Some end-of-the day (but not end-of-the-world) bits and pieces in the emerging swine flu story.
From Helen Branswell (Canadian Press):
In Mexico, Secretary of Health Jose Angel Cordova Villalobos said in a television interview that there have been 45 deaths, but only 16 of those were directly related to the flu in question.
An estimated 943 people are ill, the television report said.
The majority of the cases are occurring in young, previously healthy adults in their mid 20s to mid 40s, reports suggest. Experts aren?t certain if all of those people are sick with this virus or if other flu or respiratory viruses are also circulating and muddling the picture.
Schools were closed Friday in Mexico City, one of three areas of the country where cases have been reported.
Hartl said the WHO is sending staff to Mexico to help authorities there get a better handle on the scope of the problem.
“We?re extremely concerned because we?re looking at five different influenza events which may or may not be connected,” he said, referring to California, Texas and three possibly linked outbreaks in Mexico.
“But they are unusual events, either because of the time of the year that they happened and or because of the people that have been affected. This is a great concern to us and we have activated our strategic health operation centre which is a 24-hour around-the-clock command and control centre.” (Helen Branswell via Calgary Sun)
The number of people who are actual cases of swine flu in Mexico is yet to be determined. It is almost certain that many of the reported 943 cases are not swine flu, and of the specimens sent to laboratories in Canada and the US, half or less were determined to be that virus. On the other hand, there are definitely many swine flu cases in Mexico, some of the severely ill, and the unusual age distribution of young adults is a sign of infection with a new flu virus. There is ample room for serious worry. WHO is convening its expert panel under the International Health Regulations to determine if the pandemic threat level should be increased from phase 3 to phase 4. In our view, this isn’t even a close call. We are in phase 4 and if WHO doesn’t call it they risk being considered irrelevant and without credibility.
CDC, through an MMWR Dispatch (just issued), provides some additional details about the six additional US cases:
San Diego County, California. On April 9, an adolescent girl aged 16 years and her father aged 54 years went to a San Diego County clinic with acute respiratory illness. The youth had onset of illness on April 5. Her symptoms included fever, cough, headache, and rhinorrhea. The father had onset of illness on April 6 with symptoms that included fever, cough, and rhinorrhea. Both had self-limited illnesses and have recovered. The father had received seasonal influenza vaccine in October 2008; the daughter was unvaccinated. Respiratory specimens were obtained from both, tested in the San Diego County Health Department Laboratory, and found to be positive for influenza A using reverse transcription–polymerase chain reaction (RT-PCR), but could not be further subtyped. Two household contacts of the patients have reported recent mild acute respiratory illnesses; specimens have been collected from these household members for testing. One additional case, in a child residing in San Diego County, was identified on April 24; epidemiologic details regarding this case are pending.
Imperial County, California. A woman aged 41 years with an autoimmune illness who resided in Imperial County developed fever, headache, sore throat, diarrhea, vomiting, and myalgias on April 12. She was hospitalized on April 15. She recovered and was discharged on April 22. A respiratory specimen obtained April 16 was found to be influenza A positive by RT-PCR at the San Diego Country Health Department Laboratory, but could not be further subtyped. The woman had not been vaccinated against seasonal influenza viruses during the 2008–09 season. Three household contacts of the woman reported no recent respiratory illness.
Guadalupe County, Texas. Two adolescent boys aged 16 years who resided in Guadalupe County near San Antonio were tested for influenza and found to be positive for influenza A on April 15. The youths had become ill with acute respiratory symptoms on April 10 and April 14, respectively, and both had gone to an outpatient clinic for evaluation on April 15. Identification and tracking of the youths’ contacts is under way.
Five of the new cases were identified through diagnostic specimens collected by the health-care facility in which the patients were examined, based on clinical suspicion of influenza; information regarding the sixth case is pending. The positive specimens were sent to public health laboratories for further evaluation as part of routine influenza surveillance in the three counties. (CDC, MMWR Dispatch)
These case reports emphasize once again the relatively mild nature of the US cases. The only one hospitalized was immunosuppressed with an autoimmune disease (said elsewhere to be an autoimmune hepatitis). Only one of the eight had received a flu vaccination this year (the 54 year old father of the father – daughter household cases). It’s not possible to say whether the lack of vaccination has any bearing on risk. There is not enough data.
We will keep following this. We are not the only ones, of course. There is an army of flu bloggers on the net. If you go to one of the best, Crof’s H5N1 blog, you will also find an extensive international blog roll. Many of you are also in a position to hear or see things, so pass on any information you think has been missed.