UPDATE: Mexican Swine Flu Spreads To U.S.

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UPDATE: Mexican Swine Flu Spreads To U.S.

CDC and WHO are closely following a large outbreak of swine flu in central Mexico and a much smaller cohort in the US (no data on anywhere else at this time.) You’ll be hearing about it on the news (but, of course, readers of Daily Kos are well familiar with the topic.)

There are 6 documented cases of swine H1N1 in the San Diego area and Imperial County, and 2 in the San Antonio area, all relatively mild (one case was hospitalized, but not primarily for flu.) Seasonal H1N1 is an antigenically distinct virus which means that rapid flu tests cannot tell them apart (CDC will be issuing guidance to clinicians on this), and the current vaccine may not be protective. Tamiflu works, as does Relenza. while there are likely more cases in the US, there are no large scale outbreaks. Mexico is having a larger problem, but details are sketchy and will likely remain so.

This is a unique set of circumstances that’s concerning enough for CDC and WHO to ramp up their surveillance, and collect data and investigate the outbreak. It is not a pandemic alert, and guidance on that topic has not changed, but this is an “evolving situation”, and the story and guidance could change. It’s at the very least become a news story. It could easily fizzle out in a few days, but until it does, it bears watching (and not necessarily on the front page here.)

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60 Dead From Mexican Swine Flue, Fear of Global Epidemic

Mexican authorities said 60 people may have died from a swine flu virus in Mexico, and world health officials worry it could unleash a global flu epidemic. Mexico City closed schools across the metropolis Friday in hopes of containing the outbreak that has sickened more than 900.

Scientists were trying to determine if the deaths involved the same new strain of swine flu that sickened seven people in Texas and California — a disturbing virus that combines genetic material from pigs, birds and humans in a way researchers have not seen before.

The World Health Organization was looking closely at the 60 deaths — most of them in or near Mexico’s capital. It wasn’t yet clear what flu they died from, but spokesman Thomas Abraham said “We are very, very concerned.”

“We have what appears to be a novel virus and it has spread from human to human,” he said. “It’s all hands on deck at the moment.”

WHO raised its internal alert system Friday, preparing to divert more money and personnel to dealing with the outbreak.

President Felipe Calderon cancelled a trip and met with his Cabinet to coordinate Mexico’s response. The government has 500,000 flu vaccines and planned to administer them to health workers, the highest risk group.

There are no vaccines available for the general public in Mexico, and authorities urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection.

They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks, and authorities at Mexico City’s international airport were questioning passengers to try to prevent anybody with possible influenza from boarding airplanes and spreading the disease.

But the U.S. Centers for Disease Control and Prevention said Americans need not avoid traveling to Mexico, as long as they take the usual precautions, such as frequent handwashing.

Mexico’s Health Secretary, Jose Cordova, said only 16 of the deaths have been confirmed as the new swine flu strain, and that government laboratories were testing samples from 44 other people who died. At least 943 nationwide were sick from the suspected flu, the health department said.

“We certainly have 60 deaths that we can’t be sure are from the same virus, but it is probable,” Cordova said, adding that samples were sent to the CDC to look for matches with the virus that infected seven people in Texas and California.

Cordova called it a “new, different strain … that originally came from pigs.”

Epidemiologists are particularly concerned because the only people killed so far were normally less-vulnerable young people and adults. It’s possible that more vulnerable populations — infants and the aged — had been vaccinated against other strains, and that those vaccines may be providing some protection.

Dr. Anne Schuchat of the CDC said “at this point, we do not have any confirmations of swine influenza in Mexico” of the kind that sickened seven California and Texas residents. All seven recovered from symptoms that were like those of the regular flu, mostly involving fever, cough and sore throat, though some of the seven also experienced vomiting and diarrhea.

Scientists have long been concerned that a new flu virus could launch a pandemic, a worldwide spread of a killer disease. A new virus could evolve when different flu viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.

The most notorious flu pandemic is thought to have killed at least 40 million people worldwide in 1918-19. Two other, less deadly flu pandemics struck in 1957 and 1968.

Nobody can predict when pandemics will happen. Scientists had been concerned about swine flu in 1976, for example, and some 40 million Americans were vaccinated. No flu pandemic ever appeared, but thousands of vaccinated people filed claims saying they’d suffered a paralyzing condition andother side effects from the shots.

In recent years, scientists have been particularly concerned about birds. There have been deaths from bird flu, mostly in Asia, but the virus has so far been unable to spread from person to person easily enough to touch off a pandemic.

Closing the schools across the metropolis of 20 million kept 6.1 million students home from day care centers through high schools, and thousands more were affected as colleges and universities closed down. Parents scrambled to juggle work and family concerns due to what local media said was the first citywide schools closure since Mexico City’s devastating 1985 earthquake.

Authorities also advised capital residents not to go to work if they felt ill, and to wear surgical masks if they had to move through crowds. A wider shutdown — perhaps including shutting down government offices — was being considered.

“It is very likely that classes will be suspended for several days,” Cordova said. “We will have to evaluate, and let’s hope this doesn’t happen, the need to restrict activity at workplaces.”

Mexico’s initial response in its overcrowded capital brought to mind other major outbreaks — such as when SARS hit Asia. At its peak in 2003, Beijing was the hardest-hit city in the world. Schools, cinemas and restaurants were shuttered to prevent the spread the deadly respiratory virus, and thousands of people were quarantined at home.

In March 2008, Hong Kong ordered more than a half million young students to stay home for two weeks because of a flu outbreak. It was the first such closure in Hong Kong since the outbreak of SARS, or severe acute respiratory syndrome.

Lillian Molina and other teachers at the Montessori’s World preschool scrubbed down their empty classrooms with Clorox, soap and Lysol on Friday between fielding calls from worried parents. While the school has had no known cases among its students, Molina supported the government’s decision to shutter classes, especially in preschools.

“It’s great they are taking precautions,” she said. “I think it’s a really good idea.”

Still, U.S. health officials said it’s not yet a reason for alarm in the United States. The five in California and two in Texas have all recovered, and testing indicates some common antiviral medications seem to work against the virus.

Schuchat of the CDC said officials believe the new strain can spread human-to-human, which is unusual for a swine flu virus. The CDC is checking people who have been in contact with the seven confirmed U.S. cases, who all became ill between late March and mid-April.

The U.S. cases are a growing medical mystery because it’s unclear how they caught the virus. The CDC said none of the seven people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.

CDC officials described the virus as having a unique combination of gene segments not seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia.

Health officials have seen mixes of bird, pig and human virus before, but never such an intercontinental combination with more than one pig virus in the mix.

Scientists keep a close eye on flu viruses that emerge from pigs. The animals are considered particularly susceptible to both avian and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of pandemic flu, said Dr. John Treanor, an infectious disease specialist at the University of Rochester Medical Center.

The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said.

The virus was first detected in two children in southern California — a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County.

It’s not known if the seasonal flu vaccine Americans got this winter protects against this type of virus. People should wash their hands and take other precautions, CDC officials said.

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