (43): case counts 20090523.1931
Influenza A (H1N1) - worldwide (42) 20090523.1929
Influenza A (H1N1) - worldwide (41): case counts 20090522.1921
Influenza A (H1N1) - worldwide (40): case counts 20090521.1906
Influenza A (H1N1) - worldwide (30): case counts 20090516.1831
Influenza A (H1N1) - worldwide (20): case counts 20090510.1741
Influenza A (H1N1) - worldwide (10): case counts 20090504.1675
Influenza A (H1N1) - worldwide 20090430.1636
Influenza A (H1N1) "swine flu": worldwide (07), update, pandemic 5
Influenza A (H1N1) "swine flu": Worldwide 20090427.1583
Influenza A (H1N1) virus, human: worldwide 20090426.1577
Influenza A (H1N1) virus, human - New Zealand, susp 20090426.1574
Influenza A (H1N1) virus, human - N America (04) 20090426.1569
Influenza A (H1N1) virus, human - N America 20090425.1552
Acute respiratory disease - Mexico, swine virus susp 20090424.1546
Influenza A (H1N1) virus, swine, human - USA (02): (CA, TX) 20090424.1541
Influenza A (H1N1) virus, swine, human - USA: (CA) 20090422.1516
Influenza A (H1N1) virus, swine, human - Spain 20090220.0715
Influenza A (H1N1) virus, swine, human - USA (TX) 20081125.3715
Influenza A (H2N3) virus, swine - USA 20071219.4079
Influenza, swine, human - USA (IA): November 2006 20070108.0077]


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