Swine flu - Frequently Asked Questions

An outbreak that has killed more than 100 people in Mexico was caused by a new strain of swine influenza "that can attack anyone," Mexico's health minister said.

"It is a virus that mutated from pigs and then at some point was transmitted to humans," Jose Angel Cordova Villalobos said on April 24.

The outbreak, which Mexican authorities began reporting April 18, is being investigated by public health officials throughout North America.

So far, cases in Canada, the U.S. and Mexico suggest human-to-human transmission of this new swine flu virus occurred.

Canada's National Microbiology Laboratory in Winnipeg and the U.S. Centers for Disease Control confirmed that samples from Mexico were a new strain of swine flu.

In the meantime, the following is a summary of frequently asked questions about swine influenza prepared by the U.S. Centers for Disease Control and Prevention.

What is swine influenza?

Swine influenza (swine flu) is caused by type A influenza virus and gives pigs the flu. Swine flu viruses cause regular outbreaks of flu in pigs but death is infrequent. The viruses may circulate among pigs throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

How many swine flu viruses are there?

Like all flu viruses, swine flu viruses change constantly. Pigs can be infected by avian, human and swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort and new ones emerge that are a mix of swine, human and/or avian influenza viruses. Over the years, different variations of swine flu viruses have emerged. Right now, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs, such as children near pigs at a fair or workers in the swine industry.

There have been documented cases of one person spreading swine flu to others. In 1988, an outbreak of apparent swine flu infection in pigs in Wisconsin resulted in multiple human infections, and although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

Why is this strain of flu causing so much concern?

It's a brand new mutation that's never been seen before. That's why it's not just hitting people in the highest risk groups — those over 65 and younger than two.

Flu is not usually a huge worry among the vast majority of healthy people because over the course of our lives, we are exposed to several flu strains. We develop some immunities. When we get the flu, we'll normally just feel really awful for a week or two. But when you have no immunities at all to a new strain, normally healthy people face as much of a risk as higher risk groups.

How does swine flu kill?

Swine flu — just like any other flu — is a respiratory infection. It exploits a weakened immune system to attack major organs — especially your lungs. When it gets into your lungs, it can lead to pneumonia, which can kill you. The flu can also cause secondary infections in your body — any of which can lead to failure of vital organs and death.

Can people catch swine flu from eating pork?

No. Swine flu viruses are not transmitted by food. You cannot get swine flu from eating pork or pork products. You won't get swine flu from handling uncooked pork either. You can get sick from putting uncooked or undercooked pork in your mouth, but you won't get swine flu.

It's also impossible to catch swine flu from eating fruits and vegetables imported from Mexico. Swine flu — like all influenza viruses — is not a food-borne illness.

How common is swine flu infection in humans?

In the past, the U.S. Centers for Disease Control and Prevention received reports of about one human swine flu virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine flu have been reported. Five of the 12 cases occurred in patients who had direct exposure to pigs, six in patients reported being near pigs, and the exposure in one case was unknown.

What are the symptoms of swine flu in humans?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

How does swine flu spread?

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with swine flu viruses are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits at fairs.

Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the flu virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

What is known about human-to-human spread of swine flu?

In September 1988, a healthy 32-year-old pregnant woman was hospitalized for pneumonia and died eight days later. A swine H1N1 flu virus was detected. Four days before getting sick, she had visited a county fair swine exhibition where there was widespread flu-like illness among the pigs.

In follow-up studies, 76 per cent of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

How are human infections with swine flu diagnosed?

To diagnose swine influenza A infection, a respiratory specimen is ideally collected within the first four to five days of illness and sent to the CDC for testing.

What medications are available to treat humans with swine flu?

Four antiviral drugs are licensed for use in the United States: amantadine, rimantadine, oseltamivir and zanamivir. While most swine flu viruses have been susceptible to all four drugs, the most recent seven swine flu viruses isolated from humans are resistant to amantadine and rimantadine. Right now, the CDC recommends oseltamivir or zanamivir for the treatment and/or prevention of infection with swine flu viruses.

What other examples of swine flu outbreaks are there?

The most well known outbreak of swine flu was 1976 one among soldiers in Fort Dix, N.J. The virus caused illnesses in at least four soldiers and one death; all were previously healthy. The virus was transmitted in close contact at a basic training camp. It was thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix and factors limiting its spread and duration are unknown. The outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact during the winter.


Source: Swine Influenza Top News

Is it safe to travel?

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The focus now is on minimizing the impact of the virus through the rapid identification of cases and providing patients with appropriate medical care, rather than on stopping its spread internationally. Furthermore, although identifying the signs and symptoms of influenza in travellers can be an effective monitoring technique, it is not effective in reducing the spread of influenza as the virus can be transmitted from person to person before the onset of symptoms. Scientific research based on mathematical modelling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease.

Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.

Travellers can protect themselves and others by following simple recommendations related to travel aimed at preventing the spread of infection. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases and not only Influenza A(H1N1).

Source: Swine Influenza Top News

What can I do?

What are the recommendations for face masks?

If you are not sick you do not have to wear a mask. If you are caring for a sick person you should wear a mask. All home made masks should be cleansed regularly.

If you are sick, stay at home and avoid contact with people.

How can I protect myself and prevent illness?

Practise general preventive measures for influenza to prevent infection:

• avoid close contact with people who appear unwell and have fever and cough;
• wash your hands with soap and water thoroughly and often;
• practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

How do I care for an ill person at home?

• Separate the ill person from others, keeping the person at least 1 metre in distance from others.
• Cover your mouth and nose when caring for the ill person. Either commercial or homemade materials are fine, as long as they are disposed of or cleaned properly after use.
• Wash your hands with soap and water thoroughly after each contact with the ill person.
• Improve the air flow where the ill person stays. Use doors and windows to take advantage of breezes.
• Keep the environment clean with readily available household cleaning agents.

If you are living in a country where there are infections follow additional advice from your national and local health authorities.

What should I do if I think I have the illness?

If you feel unwell, have high fever, cough or sore throat:

• Stay at home and keep away from work, school or crowds.
• Rest and take plenty of fluids.
• Cover your mouth and nose with disposable tissues when coughing and sneezing, and dispose of the used tissues properly.
• Wash your hands with soap and water often and thoroughly, especially after coughing or sneezing.
• Inform family and friends about your illness and try to avoid contact with other people.

What should I do if I need medical attention?

• Contact your doctor or healthcare provider before travelling to a health facility, and report your symptoms. Explain why you think you have influenza A(H1N1) (if you have recently travelled to a country where there is an outbreak in humans). Follow the advice given to you.
• If it is not possible to contact your healthcare provider in advance, communicate your suspicion of infection as soon as you arrive at the facility.
• Cover your nose and mouth during travel.

Source: Swine Influenza Top News

Vaccines for the new influenza A (H1N1)

Is an effective vaccine already available against the new influenza A(H1N1) virus?
No, but work is already under way to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months.

What implications does the declaration of a pandemic have on influenza vaccine production?
Declaration by WHO of phase 6 of pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers.

How important will influenza A(H1N1) vaccines be for reducing pandemic disease?
Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene.

Will currently available seasonal vaccine confer protection against influenza A(H1N1)?
The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against influenza A(H1N1).

What is WHO doing to facilitate production of influenza A(H1N1) vaccines?
As soon as the first human cases of new influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible.

Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a influenza A(H1N1) vaccine yet?
WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250 000 to 500 000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.

Is it possible that manufacturers produce both seasonal and pandemic vaccines at the same time?
There are several potential options which must be considered based on all available evidence.

What is the process for developing a pandemic vaccine? Has a vaccine strain been identified, and if so by whom?
A vaccine for the Influenza A(H1N1) virus will be produced using licensed influenza vaccine processes in which the vaccine viruses are grown either in eggs or cells. Candidate vaccine strains have been identified and prepared by the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America)1. These strains have now been received by the other WHO Collaborating Centers which have also started preparation of vaccine candidate viruses. Once developed, these strains will be distributed to all interested manufacturers on request. Availability is anticipated by mid-May.

How quickly will influenza A(H1N1) vaccines be available?
The first doses of Influenza A(H1N1) vaccine could be available in five to six months from identification of the pandemic strain. The regulatory approval will be conducted in parallel with the manufacturing process. Regulatory authorities have put into place expedited processes that do not compromise on the quality and safety of the vaccine. Delays in production could result from poor growth of the virus strain used to make the vaccine.

How would manufacturers be selected?
There are currently more than a dozen vaccine manufacturers with licenses to produce influenza vaccines. Upon request, the vaccine strain will be available to each of them, as well as to other qualified vaccine manufacturers who are preparing to make influenza vaccine but do not yet have a licensed influenza vaccine.

What is the global manufacturing capacity for a potential influenza A(H1N1) pandemic vaccine? Is this the same as the global manufacturing capacity for H5N1?
The projections made for the production capacity of an vaccine for H5N1 cannot be automatically assumed to be the capacity to make an H1N1 vaccine. H5N1 and H1N1 viruses are different and the amount of antigen needed to make an effective H1N1 vaccines may be different than for H5N1. Therefore it is not possible to make a precise estimate. However, given these considerations, a conservative estimate of global capacity is at least 1 to 2 billion doses per year.

How is production capacity for influenza vaccines distributed geographically?
More that 90% of the global capacity today is located in Europe and in North America. However, during the past five years, other regions have begun to acquire the technology to produce influenza vaccines. Six manufacturers in developing countries have done so with technical and financial support from WHO.

What will be the storage requirements for influenza A(H1N1) vaccine?
The vaccine should be stored under refrigerated conditions at between 2°C and 8°C.

It has been impossible so far to develop vaccines for major killers such as HIV and malaria. How sure are we that there will not be scientific or other hurdles in developing an effective influenza A(H1N1) vaccine?
Typically, development of influenza vaccines has not posed a problem. Influenza vaccines have been used in humans for many years and are known to be immunogenic and effective. Each year seasonal influenza vaccines with varying composition are produced for the northern and southern hemisphere influenza seasons. Vaccine manufacturers will employ a number of different technologies to develop their vaccines. They will take advantage, notably, of novel approaches that were developed over the past years for H5N1 avian influenza vaccines. One key unknown is yield of vaccine virus production, since some strains grow better than others and the behavior of the new influenza A(H1N1) strain in manufacturers’ systems is not yet known. New recombinant technologies are under development, but have not yet been approved for use.

Will influenza A(H1N1) vaccines be effective in all population groups?
There are not data on this but there also is no reason to expect that they would not, given current information.

Will the influenza A(H1N1) vaccine be safe?
Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety of new influenza A(H1N1) vaccines.

How can a repeat of the 1976 swine flu vaccine complications (Guillain-Barré syndrome) experienced in the United States of America be avoided?
Guillain-Barré syndrome is an acute disorder of the nervous system. It is observed following a variety of infections, including influenza. Studies suggest that regular seasonal influenza vaccines could be associated with an increased risk of Guillain-Barré syndrome on the order of one to two cases per million vaccinated persons. During the 1976 influenza vaccination campaign, this risk increased to around 10 cases per million vaccinated persons which led to the withdrawal of the vaccine.

Pandemic vaccines will be manufactured according to established standards. However, they are new products so there is an inherent risk that they will cause slightly differently reactions in humans. Close monitoring and investigation of all serious adverse events following administration of vaccine is essential. The systems for monitoring safety are an integral part of the strategies for the implementation of the new pandemic influenza vaccines. Quality control for the production of influenza vaccines has improved substantially since the 1970s.


Will it be possible to deliver new influenza A(H1N1) vaccine simultaneously with other vaccines?
Inactivated influenza vaccine can be given at the same time as other injectable vaccines, but the vaccines should be administered at different injection sites.

If the virus causes a mild pandemic in the warmer months and changes into something much more severe in, say, 6 months, will vaccines being developed now be effective?
It is too early to be able to predict changes in the influenza A(H1N1) virus as it continues to circulate in humans or how similar a mutated virus might be to the current virus. Careful surveillance for changes in the influenza A(H1N1) virus is ongoing. This close and constant monitoring will support a quick response should important changes in the virus be detected.

Will there be enough influenza A(H1N1) vaccine for everyone?
The estimated time to make enough vaccine to vaccinate the world's population against pandemic influenza will not be known until vaccine manufacturers will have been able to determine how much active ingredient (antigen) is needed to make one dose of effective influenza A(H1N1) vaccine.

In the past two years, influenza vaccine production capacity has increased sharply due to expansion of production facilities as well as advances in research, including the discovery and use of adjuvants. Adjuvants are substances added to a vaccine to make it more effective, thus conserving the active ingredient (antigen).


What is WHO's perspective on fairness and equity for vaccine availability?
The WHO Director-General has called for international solidarity in the response to the current situation. WHO regards the goal of ensuring fair and equitable access by all countries to response measures to be among the highest priorities. WHO is working very closely with partners including the vaccine manufacturing industry on this.

Who is likely to receive priority for vaccination with a future pandemic vaccine?
This decision is made by national authorities. As guidance, WHO will be tracking the evolution of the pandemic in real-time and making its findings public. As information becomes available, it may be possible to better define high-risk groups and to target vaccination for those groups, thus ensuring that limited supplies are used to greatest effect.

Will WHO be conducting mass influenza A(H1N1) vaccination campaigns?
No. National authorities will implement vaccination campaigns according to their national pandemic preparedness plans. WHO is exploring whether the vaccine can be packaged, for example, in multi-dose vials, to facilitate the rapid and efficient vaccination of large numbers of people.

Developing countries are very experienced in administering population-wide vaccination campaigns during public health emergencies caused by infectious diseases, including diseases like epidemic meningitis and yellow fever, as well as for polio eradication and measles control programmes.


How feasible will it be to immunize large numbers of people in developing countries against a pandemic virus?
Developing countries have considerable strategic and practical experience in delivering vaccines in mass campaigns. The main issue is not feasibility, but how to ensure timely access to adequate quantities of vaccine.


What is the estimated global number of doses of seasonal vaccine used annually?
The current annual demand is for less than 500 million doses per year.

Will seasonal influenza vaccine continue to be available?
At this time there is no recommendation to stop production of seasonal influenza vaccine.
Source: Swine Influenza Top News

Levels of pandemic alert

What does pandemic alert phase 5 mean?
According to WHO definitions of phases - the virus has caused sustained community level outbreaks in at least two countries in one WHO region. At phase 5 a pandemic is considered imminent.

What is sustained human to human transmission?
This occurs when three generations are involved - i.e. the virus has passed from person A to person B and then to person C.

What is the difference between a probable case and a confirmed case?
A probable case is one that shows the symptoms of influenza such as cough, fever, headache, chills and fatigue and either tests positive for type A influenza or is considered linked to another probable or confirmed case.
A confirmed case is one which tests positive in a laboratory for the influenza A(H1N1) virus.

At what point does WHO consider a pandemic to have started?
Phase 6, as defined by the WHO pandemic preparedness guidelines. However, during both phase 5 and phase 6, national and local actions to respond to the outbreak shift from preparedness to response at a global level. The goal of recommended actions during these phases is to reduce the impact of the pandemic on society.

Source: Swine Influenza Top News

About the disease

How do people become infected with influenza A(H1N1)?
Outbreaks in humans are now occurring from human-to-human transmission. When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.

What are the signs and symptoms of infection?
Early signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea.

Regarding study of the first outbreak, have you received any feedback from the WHO team sent to Mexico to investigate the outbreak?
Teams are already sending epidemiological evidence but we will know more over the next few days.

Is there any confirmation of transmission between pigs and humans at this point?
No.

Is there any information on the economic impact of the outbreak so far?
No.

Why are we so worried about this pandemic possibility when thousands die every year from seasonal epidemics?
Seasonal epidemics occur every year and we are able to treat the virus with seasonal vaccines. A pandemic is a worldwide epidemic. It is a new virus and one to which the populations will have no immunity.

Source: Swine Influenza Top News

No rationale for travel restrictions

WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts of the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The focus now is on minimizing the impact of the virus through the rapid identification of cases and providing patients with appropriate medical care, rather than on stopping its spread internationally. Furthermore, although identifying the signs and symptoms of influenza in travellers can be an effective monitoring technique, it is not effective in reducing the spread of influenza as the virus can be transmitted from person to person before the onset of symptoms. Scientific research based on mathematical modelling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.

Travellers can protect themselves and others by following simple recommendations related to travel aimed at preventing the spread of infection. Individuals who are ill should delay travel plans and returning travellers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases and not only influenza A(H1N1).

Source: Swine Influenza Top News

Influenza A(H1N1) - update 12

As of 1600 GMT, 3 May 2009, 18 countries have officially reported 898 cases of influenza A(H1N1) infection.

Mexico has reported 506 confirmed human cases of infection, including 19 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens. The United States Government has reported 226 laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (8), Ireland (1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15).

Further information on the situation will be available on the WHO website on a regular basis.

WHO advises no restriction of regular travel or closure of borders.It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

Canada on 2 May reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time.

There is no risk of infection from this virus from consumption of well-cooked pork and pork products.

Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

Source: Swine Influenza Top News

Mexico: Swine flu epidemic in decline

Mexico's health secretary said Sunday the swine flu epidemic in his country "is in its declining phase," but stressed that people should remain vigilant against the disease.

Jose Angel Cordova said his country's death toll from the swine influenza A/H1N1 virus stands at 22 and the number of confirmed cases has increased to 568 from 506, including the dead.

Also Sunday, Mexican President Felipe Calderon denounced some countries for taking discriminatory measures against Mexicans because of the swine flu epidemic.

"Some countries or places are taking discriminatory measures because of ignorance and misinformation," Calderon said in an interview broadcast on state television.

He did not single out any country. But Mexico's ambassador to China says the Asian country has quarantined more than 70 Mexican travellers in hospitals — including some with no symptoms of swine flu.

A Foreign Relations Department official said Mexico will send a plane to China to bring back citizens who wish to leave.

The number of cases worldwide reached at least 1,000 in 18 countries, including the first confirmed case in Colombia — with the vast majority of infections in Mexico, the U.S. and Canada, global health officials said Sunday.

In a statement, World Health Organization spokesman Gregory Hartl warned that it's not unusual for viral outbreaks to decrease in size before increasing.

"I would like to also remind people that in 1918, the Spanish flu showed a surge in the spring and then disappeared in the summer months, only to return in the autumn of 1918 with a vengeance, eventually killing 40 to 50 million people," he said at a news conference in Geneva.

Hartl said it's possible health officials could see a decline in swine flu numbers over the summer in the Northern Hemisphere, followed by an increase when colder weather returns.

"So I think that while tracing these kind of curves of activity — increase and decrease in activity — we cannot lower our guard," he said.
H1N1 virus found in Alberta pig herd

WHO spokesman Dr. Peter Embarak said it's "not a big surprise" that the same strain of swine flu that has made people sick in several countries has been detected in part of a 2,200-head pig herd in central Alberta.

Officials on Saturday said the pigs probably contracted the infection from a farm worker who recently returned from Mexico. The farm is under quarantine.

The number of pigs infected and the exact location of the farm have not been disclosed.

"It's necessary to re-emphasize that this is not a food-borne disease. You don't get this through eating pork, and therefore there is no reason to be afraid of consuming pork products as long as the pork is cooked," Embarak said.

Nevertheless, China is halting imports of Alberta pork, according to the official Chinese news agency. Xinhua attributed the information to China's General Administration of Quality Supervision, Inspection and Quarantine and the Ministry of Agriculture.

Dr. Brian Evans, executive vice-president of the Canadian Food Inspection Agency said, "With all the factors at play, I would have no issue eating pork from these pigs."

Jurgen Preugschas, chairman of the Canadian Pork Council, said there is no danger to the public in eating pork.

"We have to understand that this is not a food safety issue but it is a human health issue and that it is safe to eat pork."

The U.S. government said it will not impose any trade restrictions on Canadian pork over the infected pigs and will wait for further test results before considering any action.

The caseload in Canada has jumped from 51 late last week to 101, with all those afflicted reporting relatively mild symptoms. Nova Scotia has the highest number of cases at 33.

Eleven of the new cases were at King's-Edgehill, a private school in Windsor, N.S., that has been the centre of the outbreak in the province. A group of students from the school visited Mexico last month.

More cases of swine influenza A/H1N1 have also been reported in Europe. The Spanish health ministry on Sunday said the country now has 40 confirmed cases, making it the European nation hardest hit by the virus.

Spanish health officials said most of the sufferers have already recovered. All but two had recently visited Mexico.

Britain, Italy and Germany also reported new cases.

In China, more than 70 Mexican tourists were quarantined in hospitals and hotels, and Mexicans on arriving flights were isolated, Mexican Ambassador Jorge Guajardo said. Even the Mexican consul in Guangzhou was briefly held after returning from a vacation in Cambodia, Guajardo said.

Several Canadian students travelling in Beijing were quarantined at a university simply because they're Canadian and were told they couldn't leave for a week. Food is being delivered to them and doctors visit them once a day, one student told CBC News in an email.

In Hong Kong, the government has ordered 350 guests and employees of the Metropark Hotel to remain isolated inside the hotel for seven days.

The order was issued Friday after the government said a Mexican man who stayed there had the swine flu virus.

The Taipei Times in Taiwan reports many guests are angry with the decision because they were initially told they would only be quarantined for 24 hours.

In Trinidad, crew members aboard a Mexican tanker have been isolated since Friday at the Point Lisas port. The Ministry of Health said Sunday they were tested and cleared of any flu infection and the vessel is expected to be released.

Source: Swine Influenza Top News

India safe but ill equipped on epidemic drugs

Swine flu was first reported in Mexico, SARS and bird flu in China, but India surprisingly escaped being ground zero for any.

China: SARS in 2002-2003 and bird flu in 1996, both in the southern provinces. Malaysia: the Nipah virus in 1998 -- encephalitis in humans via pigs, from fruit bats. Probably Mexico: swine flu or Mexican flu this year, a hybrid of human, swine and avian viruses which the WHO politely rechristened Influenza A(H1N1), using the technical terminology, a few days ago.

Pair up these widely feared pandemics -- there have been many others in history -- with their supposed places of origin and one fact is prominent for its absence: India. Doesn't India incubate any such dangerous viruses?

To start with, the reason these viruses are such a threat is that they are totally new in humans, and therefore we have no immunity to them. Since the body has no defence, even a relatively mild pathogen can become a severe hazard, even a killer.

The reason such viruses are new is that they evolved at first in animals other than humans, typically vertebrates like pigs, birds, cats, dogs, horses.

Each of these species, like humans, is a reservoir of hundreds of specific pathogens which are perfectly adapted to them. The animal, or the human, does not even need to be apparently sick to be harbouring, or indeed spreading or "shedding" the pathogens.

Clearly these are animals with which people live and work. In poorer parts of the world, humans may even share living space with some of these animals.

Such extended proximity explains why what starts out as an animal virus can eventually evolve enough to make the jump from one species to another -- to humans. In the case of the ongoing influenza, which probably originated in pigs (physiologically not dissimilar to humans), scientists think that the pigs were a mixing bowl in which avian and human respiratory viruses came together with a swine virus, to make a hybrid virus which could attack human cells and, thanks to the avian element, could reproduce speedily.

Such a virus can be a quick learner and a quick adapter -- and therefore more virulent. The human-to-human transmission of Influenza A(H1N1) comes from such adaptability, and this is what has health professionals so worried now.

So why has this not happened in India? After all, the conditions that made a cross-species jump possible in south China or Malaysia are not so different from conditions in parts of India.

"It's the heat that has killed the virus," speculates medical historian Mridula Ramanna, who has closely studied the Indian career of the 1918-19 pandemic of 'Spanish flu', which is estimated to have killed between 35 and 100 million people worldwide in the immediate aftermath of World War I.

"The number of deaths was almost 17 million in India in 1918," says Ramanna. "The colonial power attributed [the flu] to India, but it appears to have come from outside by ship." Many epidemiologists (experts on the transmission and control of disease) and historians think the 1918 influenza started in southern China and probably, like the ongoing 'swine' flu, combined avian and swine with human traits -- although at a much higher level of virulence. (Even so, only a small proportion of those who contracted it actually died.)

Spanish flu is the spectre in the minds of modern epidemiologists.

The unseasonal April heat in India is one reason medical opinion cites, because the influenza virus does not last long in hot weather outside the host's body; but it is not always hot here. Peak influenza season (when people have coughs and colds), moreover, is cool weather, yet no outbreak of an emerging virus has started in India even in winter.

Not surprisingly, medical professionals are extremely wary of speaking about the influenza situation in India.

"We don't know that they don't occur in India. They probably do, and we don't know." say Kalpana Swaminathan and Ishrat Syed, authors of a substantial new book on mass disease and history, and both paediatricians.

"If 10 people die one after another in a jhuggi cluster, who notices? Next time you're travelling across the city, look and you will see lots of swine and humans around living in close proximity, living together in some cases."

And it's a misconception, they point out, that doctors always know what they are treating: "Most of these new emerging diseases which are viral or present mainly as fevers -- all you can do is make sure the person stays alive until his own body can overcome the pathogen. These diseases are killers because we don't know anything about them."

Given the constraints they are so familiar with, these doctor-authors are full of praise for China during SARS, once the government realised that concealment was counterproductive: "China is like us -- sprawling -- so when you look at what China did to control SARS, it's really marvellous. Would we be able to do it?"

For the moment, Influenza A(H1N1) appears to be less potent than doctors originally feared. The number of confirmed fatalities, while tragic, is not large. Yet such viruses don't vanish -- they continue to exist in various reservoirs, and may come into play again in cooler weather.

The more widely they spread, the greater the risk they pose. It's just possible that India has not given the world such a virus -- yet -- but the future is wide open.

India yet to wake up to epidemic drugs

Although the Influenza A (H1N1) virus (swine flu), has so far killed 16 people (in Mexico only) and infected 615 people in 15 countries (the World Health Organisation (WHO) figures) as of Sunday, and caused a global panic and media attention, statistics reveal that hundreds of people died and millions were infected in India since 2000 with epidemics such as Chikungunya, Japanese Encephalitis (JE), Meningococcal disease, Dengue fever, Plague and Cholera.

However, most of these outbreaks in India have not attracted the same level of interest in the global healthcare industry. Pharma companies are yet to even develop drugs for diseases such as chikungunya and JE, note industry experts.

According to WHO's India statistics, 151 districts in 9 states of Andhra Pradesh, Tamil Nadu, Karnataka, Maharashtra, Gujarat, Madhya Pradesh, Kerala, Delhi and Andhra Pradesh were affected by chikungunya and dengue fever, spread by Aedes albopictus mosquitos in 2006. More than 1.25 million suspected cases were reported from the country from February to October 2006.

Neither the multinational drug companies, nor any of the Indian drug companies are yet to develop an effective drug for this disease. During the outbreak, doctors had to prescribe paracetamol and other antibiotics to check the viral infection.

Nicholas Piramal India, which planned to form a joint venture drug discovery research programme with the French pharmaceutical company, Laboratories Pierre Fabre backed out from the project due to procedural delays.

"We dropped the drug research plans for chikungunya, since the drug controller general of India (DCGI) delayed to sanction the project. It is almost six months' since we applied," Swati Piramal, director- strategic alliances, NPIL, told Business Standard in November, last year.

Pierre Fabre had developed effective medicines to prevent the disease outbreak which happened in Re-Union islands, a French colony, about three years ago and in some other tropical countries.

In July -August period of 2005, 1,145 cases of Japanese Encephalitis(JE) or brain fever cases were reported from 14 districts of Uttar Pradesh. Of this, one fourth or 296 people had died. Another 90 cases were reported from Bihar.

The disease was caused by Culex tritaeniorhynchus and Culex vishnui group of mosquitos, the vectors of JE. Only two months ago the U.S. Food and Drug Administration approved Ixiaro, a new generation vaccine manufactured by a UK based biotech company Intercell, that can effectively prevent this disease.

Another fatal disease that infect India repeatedly is the meningococcal disease. In 2005, about 405 cases were reported in Delhi and suburbs and of this, 48 had died. Meningococcal disease is endemic in Delhi and outbreaks of Meningococcal Meningitis in and around Delhi were reported in 1966 and 1985. During 1966, 616 cases of meningitis were reported with case-fatality rate of 20.9 per cent.

The outbreak in 1985 was bigger in magnitude, both in terms of cases and the geographical area affected, with 6133 cases with 799 deaths.

Vaccines are currently available against four of the five strains of this disease, and a vaccine against the B strain is in development.

Menactra, Menomune of Sanofi-Aventis, Mencevax of GlaxoSmithKline and NmVac of JN-International Medical Corporation are commonly used vaccines. Indian companies such as Serum Institute are also developing vaccines for this disease.

Antibiotics such as ciprofloxacin is normally used by doctors to prevent the disease. P B Jayakumar, Business Standard

Swine Flu epidemic plays out in cyberspace

Scammers - netizens who spam with the intention of cheating -- are cashing-in on the H1N1 influenza (swine flu) scare. With email messages that include subject lines like 'Salma Hayek caught swine flu!', "Madonna caught swine flu!", 'US Swine Flu Statistics', and "Swine flu in Hollywood", they are (mis)leading gullible users to online pharmacies.

Online security company McAfee Avert Labs has noted that such emails now account for 2 per cent of all spam messages. Some e-mails contain malware too.

One such email which references a vaccine for swine flu reportedly includes a link to a malicious file on a Mexican website that is designed to steal bank login information, according to security firm SonicWall.

Simultaneously, F-Secure Corp, another online security company, said that over 250 websites with the term "swine flu" were registered within the first few days following the announcement of the outbreak. Sites like these which include noswineflu.com, surviveswineflu.com and pigflufighter.com claim to have cures for the influenza.

Noswineflu, for instance, claims to have a concoction of special Chinese and a Western herb which can "crush almost any flu symptom, sometimes overnight." Pigflufighter, on its part, lists all swine flu infections by country and cajoles visitors to buy eight boxes of 'pig flu' masks (160 pieces for $190 plus free shipping).

Even the US Food and Drug Administration has alerted the public to be wary of internet sites selling products that claim to prevent, treat or cure the H1N1 flu virus, and has informed offending websites that they must take prompt action to correct and/or remove promotions of these fraudulent products or face immediate enforcement action.

The Better Business Bureau too has warned consumers to be on the lookout for fraudulent emails and websites trying to take advantage of the current flu outbreak. The operators of these websites, according to USFDA, take advantage of the public's concerns about H1N1 influenza and their desire to protect themselves and their families.

However, the internet is also helping hundreds of thousands of users in getting relevant information on the flu. Wikipedia's page on the flu, according to Nielsen Online, was updated literally hundreds of times this week (119 times as of early on May 1).

There were around 100 Facebook groups dedicated to the flu till early May 1, and more than 500 other groups (the three largest groups have a combined total of over 10,000 members), according to Nielsen. And despite the flutter it caused with its earlier tweets last week, Twitter too churned out flu tweets at a rate of more than 10,000 per hour earlier in the week.

Even the Centre for Disease Control (CDC) is leveraging several different online channels to provide a "voice of reason in the fury of discussion around the flu -- and in the process is setting a roadmap for those wondering how social media can be used for crisis communication", according to Nielsen.

CDC has a few Twitter accounts and over 65,000 followers (users who follow the tweets) -- up 86 per cent since Nielsen began tracking it. It also has set up a dedicated page about flu on its site, which according to Nielsen estimates, has seen a nearly 100 per cent increase in unique visitors. -- Leslie D'Monte, Business Standard



Source: Swine Influenza Top News

Swine flu goes person-to-pig; What's next?

Now that the swine flu virus has passed from a farmworker to pigs, could it jump back to people? The question is important, because crossing species again could make it more deadly.

The never-before-seen virus was created when genes from pig, bird and human viruses mixed together inside a pig. Experts fear the virus that has gone from humans back into pigs in at least one case could mutate further before crossing back into humans again. But no one can predict what will happen.

"Could it gain virulence? Yes," Juan Lubroth, an animal health expert at the U.N. Food and Agriculture Organization in Rome, said Sunday. "It could also become milder. It could go in both directions."

Canadian officials announced Saturday that the virus had infected about 200 pigs on a farm — the first evidence that it had jumped to another species. It was linked to a farmworker who recently returned from Mexico, where 19 people have died from the virus. The farmworker has recovered, and the mildly infected pigs have been quarantined.

Agriculture officials believe the worker may have sneezed or coughed near the pigs, possibly in a barn. About 10 percent of the herd experienced loss of appetite and fever, but all are recovering.

Experts say pork — even from infected pigs — is safe to eat.

Lubroth stressed that sick people should avoid contact with swine, but said healthy farmworkers don't need to take any extra precautions because the chance of catching flu from a pig is small.

Unlike the H5N1 bird flu virus, which infects the blood, organs and tissue of poultry, most swine flus are confined to the respiratory tract, meaning the risk of a human getting infected by a pig is "probably 10 or a 1,000 times less," Lubroth said.

But pigs are of special concern because they share some basic biological similarities with humans, and they have served as "mixing vessels" in which various flu strains have swapped genetic material. That's what happened to create the current swine flu strain.

Scientists are unsure when the virus leaped from pigs to humans — possibly months or even a year ago — but it was identified as a new strain about a week and a half ago. Since then, nearly 800 cases have been confirmed worldwide. The only death outside Mexico occurred when a Mexican toddler died in a Texas hospital.

There have been sporadic cases of pigs infecting humans with influenza in the past. Most cases resulted in mild symptoms, typically among people who were in close contact with sick pigs. A few deaths have been recorded, and limited human-to-human transmission also has been documented, but nothing sustained.

Dr. Tim Uyeki, an epidemiologist with the U.S. Centers for Disease Control and Prevention who has worked on SARS and bird flu outbreaks, said there may be more pig-to-human cases that have gone unnoticed because surveillance among swine populations tends to be weaker than among poultry stocks.

Given that the past three flu pandemics — the 1918 Spanish flu, the 1957-58 Asian flu and the Hong Kong flu of 1968-69 — were all linked to birds, much of the global pandemic preparedness has focused on avian flus.

"The world has been watching and preparing and trying to prevent a pandemic from an avian influenza reservoir," he said. "The focus has been on birds, and here is a virus that's coming from a swine reservoir. Now it's a human virus."

Source: Swine Influenza Top News

WHO fears pandemic is imminent

The UN's World Health Organization has raised the alert over swine flu to level five
- indicating human-to-human transmission in at least two countries.
It is a "strong signal that a pandemic is imminent", the WHO says.
In Mexico, at the epicentre of the outbreak, people have been urged to stay at home over the next five days.
There are numerous cases elsewhere - the highest number outside Mexico is the US - and Europeans have been told it is certain there will be deaths.
Several countries have restricted travel to Mexico and many tour operators have cancelled holidays.
Other countries are resisting calls to implement travel bans or close borders, on the grounds - backed by the WHO - that there is little evidence of their efficacy.

In the latest developments:
* The Netherlands confirms its first case of swine flu, in a three-year-old boy recently returned from Mexico. Cases have also been confirmed in Switzerland, Costa Rica and Peru
* European health ministers were set to meet for emergency talks to co-ordinate national efforts to contain the spread of the virus
* Ghana has become the latest country to ban pork imports as a precaution against swine flu, though no cases have been found in the West African country
* China's health minister says that the country's scientists have developed a "sensitive and fast" test for spotting swine flu in conjunction with US scientists and the WHO. The country has recorded no incidence of the flu yet.

'Urgent action'
Announcing the latest alert level after an emergency WHO meeting in Geneva, Director General Margaret Chan urged all countries to activate their pandemic plans, including heightened surveillance and infection-control measures.
She said action should be undertaken with "increased urgency".
She added: "It really is the whole of humanity that is under threat in a pandemic."
But she also said the world was "better prepared for an influenza pandemic than at any time in history".
Ms Chan stressed on Wednesday that there was no danger from eating properly cooked pork.
She advised hygiene measures such as hand-washing to prevent infection and said it was important "to maintain a level of calm".
Meanwhile in Mexico, President Felipe Calderon has announced the partial suspension of non-essential work and services from 1 to 5 May - a holiday period there.
In a TV address, he urged people to stay in with their families - saying there was "no place as safe as your own home".
He said he was "proud" of the response of Mexicans to the crisis, and assured people Mexico was well-stocked with anti-viral medicines.
Already, schools across Mexico have closed, public gatherings are restricted and archaeological sites have been placed off-limits.
Mexico is already being hit hard by the global economic slowdown, and the country's finance minister says swine flu could cut a further half-percent of GDP.
The search for the source of the outbreak continues, with the focus on the vicinity of a pig farm in the eastern part of the country.
The Mexican government is urging against jumping to conclusions and is suggesting the possibility remains that the virus originated outside the country.
Officials have put the number of suspected deaths from swine flu in Mexico at 168, although just eight deaths have been confirmed, with 26 infections positively tested.
In Europe, the director-general of health and consumer protection, Robert Madelin, said the continent was well prepared but nonetheless deaths from the disease were expected.
"It is not a question of whether people will die, but more a question of how many. Will it be hundreds, thousands or tens of thousands?", he said, speaking to Reuters news agency.

Movement bans?
At the meeting of health ministers on Thursday, a French proposal of issuing a continent-wide travel advisory for Mexico will be discussed - though it is unclear whether it is in the power of the EU executive to impose such a ban.
Spain has seen the first case of a person contracting swine flu without having travelled there.
After Mexico, the US has recorded the next highest number of confirmed cases, with 91 - and the first death of swine flu outside Mexico, after a visiting Mexican child died in Texas.
President Barack Obama has urged local public-health bodies to be vigilant and said schools with confirmed cases "should consider closing". About 100 have so far done so.
There are no current plans to close the border with Mexico, Mr Obama said on Wednesday evening.


Source: Swine Influenza Top News

Mexico shuts down to control flu

Mexico is beginning a five-day shutdown of parts of its economy in a bid to slow the spread of swine flu.
Non-essential government services will stop, while businesses like cinemas and restaurants will be shut. Traditional May Day rallies have been cancelled.
Mexican officials say the spread of the virus - suspected in more than 160 deaths - is slowing, but international experts are more cautious.
Swine flu cases have now been confirmed in 12 countries over three continents.
In cases outside Mexico the virus does not appear to be severe, although one death has been confirmed in the US.
The WHO has set its pandemic alert level at five - but says it has no immediate plans to move to the highest level of six.

Economy fears
The shut-down in Mexico covers two public holidays and a weekend.
Some factories will stop production and schools are already closed. Residents have been urged to stay at home.
But some people say they will ignore it because they cannot afford not to work.
There is also growing concern at the effect the virus could have on Mexico's already-struggling economy.
The number of confirmed cases of swine flu infection in Mexico now stands at about 300, officials say.
Twelve people are known to have died from the virus and it is suspected in more than 160 other deaths.
Announcing the figures, Mexican Health Secretary Jose Angel Cordova said that new cases of the virus were levelling off.
"The fact that we have a stabilisation in the daily numbers, even a drop, makes us optimistic," he said.
But Dr Keiji Fukuda, acting assistant director general of the World Health Organisation, said fluctuations were to be expected. "If it didn't do that [it] would be very unusual," he said.

In other developments:
• The US has announced that it will buy 13 million new courses of antiviral treatment and send 400,000 of them to Mexico
• An aide to US Energy Secretary Stephen Chu who helped arrange President Obama's recent trip to Mexico is being tested for swine flu, AP reports, although the aide is said not to have been in contact with the president
• German authorities confirm that a nurse who treated a patient with swine flu also contracted the disease, in the first person-to-person transmission in the country
• Test results are expected to confirm the UK's first person-to-person transmission of swine flu, in a friend of a couple from Scotland who were first in the country to be diagnosed with the virus
• Mexico says it will lodge a formal challenge at the World Trade Organisation demanding explanations from countries that have banned imports of Mexican pork products

'No panic'
On Thursday European health ministers held an emergency meeting on measures to tackle the virus, which has been confirmed in six European countries.
EU Health Commissioner Androulla Vassiliou said Europe was well prepared to handle swine flu and there was "no need to panic".
The ministers agreed to work with pharmaceutical companies to develop a vaccine, but rejected a French plan to suspend flights to Mexico.
Several countries have restricted travel to Mexico and many tour operators have cancelled holidays.
The WHO, meanwhile, says it will now call the virus influenza A (H1N1) rather than swine flu - which it says is misleading as pork meat is safe and the virus is being transmitted from human to human.

Source: Swine Influenza Top News

WHO PANDEMIC ALERT PHASES

Phase 1: No infections in humans are being caused by viruses circulating in animals.












Phase 2: Animal flu virus causes infection in humans, and is a potential pandemic threat.












Phase 3: Flu causes sporadic cases in people, but no significant human-to-human transmission.












Phase 4: Human-to-human transmission and community-level outbreaks.












Phase 5: Human-to-human transmission in at least two countries. Strong signal pandemic
imminent.











Phase 6: Virus spreads to another country in a different region. Global pandemic under way.












Post-peak: Pandemic activity appears to be decreasing though second wave possible.
Post-pandemic: activity returns to normal, seasonal flu levels.

Source: Swine Influenza Top News

Flu Pandemics

1918: The Spanish flu pandemic remains the most devastating outbreak of modern times. Caused by a form of the H1N1 strain of flu, it is estimated that up to 40% of the world's population were infected, and more than 50 million people died, with young adults particularly badly affected

1957: Asian flu killed two million people. Caused by a human form of the virus, H2N2, combining with a mutated strain found in wild ducks. The impact of the pandemic was minimised by rapid action by health authorities, who identified the virus, and made vaccine available speedily. The elderly were particularly vulnerable

1968: An outbreak first detected in Hong Kong, and caused by a strain known as H3N2, killed up to one million people globally, with those over 65 most likely to die

Source: Swine Influenza Top News

How Swine Flu Outbreak Emerged

Cases of swine flu, which has killed people in Mexico, have been confirmed around the world. With experts scrambling to develop a vaccine, there is concern at the potential for a pandemic affecting millions of people.

What is swine flu?
Swine flu is a respiratory disease, caused by influenza type A which infects pigs.
There are many types, and the infection is constantly changing.
Until now it has not normally infected humans, but the latest form clearly does, and can be spread from person to person - probably through coughing and sneezing.

What is new about this type of swine flu?
The World Health Organization has confirmed that at least some of the human cases are a never-before-seen version of the H1N1 strain of influenza type A.
H1N1 is the same strain which causes seasonal outbreaks of flu in humans on a regular basis.
But this latest version of H1N1 is different: it contains genetic material that is typically found in strains of the virus that affect humans, birds and swine.
Flu viruses have the ability to swap genetic components with each other, and it seems likely that the new version of H1N1 resulted from a mixing of different versions of the virus, which may usually affect different species, in the same animal host.
Pigs provide an excellent 'melting pot' for these viruses to mix and match with each other.

How dangerous is it?
Symptoms of swine flu in humans appear to be similar to those produced by standard, seasonal flu.
These include fever, cough, sore throat, body aches, chills and fatigue.
It is worth remembering that seasonal flu often poses a serious threat to public health: each year it kills 250,000 - 500,000 around the world.
So far, most cases of swine flu around the world appear to be mild, albeit with diarrhoea more common than it is with seasonal flu.
But lives have been lost in Mexico, and a single death - of a Mexican child - has been confirmed in the US.

How worried should people be?
When any new strain of flu emerges that acquires the ability to pass from person to person, it is monitored very closely in case it has the potential to spark a global epidemic, or pandemic.
The World Health Organization has warned that swine flu could potentially trigger a global pandemic, and stress that the situation is serious.
However, experts say it is still too early to accurately assess the situation fully.
Currently, they say the world is closer to a flu pandemic than at any point since 1968 - upgrading the threat from four to five on a six-point scale following a meeting on Wednesday.
This means all governments have to mobilise their pandemic flu plans.
Nobody knows the full potential impact of a pandemic, but experts have warned that it could cost millions of lives worldwide. The Spanish flu pandemic, which began in 1918, and was also caused by an H1N1 strain, killed millions of people.
There is hope that, as humans are often exposed to forms of H1N1 through seasonal flu, our immune systems may have something of a head start in fighting infection.
However, the fact that many of the victims are young does point to something unusual. Normal, seasonal flu tends to affect the elderly disproportionately

Is Mexico different?
The death toll in Mexico - where the virus at present seems to producing much more severe symptoms - suggests there may be unusual factors coming into play there.
Some experts have suggested the possibility that other, unrelated viruses may also be circulating in Mexico, making symptoms worse.
This would be unlikely to come into play in the rest of the world.
Alternatively, people infected in Mexico may have sought treatment at a much later stage than those in other countries.
It may also be the case that the form of the virus circulating in Mexico is subtly different to that elsewhere - although that will only be confirmed by laboratory analysis.
The Mexican authorities have downgraded the official death toll from the virus, ordering a new round of more stringent tests.

Can the virus be contained?
The virus appears already to have started to spread around the world, and most experts believe that, in the era of readily available air travel, containment will be extremely difficult.
The World Health Organization says that restricting flights will have little effect. It argues that screening of passengers is also unlikely to have much impact, as symptoms may not be apparent in many infected people.

Can it be treated?
The US authorities say that two drugs commonly used to treat flu, Tamiflu and Relenza, seem to be effective at treating cases that have occurred there so far. However, the drugs must be administered at an early stage to be effective.
Use of these drugs may also make it less likely that infected people will pass the virus on to others.
The UK Government already has a stockpile of Tamiflu, ordered as a precaution against a pandemic.
It is unclear how effective currently available flu vaccines would be at offering protection against the new strain, as it is genetically distinct from other flu strains.
A new bespoke vaccine is being worked on by scientists in the UK and the US, but it may take months to perfect it, and manufacture enough supplies to meet what could be huge demand.
A vaccine was used to protect humans from a version of swine flu in the US in 1976.
However, it caused serious side effects, including an estimated 500 cases of Guillain-Barré syndrome. There were more deaths from the vaccine than the outbreak.

What should I do to stay safe?
Anyone with flu-like symptoms who might have been in contact with the swine virus - such as those living or travelling in the areas of Mexico that have been affected - should seek medical advice.
But patients are being asked not to go into GP surgeries in order to minimise the risk of spreading the disease to others. Instead, they should stay at home and call their healthcare provider for advice.
Countries around the world have taken varying measures but are mostly stepping up monitoring and issuing advice about travel to Mexico.
In the UK, the Foreign Office is advising against all but essential travel to Mexico.

What measures can I take to prevent infection?
Avoid close contact with people who appear unwell and who have fever and cough.
General infection control practices and good hygiene can help to reduce transmission of all viruses, including the human swine influenza. This includes covering your nose and mouth when coughing or sneezing, using a tissue when possible and disposing of it promptly.
It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people and cleaning hard surfaces like door handles frequently using a normal cleaning product.
If caring for someone with a flu-like illness, a mask may be worn to cover the nose and mouth to reduce the risk of transmission. The UK is looking at increasing its stockpile of masks for healthcare workers for this reason.
In Mexico masks have been handed out to the general public, but experts are sceptical about how useful this is.

May it take some time for a pandemic to strike?
Possibly. The flu virus tends to thrive in cooler conditions, and to struggle in warmer weather.
The initial cases have developed right at the tail end of the winter flu season in the northern hemisphere, so it is possible that the number of infections may only begin to accelerate once the weather turns colder in the autumn.
However, the southern hemisphere is about to enter its winter season and it is possible that the virus will take hold there first.

Is it safe to eat pig meat?
Yes. There is no evidence that swine flu can be transmitted through eating meat from infected animals.
However, it is essential to cook meat properly. A temperature of 70C (158F) would be sure to kill the virus.
Experts are also stressing that this is now a disease which is being passed between people.
The World Organisation for Animal Health said culling pigs, as Egypt has proposed, was therefore "inappropriate" as a measure to stop swine flu spreading.
It added there was no evidence of infection in pigs, nor of humans acquiring infection directly from pigs.

What about bird flu?
The strain of bird flu which has caused scores of human deaths in South East Asia in recent years is a different strain to that responsible for the current outbreak of swine flu.
The latest form of swine flu is a new type of the H1N1 strain, while bird, or avian flu, is H5N1.
Experts fear H5N1 holds the potential to trigger a pandemic because of its ability to mutate rapidly.
However, it has so far remained very much a disease of birds.
Those humans who have been infected have, without exception, worked closely with birds, and cases of human-to-human transmission are extremely rare. There is no suggestion that H5N1 has gained the ability to pass easily from person to person.

Where can I get further advice?
Further information and advice on swine flu can be found at websites of leading health and research organisations around the world. The World Health Organisation gives background information on the virus.
The UK's government services website is carrying regularly updated health and travel information. The Health Protection Agency advises the public about what to do if returning from an affected area. NHS Choices outlines how swine flu is different from other flu.
The US government's Centre for Disease Control is counting the number of cases in the US.
You can also track the spread of swine flu reports using unofficial sources. Google is mapping search term data as an indicator of flu activity both across the US down to state level and in Mexico. Healthmaps maps viruses using news reports. Social media guide Mashable lists a range of ways to track the virus .
Information and links to useful websites are being shared on Twitter, the micro-blogging service, while social networking website Facebook is tracking swine flu discussion amongst users.
Further questions from our readers have been answered by a UK-based expert.

Source: Swine Influenza Top News

Different species harbour different strains of the flu virus...

For the example:












Flu viruses mutate over time causing small changes to proteins on their surface called antigens. If the immune system has met a particular strain of the virus before, it is likely to have some immunity; but if the antigens are new to the immune system, it will be weakened.













The influenza A virus can mutate in two different ways; antigenic drift, in which existing antigens are subtly altered, and antigenic shift, in which two or more strains combine. Antigenic drift causes slight flu mutations year on year, from which humans have partial, but not complete, immunity. By contrast, the new strain of H1N1 appears to have originated via antigenic shift in Mexican pigs













The name "swine flu" is a slight misnomer as it is believed pigs acted as a mixing pot for several flu strains, containing genetic material from pigs, birds and humans. Most humans have never been exposed to some of the antigens involved in the new strain of flu, giving it the potential to cause a pandemic.













The new virus has made the jump from pigs to humans and has demonstrated it can also pass from human to human. This is why it is demanding so much attention from health authorities. The virus passes from human to human like other types of flu, either through coughing, sneezing, or by touching infected surfaces, although little is known about how the virus acts on humans.

Source: Swine Influenza Top News

Swine influenza 2009 swine flu outbreak

The 2009 swine flu outbreak is an epidemic that began in April 2009 with a new strain of influenza virus. The new strain is commonly called swine flu, but some authorities object to the name and it is also called Mexican flu, swine-origin influenza, North American influenza, and 2009 H1N1 flu. The outbreak is believed to have started in March 2009 and was classified as meeting the criteria for the World Health Organization pandemic Phase 5 status on 29 April. Local outbreaks of an influenza-like illness were first detected in three areas of Mexico, but the virus responsible was not clinically identified as a new strain until April 24, 2009. Following the identification, its presence was soon confirmed in various Mexican states and in Mexico City. Within days, isolated cases (and suspected cases) were identified elsewhere in Mexico, the U.S., and several other Northern Hemisphere countries.

By April 28, the new strain was confirmed to have spread to Spain, the United Kingdom, New Zealand, and Israel, and the virus was suspected in many other nations, with a total of over 3,000 candidate cases, prompting the World Health Organization (WHO) to change its pandemic alert phase to "Phase 5", which denotes "widespread human infection". Despite the scale of the alert, the WHO stated on April 29 that the majority of people infected with the virus have made a full recovery without need of medical attention or antiviral drugs.

The new strain is an apparent reassortment of four strains of influenza A virus subtype H1N1. Analysis at the United States Centers for Disease Control and Prevention (CDC) identified the four component strains as one endemic in humans, one endemic in birds, and two endemic in pigs (swine). One swine strain was widespread in the United States, the other in Eurasia.

In late April both the United Nations WHO and the U.S. CDC expressed serious concern about the situation, as it had the potential to become a flu pandemic due to the novelty of the influenza strain, its transmission from human to human, and the unusually high mortality rate in Mexico. On April 25, 2009, the WHO formally determined the situation to be a "public health emergency of international concern", with knowledge lacking in regard to "the clinical features, epidemiology, and virology of reported cases and the appropriate responses". Government health agencies around the world also expressed concerns over the outbreak and are monitoring the situation closely.

On April 24, 2009, Mexico's schools, universities, and all public events were closed until May 6, 2009. On April 27, 2009, a few schools in the U.S. closed due to confirmed cases in students. On April 29, 2009 18 more U.S. schools shut down as the disease became more widespread in the U.S.

Source: Swine Influenza Top News

Swine flu Outbreaks in humans

Outbreaks in humans - 1976 U.S. outbreak

On February 5, 1976, an army recruit at Fort Dix said he felt tired and weak. He died the next day and four of his fellow soldiers were later hospitalized. Two weeks after his death, health officials announced that swine flu was the cause of death and that this strain of flu appeared to be closely related to the strain involved in the 1918 flu pandemic. Alarmed public-health officials decided that action must be taken to head off another major pandemic, and they urged President Gerald Ford that every person in the U.S. be vaccinated for the disease.

However, the vaccination program was plagued by delays and public relations problems. But on Oct. 1, 1976, the immunization program began and by Oct. 11, approximately 40 million people, or about 24% of the population, had received swine flu immunizations. That same day, three senior citizens died soon after receiving their swine flu shots and there was a media outcry linking the deaths to the immunizations, despite not having any positive proof. According to science writer Patrick Di Justo, however, by the time the truth was known — that the deaths were not proven to be related to the vaccine — it was too late. "The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations." This became a strong setback to the program.

There were reports of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, affecting some people who had received swine flu immunizations. This syndrome is a rare side-effect of influenza vaccines, with an incidence of about one case per million vaccinations. As a result, Di Justo writes that "the public refused to trust a government-operated health program that killed old people and crippled young people." In total, less than 33 percent of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on Dec. 16.

Overall, about 500 cases of Guillain-Barré syndrome (GBS), resulting in death from severe pulmonary complications for 25 people, which, according to Dr. P. Haber, were probably caused by an immunopathological reaction to the 1976 vaccine. Other influenza vaccines have not been linked to GBS, though caution is advised for certain individuals, particularly those with a history of GBS. Still, as observed by a participant in the immunization program, the vaccine killed more Americans than the disease did.


Outbreaks in humans - 1988 swine flu outbreak

In September 1988, a swine flu virus killed one woman in Wisconsin, and infected at least hundreds of others. 32-year old Barbara Ann Wieners was eight months pregnant when she and her husband, Ed, became ill after visiting the hog barn at the Walworth County Fair. Barbara died eight days later, though doctors were able to induce labor and deliver a healthy daughter before she passed away. Her husband recovered from his symptoms.

Influenza-like illnesses were reportedly widespread among the pigs at the fair they had visited, and 76% of the swine exhibitors there tested positive for the swine flu antibody but no serious illnesses were detected among this group. Additional studies suggested between one and three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.


Outbreaks in humans - 2009 swine flu outbreak

The new strain of swine influenza A (H1N1) involved in the 2009 flu outbreak in humans is a reassortment of several strains of influenza A virus subtype H1N1 that are, separately, endemic in humans, endemic in birds, and endemic in swine. Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in United States pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. Viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, but there is no formal national surveillance system to determine what viruses are circulating in pigs in the United States. The origins of this new strain remain unknown.

The earliest known human case, 5 year old Edgar Hernandez, was near a pig farm in La Gloria, Veracruz state, Mexico, that raises almost 1 million pigs a year. Residents of La Gloria have long complained about the clouds of flies that are drawn to the so-called 'manure lagoons' created by such mega-farms. Edgar Hernandez was thought to be suffering from ordinary influenza but laboratory testing revealed he had contracted swine flu. The boy went on to make a full recovery.

"If the people who are supposed to be familiar with this didn't know what it was, how will we ever know how my son got it?" Edgar's mother, Hernandez said.

La Gloria, Perote, Veracruz is a small community, surrounded by large pig farms. Reports indicate that during February 2009 over 400 persons in the town had flu like symptoms and 2 infants died of 'pneumonia'.

Juan Rodriguez died of 'pneumonia' February 9th at age 7 months.

Yovanni Apolinar died of 'pneumonia' March 12th at age 2 months.

Unidentified mexican toddler contracted swine flu in Brownsville, Texas, United States and died of swine flu April 29th in Houston, Texas, United States at age 23 months.

The United States Department of Agriculture researchers say that while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.

Dr. Anne Schuchat, interim Deputy Director for CDC Science and Public Health, said that the American cases were found to be made up of genetic elements from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – "an unusually mongrelised mix of genetic sequences." Pigs have been shown to act as a potential "mixing vessel" in which reassortment can occur between flu viruses of several species. This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, presumably due to superinfection in an individual human. Influenza viruses readily undergo reassortment due to antigenic shift because their genome is split between eight pieces of RNA (see Orthomyxoviridae).

The current strain of swine flu can adapt to humans and spread more efficiently than previously known swine H1N1 strains. Moreover, co-infection of H1N1 swine flu and Oseltamivir resistant H1N1 season flu can lead to acquisition of the H274Y mutation by the swine flu via recombination or reassortment. Swine H1N1 with human H1 and N1 have been reported.

The 1918 flu pandemic strain had undergone polymorphism from swine and human H1N1 in all eight pieces of RNA gene segments. Similar swapping of gene segments in humans co-infected with seasonal human influenza and swine H1N1 can lead to rapid evolution.

The new strain of swine influenza A (H1N1) is currently listed by the United States and World Health Organization as a Stage 5 pandemic virus

Source: Swine Influenza Top News