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Image of the day: The Masked Mariachi

A Mariachi wears a mask as he plays the violin at Plaza Garibaldi in Mexico City April 25, 2009. REUTERS/Jorge Dan. Image may be subject to copyright.

Swine Flu Update 28-04-09

World Health Organization (WHO) flu expert, Dr Keiji Fukuda:

“Containment is not a feasible operation”

WHO has raised its swine flu alert level from three to four – two levels short of a full pandemic.

There has been  a “significant step towards pandemic influenza”, but “we are not there yet,” Dr Keiji Fukuda, WHO Assistant Director General said.

“What this can really be interpreted as is a significant step towards pandemic influenza. But also, it is a phase that says we are not there yet,” Fukuda said.

“In other words, at this time we think we have taken a step in that direction, but a pandemic is not considered inevitable.”

Because  the virus has become too widespread, containment is no longer a feasible option, he said, adding that the countries must focus measures that mitigate circumstances.

Alert level four means the virus is showing a sustained ability to pass from human to human, and is capable of causing community-level outbreaks.

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required. —WHO

Confirmed and suspected cases

• In Mexico the death toll from swine flu outbreak rose to 149 , but the authorities have only confirmed 20 cases.

• The victims are all aged between 20 and 50.

• A total of about 2,000 people had been hospitalized since April 13, when the first case of swine flu was reported, but a half had been released.

• Cases are confirmed in the US, Canada, Spain and Britain.

• In New Zealand a total of about 80 suspected cases were reported.

• The first batches of a swine flu vaccine could be ready in about four to six months, but it would take several more months to produce it in large quantities, Fukuda said. [But is it guaranteed to work? And more importantly, is it safe?]

• The newly-detected virus contains genetic material from previous versions of swine flu and avian flu viruses, experts say.

• Schools nationwide will remain closed until  May 6, as a precautionary measure to mitigate the outbreak.

The U.S. Cases

• A further 20 cases of swine flu were confirmed in New York, with other cases reported in  California,  Kansas, Ohio, Texas reaching a total of about 40 nationwide.

• Patients with swine flu outside Mexico are said to be making a full recovery, so far.

• It is thought that only person in the US had been hospitalised as a result of contracting the virus, and all had recovered.

• The US Centers for Disease Control and Prevention (CDC) is advising that  “non-essential travel to Mexico be avoided”.

New Zealand, Australia, Brazil, Canada, Israel, Scotland  South Korea, Spain

• At least six cases have been recorded in British Columbia and in Nova Scotia.

• Two people in Scotland and a young man in Spain who returned from Mexico were tested positive for the virus.

• Suspected cases of swine flu infection are being reported in New Zealand, Australia, Brazil, Israel and South Korea among visitors who returned from Mexico.

• Many countries have banned imports of raw pork and pork products from Mexico and the US.

• Shares in airlines have nosedived amid fears of the economic impact of the virus outbreak.

• Oil futures fell 5% in early trading Monday because of concerns over global economic recovery.

Related Links:

• Swine Flu Mystery Deepens

• Swine Flu Mystery and Air New Zealand
• Was Dr Adu-Bobie A Victim of Biological Warfare Experiments?
• More on Swine Flu
• Swine flu kills dozens in Mexico
• New type of swine flu hits California and Texas

• A (H1N1) Virus [Swine Flu Index Page]