World Health Assembly

In view of the threat posed by the current outbreak of new influenza A (H1N1), the Director-General of the World Health Organization convened a High-Level Consultation for all Member States at the start of the Sixty-second World Health Assembly.

The consultation provided an opportunity for Member States to share experiences, to discuss lessons learnt, and to highlight the challenges that now confront the world community. The list of main speakers and programme is given in the Annex. As at 18 May 2009, 40 countries have officially reported 8829 laboratory-confirmed cases of new influenza A (H1N1) infection.

Countries reporting the largest number of confirmed cases include:

• The United States of America 4714
• Mexico 3103
• Canada 496
• Japan 125
• Spain 103
• Great Britain and Northern Ireland 101

Together these six countries account for 97.9% of the total number of confirmed cases. A total of 74 new influenza A (H1N1) infection-related deaths have been reported from four countries :

• Mexico 68
• United States of America 4
• Canada 1
• Costa Rica 1

The majority of deaths have occurred in persons below 60 years of age. The virus is transmitted sufficiently easily from person-to-person to sustain institutional and community outbreaks and to spread regionally. Most cases of new influenza A (H1N1) infection seem to be mild and self-limited and do not require admission to hospital. However, severe illness and death have been reported in a small proportion of cases.

In seasonal influenza, the overwhelming majority of severe morbidity and mortality occur in persons of 65 years of age or more. However, with new influenza A (H1N1), a substantial proportion of the cases of severe illness and death has occurred among young and previously healthy adults.

In addition, severe illness and deaths have also been reported in adults with underlying medical conditions including: chronic lung or cardiovascular disease, diabetes, immunodeficiencies and obesity. Moreover, pregnant women may be at increased risk of complications from new influenza A. WHO.

China

China's Health Ministry on Tuesday confirmed a fourth case of swine flu on the Chinese mainland .Chinese state television (CCTV) broadcast video of the man, found in Southern China's Guangdong province.The 59-year-old man, with the last name of Yang, had earlier arrived in Hong Kong after travelling from the US on a flight via South Korea.

He then took a train to China's Guangdong Province. While on board the train, he showed symptoms of having contracted swine flu, including a fever, CCTV said.Yang was taken to a hospital in Guangdong, where he was quarantined. Health officials, speaking to CCTV, said that 80 percent of the people who had come into contact with him had been traced.

Meanwhile, in Shandong, CCTV said a patient, named Lu, who had been quarantined for one week showing symptoms of swine flu had been released. Officials and his family members celebrated his release from hospital, CCTV said.China has had seven cases of the virus, four on the mainland and three in its territory Hong Kong. None have become seriously ill. APTN.

New York City

Swine flu has become deadly.

The Queens assistant principal stricken with the now-deadly H1N1 virus succumbed to the illness late today, the first known fatality in the city from the disease, hospital officials said. Mitchell Wiener, 55, died at 6:17 p.m., just hours after his family optimistically told The Post his condition had stabilized. The somber news came as city officials ordered five more schools closed today in an attempt to stop the spread of the deadly virus - bringing the total number to 11 citywide that will be shuttered this week.

"We were treating him very aggressively," said Flushing Hospital spokesman Ole Pedersen. "He was in critical condition. His family was saying that he had not, in fact, deteriorated, which was true, but he was still extremely critical." Wiener is the sixth person in the US to die from the highly contagious disease. The assistant principal at IS 238 in Jamaica Estates first fell ill more than a week ago, but didn't seek help at the hospital until his symptoms became severe early Wednesday morning. Since that time, he had been in a medically induced coma and on a ventilator.

Just hours before his death, his wife, Bonnie, said there were hopeful signs. "There's no change," she told The Post earlier today. "He's stabilized. They're just giving him supporting care and hoping the treatment will kick in." The additional schools ordered closed today, all in Queens, are IS 158Q in Bayside, Our Lady of Lourdes, a private parochial school in Queens Village, and IS 25Q, World Journalism Preparatory School and PS 233Q, all of which share the same Flushing campus. "We think it will help stop transmissions throughout the city," the mayor said today.

Coy Jones, the mother of an 8-year-old girl at Our Lady of Lourdes, said, "I thought it was over a week or two ago, and now it's back worse than ever," The decision to close the schools was made after high numbers of students at each building reported flu-like symptoms.

At IS 158Q, 41 students out of a total population of 1,127 reported the symptoms, the Health Depart ment said. At the three- school IS 25Q complex, 27 felt sick out of a total of 825 students, and at Our Lady of Lourdes, 37 students were ill out of a total population of 424. "In my class, five people have been sick," said 14-year-old Ethan Kim, an eighth-grader at IS 158Q. "I know one class had over 20 people out. A lot of my friends' parents pulled their kids out."

Anne Marie Karcinski has a daughter at IS 25Q and a son at St. Francis Prep, site of the first known swine flu outbreak in the city. "This is the second time for us, to have to go through that," she said. The closures announced today will remain in effect for a minimum of five days. Six schools were already under closure before today: JHS 74Q in Bayside; PS 107Q in Flushing; IS 238Q in Jamaica; PS 16Q in Corona; IS 5Q in Elmhurst; IS 318K in Williamsburg, Brooklyn.

Health officials were at a loss to explain why the outbreaks have occurred overwhelmingly in Queens. "We could see similar activity in the other boroughs," said Dr. Scott Harper, an epidemiologist with the Health Department. "We just don't know." Harper urged parents with sick kids to keep them out of school until a full day without symptoms had gone by.

The mayor's handling of the swine flu crisis drew criticism today from city comptroller Bill Thompson, who's running for mayor. "We went from 'This is a crisis' to 'Don't pay attention' to 'OK, it's a crisis again,' " Thompson said. Additional reporting by Matthew Nestel.
joe.mollica@nypost.com

Malaysia second swine flu case

Malaysia on Saturday confirmed its second case of swine flu, a female student who was on the same flight as a 21-year-old man whom authorities a day earlier announced had tested positive. "Malaysia has a second case of the A(H1N1) influenza, which was confirmed by the Institute of Medical Research this morning," the health ministry's deputy director general Ramlee Rahmat told reporters. "She is a student.

She was on the same flight as the first case (and) she is a friend of the first case," he added. "She was admitted to the Penang hospital yesterday. She is in a stable condition and her fever has subsided." Ramlee said the student's family had been placed in home quarantine but were healthy. Five family members who live with the 21-year-old man, the first confirmed case Friday, were previously placed under home quarantine. Officials have urged people not to be alarmed amid fears that more people have been exposed to the disease. The government has urged all passengers who travelled on the same Malaysian Airlines flight as the two infected people to contact the ministry.

Ramlee said that there were 192 passengers and 15 crew members on Malaysian airlines flight MH091 from Newark in the United States to Kuala Lumpur that arrived on May 13. It was not a code-sharing flight (with Indonesian carrier Garuda) as announced Friday, he said. "We are prepared to handle an outbreak.

It is good that we have discovered the two cases," Ramlee said. Malaysian health authorities have installed 20 thermal scanners at the country's entry points to help detect possible cases of the virus. The latest WHO data showed 7,520 people in 34 countries were confirmed to have caught the A(H1N1) virus.

Tokyo and India

Japan confirmed its first three swine flu cases Saturday. The two teenage boys and a teacher arrived at Tokyo's Narita International Airport on a flight from Detroit after visiting Canada on a school trip, Health and Welfare Minister Yoichi Masuzoe said in a televised news conference. The three tested positive for swine flu at Japan's National Institute of Infectious Diseases. Forty-nine other passengers who returned to Japan on the same flight and sat near the patients have been taken to a facility near the airport, where they will be monitored for 10 days.

In India, health authorities isolated two men at a hospital in New Delhi after they arrived on separate flights from abroad. One of India's suspected cases arrived on a flight from London overnight while the other traveled from Texas on April 19. If confirmed they will be India's first cases of A(H1N1), the virus linked to swine flu, in a country of more than 1.1 billion people.

Meanwhile, in New Zealand the number of suspected cases there had dropped, the health ministry said, adding that there was no evidence of swine flu spreading in the country. New Zealand reported four confirmed cases after a school party returned from Mexico earlier this week on a flight from Los Angeles that landed in Auckland last Saturday. However, Radio New Zealand quoted the ministry's national coordinator for pandemic planning, Steve Brazier, as saying "no swine flu is circulating in the community at present, that we've seen."

Malaysia

Malaysia confirmed its first case of swine flu, a 21-year-old student who recently returned from the United States. A statement by the Health Ministry's director-general, Dr. Ismail Merican, said the young man was hospitalized on Thursdy after suffering from fever, sore throat and body aches. He had returned to Malaysia from the United States on Wednesday.

Tests confirmed that he was infected with the A(H1N1) virus, the statement said. He is receiving anti-viral treatment and is in stable condition, it said. Ismail said the ministryis in touch with his family members to ensure that he did not infect them, but they have not been placed under quarantine. He also urged all passengers on the Malaysia Airlines flight from Newark on Wednesday to contact the ministry. Ismail said the public has no reason to panic as his department was taki steps to protect public health.


Globally, 70 people have died of swine flu, 64 of them in Mexico where the virus originated. Four deaths have been reported in the U.S., one in Canada and one in Costa Rica. According to the World Health Organization, some 6,672 people in 33 countries are confirmed to be suffering from the disease. The WHO estimates that up to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn't be available for four to six months. The Jakarta Post.

The swine strains

Swine flus were first detected in the 1930s, but pigs have probably had their own strains for hundreds of years, said Greg Gray, director of the Center for Emerging Infectious Diseases at the University of Iowa College of Public Health.For a long time, swine flu was the suspected culprit in the 1918 Spanish flu pandemic that killed about 50 million people.

Scientists now blame a bird flu strain, which probably infected pigs and humans simultaneously, Gray said. The pandemics of 1957 and 1968 involved strains that contained a mixture of human and avian flu viruses. Experts theorize that pigs were the mixing vessel in those cases, "but there's no smoking gun to indicate that," Olsen said. Swine flu infected 200 people in 1976, including four soldiers at Ft. Dix, N.J., one of whom died.

The virus circulated for about a month, then vanished as mysteriously as it came, according to the U.S. Centers for Disease Control and Prevention in Atlanta. In 1988, a healthy 32-year-old women who visited a pig exhibit at a county fair came down with pneumonia and died eight days later. Epidemiologists tested the exhibitors and found that 76% of them had swine flu antibodies, a sign that their immune systems had tangled with the virus, according to the CDC.

The agency typically reports a case of swine flu in humans once every year or two. But from December 2005 to February 2009, it documented 12 U.S. cases. In the current outbreak, 20 people in the U.S. have contracted swine flu, along with six in Canada. Suspected cases have been reported in France, Spain, Israel and New Zealand. Mexico is hardest hit: The government there has confirmed 22 deaths in patients with the virus, and a total of 103 deaths and 1,614 infections may be linked to swine flu.

Experts don't know why the flu is more virulent south of the border. Perhaps the genetic code of the Mexican version is slightly different, Olsen said. "It can take as little as a single amino acid change to have a substantial difference in pathogenicity," he said. Mexicans may have had longer exposure to the virus, and patients there may also be more vulnerable to secondary infections, such as pneumonia.

• Cases go unreported

The World Health Organization estimates that swine flu is fatal in 1% to 4% of cases. But so many mild cases of infection go unreported that it's impossible to know its true virulence, experts said. In fact, it may not be all that rare. A 2007 study in the journal Emerging Infectious Diseases compared swine flu exposure in farmers, their spouses and a control group of university students, faculty and staff.

Compared with the control group, the farmers were 55 times more likely to have swine flu antibodies, and the spouses were 28 times more likely. "There are probably a lot of infections that are totally missed from the medical system," said Gray, who led the study. Scientists are using samples of the new swine flu strain to infect laboratory animals, including mice, guinea pigs, ferrets and primates. Researchers will test whether direct contact is necessary for transmission and whether small flu droplets can spread easily from cage to cage.

Those tests will provide clues about how easily the virus spreads and how deadly it is, Gray said. "We don't know what this virus will do," Osterholm said. "It could burn itself out in the next four to six weeks and we never see it again. It could burn itself out over a more extended period of time."But he said health officials can't ignore the chance that it could sputter out in the spring and reappear in late summer with a vengeance, as happened in 1918.

karen.kaplan@latimes.com

New Zealand

Three hotels have been earmarked by health officials as quarantine and treatment facilities as part of New Zealand's preparations to handle growing cases of swine flu. The hotels, near Auckland International Airport, were rolled into the action plan to combat the virus after officials had trouble finding somewhere to quarantine international visitors.

Last week a number of hotels refused to take visitors who needed to be quarantined after showing symptoms at the airport. A spokeswoman for the Auckland Regional Public Health Service said the three hotels came forward after reading of the refusal. The number of confirmed swine flu cases in New Zealand has grown to four.

Another 12 people are considered "probable" and a further 101 of having the virus. 388 people are in isolation. The Rangitoto College students who featured in headlines this week came free from isolation restrictions at 5am yesterday, as Lindisfarne and Hastings Girls High settled into quarantine. All 46 students and six teachers from the Hawke's Bay schools went into isolation after returning from a music trip in the United States on Tuesday.

Four students had showed flu-like symptoms. A New Zealander in Fiji who had travelled to Mexico is also being checked as a suspected swine flu carrier - one of two identified in the island nation. Health Minister Tony Ryall last night praised the hard work of health professionals working on the swine flu outbreak.

London

A SIX-year-old girl is one of two new British swine flu cases confirmed today, bringing the total number of victims to 15. The girl from Oxfordshire, who has recently returned from a holiday in Mexico, is said to be making ‘a good recovery at home’. A Merseyside man is the second swine flu victim confirmed today. He and his wife - one of the 13 people already diagnosed with the condition - had also been to Mexico recently.

The rise comes as the first known English human-to-human swine flu victim spoke out about his ordeal. Barry Greatorex, 43, is only the second Briton to have contracted the illness without travelling to Mexico, where it originated. It is thought he caught swine flu during a brief meeting with a female colleague who had recently been to the Central American country. Tulisa Contostavlos, 20, from north London, whose band feature on Tinchy Stryder’s chart-topping hit Number One, is in a Greek hospital undergoing test. The first Asian cases of swine flu have been confirmed in Hong Kong and South Korea.

Italy has also reported its first case, bringing the total number of affected countries to 17. More than 600 people in the UK are being tested for the illness. Related Links However, in Mexico, the country’s death toll from swine flu has been revised down from 176 to 101. Mr Greatorex, from Chipping Sodbury, near Bristol, told The Sun newspaper: “It has been pretty horrible. “I was in the garden at the weekend when I started feeling pains across the top of my chest and became short of breath.

“Over the next few days it grew worse and into a fever – but even though I told the doctor it was swine flu, he said it probably wasn’t. “Then they rang me on Thursday and told me I had tested positive. I haven’t been to Mexico so I was really shocked.”“My first thoughts were for my wife and son – I could never forgive myself if I passed it on to them.” Mr Greatorex and his wife Fran, 46, a childminder, have taken their son Jamie, 13, out of school as a precaution.

Fran Greatorex said: “I’m fearful for other people. I’ve been shopping at two supermarkets this week and we went to a family party on Saturday. “I hope I haven’t spread anything – but it’s not our fault because they told us earlier this week it was normal flu.” The UK’s Chief Medical Officer Liam Donaldson said: “As the WHO (World Health Organisation) has already said, it considers a pandemic to be imminent. We must all continue to be vigilant and try to reduce the spread of the virus.

“People have their part to play in controlling the spread of influenza. I would like to stress again that it is important for us all to practice good respiratory and hand hygiene.“The UK has been preparing for the possibility of a pandemic for a number of years and is among the most prepared countries in the world. “The NHS is ready to deal with a pandemic. Our plans are robust and advanced.” The first known British human-to-human swine flu victim was Scot Graeme Pacitti, 24, from Polmont, Falkirk. The other 13 Britons, who have contracted the illness, have all recently returned from Mexico.

There are now 12 confirmed cases of the virus in England and three in Scotland, according to the Department of Health. The Scottish Health Secretary Nicola Sturgeon said there were 19 other suspected cases and one probable in Scotland, “quite a significant reduction” from Friday. It also emerged today that the lead singer of chart-topping band N-Dubz has a suspected case of swine flu.

MEXICO

The swine flu virus is not as lethal as authorities originally thought, Mexico's health secretary said, though the disease continued to spread quickly and kill on Friday. Tests had confirmed 397 cases of Influenza A H1N1, or swine flu, in Mexico as of Friday night, up from 312 on Thursday night, Health Secretary José Córdova said. The number of deaths rose from 12 to 16.

In all, authorities had tested 908 people for the virus, he said."The attack rate is not as broad as was thought," Córdova told reporters, though he said it too early to say if Mexico was bringing the disease under control. He noted that China's 2002-2003 outbreak of severe acute respiratory syndrome, or SARS, lasted three months.

Of all people reporting to hospitals with acute respiratory disease, only about 1.2% were dying, he said. Mexico City, a metropolis of 20 million people, was strangely quiet on Friday after Mexican authorities ordered all schools, "non-essential" businesses and government agencies to close until Wednesday. The government is hoping the measure will reduce person-to-person contact that could spread the virus.

President Felipe Calderón on Wednesday urged people to stay in their homes. Along Mexico City's Tlalpan Viaduct Highway, stores were shuttered and sidewalks were empty. The mountains, often painted gray by smog, loomed large and green over the city's southern neighborhoods. "It's strange," said Laura Vera, 24, as she walked her dog. "It's like being in a small town all of a sudden, not a city." Mexico City Mayor Marcelo Ebrard said he was beginning to see glimmers of hope as authorities get better at identifying and treating the disease.

"The measures we have been taking are beginning to stabilize the situation," Ebrard said. Mexico City, neighboring Mexico State, and the northern state of San Luis Potosí continued to have the most cases, the federal Health Department said. There were signs of strain, however. On Friday morning, a riot broke out at Mexico City's Northern Prison after authorities canceled all visits at the prison because of the flu outbreak, the city government said. Relatives gathered outside set fire to a car, demanding they be let in. Guards quickly restored order inside the prison, but seven inmates were injured, the city government said. Riot police dispersed the crowds outside.

WHO

The World Health Organization announced on Saturday an increase in the number of confirmed cases of swine flu, but said there was no evidence of sustained community spread outside of North America, which would lead to raising the pandemic alert. “At the present time, I would still propose that a pandemic is imminent because we are seeing transmission to other countries,” Dr. Michael J. Ryan, the director of the World Health Organization global alert and response team, said in a teleconference on Saturday from Geneva. “We have to expect that Phase 6 will be reached. We have to hope that it is not.”

The organization said that 15 countries had reported a total of 615 cases of the infection, officially known as influenza A(H1N1), up from 367 cases late Friday. Dr. Ryan said that several countries in Europe reported additional confirmed cases on Saturday, including France, Germany, Spain, Great Britain, Israel, but he added: “There are a very small number of cases, it is very limited. At this stage it would be unwise to say that those events are out of control.” In the United States, the number of confirmed cases rose to 160 in 21 states, up from 141 cases in 19 states, the Centers for Disease Control and Prevention announced on Saturday morning.

But even as Mexico, believed to be the epicenter of the outbreak, found that a little more than half of its suspected cases subjected to detailed tests so far did not actually involve the virus and health officials there believed that the spread of the virus was stabilizing, officials in the United States were more cautious about saying the health risk had decreased. “Apparently the rate of infection is not as widespread as we might have thought,” José Ángel Córdova, Mexico’s health minister, said on Friday.

Of 908 suspected cases that were tested in Mexico, only 397 people turned out to have the virus, Mexican health officials reported on Friday. Of those, 16 people have died. Initially, Mexico had reported as many as 2,500 suspected cases, but the number of actual cases could turn out to be less than half the suspected number if further testing follows the same pattern as the original round. “I am encouraged by what I have heard fromt the reports from Mexico but I want to say that we are remaining vigilant,”

Dr. Anne Schuchat, the C.D.C.’s interim science and public health deputy director, said Saturday in a teleconference. “We have seen times where things appeared to be getting better but they got worse again,” Dr. Schuchat said, referring to the 2003 SARS outbreak in Canada. “In Mexico, we may be holding our breath for some time.” Dr. Javier Torres, the head of the infectious disease research unit at the Mexican Social Security Institute, Mexico’s main public health care system, said that he had been analyzing the past week’s influenza statistics. “The number of those exposed and infected has gone up, and the number of fatal cases has gone down,” he said. “We can be comfortable with those facts.”

Officials at the World Health Organization, declined to comment beyond saying that they would have to investigate details in Mexico further. “I’d be very pleased if this virus turned out to be weaker,” Dr. Ryan said. “These viruses are very unpredictable.” But a public health and infectious disease expert from Vanderbilt University, Dr. William Schaffner, said the test results were “going to change, I think in a substantial way, the image of this outbreak in Mexico.” If the outbreak is much smaller than initially thought, Dr. Schaffner said, “it would, I think, enable the world’s public health community to take a deep breath and continue to track the outbreak and reduce the tendency, as the W.H.O. has been doing, to notch up on its pandemic scale.”

If the testing also shows that the disease has caused fewer deaths than the approximately 170 suspected, he said, it might resolve a question that has been puzzling health experts: why did the disease appear to be so much more severe in Mexico than in the United States? In the United States, cases have been mild and there has been only one death, that of a 21-month-old child from Mexico who had traveled to Texas with his family.

In the United States, the number of hospitalizations as a result of the swine flu has increased to 13, up from 6 in recent days, the C.D.C. said on Saturday. Taking extreme precautions against the spread of the virus, hundreds of schools throughout the country have closed, some for a week or more. For communities that have closed schools in which some children have either exhibited flu-like symptoms or have confirmed cases of the swine flu, the centers recommended that the schools close for 14 days.