SWINE FLU INFECTIONS SPREAD

Swine flu infections spread to more locations across the United States and around the world, while the World Health Organization considered raising its pandemic threat alert level.

By Rob Stein
Washington Post Staff Writer
Thursday, April 30, 2009

The World Health Organization took the unprecedented step yesterday of warning that the world is probably on the verge of a pandemic, as new cases of swine flu mounted, the first death was reported in the United States and the dangerous virus appeared to arrive just outside the nation's capital.

The Geneva-based agency raised the alert level for the second time in three days, elevating it to one notch below a full-scale pandemic, after concluding that the virus was causing sustained outbreaks in the United States and Mexico.

The heightened alert is intended to prompt every nation to activate an emergency response plan, to spur pharmaceutical companies to increase production of antiviral drugs and help speed development of a vaccine, and to prod bankers to help poor countries afford measures to fight the virus, officials said.

The dramatic pronouncement came as officials in Maryland announced that they were investigating six probable cases of the disease -- three each in Baltimore and Anne Arundel counties -- and as at least 10 more were under investigation at the University of Delaware.

The first death from the disease in the United States came when a 22-month-old boy from Mexico City succumbed Monday at Texas Children's Hospital in Houston. The child, who had unspecified "underlying health problems," according to U.S. health officials, had taken a flight with his parents from Mexico City to Matamoros, Mexico, on April 4 to visit family in Brownsville, Tex.

After developing a fever April 8, the child was hospitalized in Brownsville and then, with his condition worsening, was transferred the next day to Houston.

State health officials were trying to determine when and where the boy became infected and how many people came into contact with him and his family, but they said no other relatives or anyone else had fallen ill.

"Texans need to know there is no cause for panic, and Texans can be assured that the state will take every necessary precaution to protect the lives of our citizens," said Gov. Rick Perry (R), as he issued a "disaster declaration" in response to the outbreak. Officials suspended high school sports events statewide until May 11 and shut more schools, sending more than 53,000 students home for at least two weeks.



President Obama offered his "thoughts and prayers and deepest condolences" to the toddler's family and to other victims and their loved ones. U.S. authorities are monitoring the spread of the virus carefully, he said, and he urged local authorities to report all suspected cases and close schools where infections are reported. Obama said people should wash their hands frequently, stay home from work or school if they are sick, and cover their mouths when coughing.

U.S. public health authorities have been worried that the virus would start producing the severe pneumonia and deaths that so far have been limited to Mexico, where the epidemic began. "The clinical picture in the United States is looking a bit more like the Mexican situation," said Nancy Cox, a flu expert at the Centers for Disease Control and Prevention.

The number of known cases in the United States hit at least 91, with infections confirmed in at least six new states -- Maine, Massachusetts, Michigan, Arizona, Indiana and Nevada -- more than doubling the number of states with confirmed cases. A Marine stationed in California also has a suspected case of swine flu.

The WHO's action came after the agency convened an unusual "global virtual science meeting" involving several hundred experts and officials to help assess the situation. The agency raised the alert from "phase 4" to "phase 5" two days after elevating it for the first time because the never-before-seen virus was spreading in Mexico.

Saying influenza viruses are "notorious for their rapid mutation and their unpredictable behavior," WHO Director General Margaret Chan told reporters: "This is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic."

The new alert level could prompt a variety of measures, including more intensive efforts to identify cases and stricter measures to prevent the illness's spread, such as discouraging or banning public gatherings.

With the virus now clearly being transmitted person-to-person in the United States, WHO officials said the outbreak appeared to be on a trajectory toward the highest alert level -- "phase 6" -- which is marked by sustained transmission in at least two regions of the world. That would mark the beginning of a pandemic -- a global spread of the virus.

"It's clear the virus is spreading, and we don't see any evidence of this slowing down at this point," said Keiji Fukuda, the WHO's interim assistant director general for health security and environment.

While there is a chance that the epidemic could stop on its own, officials said that such an outcome is impossible to predict and that governments around the world should plan for the worst.

"There may be a possibility that the virus will die out and stop, and that would be the best for us. But it can turn the other way. So the important point for us is to continue to maintain our vigilance and track its movement," Chan said. "Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world."

Asked whether the higher alert level will change the U.S. government's posture, Homeland Security Secretary Janet Napolitano said: "We have been preparing all along as if this is going to be a stage six. Our efforts have been to stay ahead of whatever number the WHO assigns."

So far, U.S. officials have referred 49 travelers with suspicious symptoms entering through border checkpoints to federal, state or local health officials. Eight cases remain under investigation, and the other 41 were negative, Napolitano said.

In addition to the new U.S. cases, infections were also confirmed for the first time in Austria and Germany, among people who recently returned from Mexico. Cases had previously been identified in Spain and Britain -- where three new cases were confirmed, bringing the total to five -- as well as in Israel, Canada and New Zealand. In France, where 30 possible cases are under investigation, the government announced that it will urge the 27-nation European Union to suspend all flights from member countries to Mexico.

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