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Spread of Swine Flu in Japan Could Raise WHO Alert to Highest Level

But U.S. health officials say the disease is no more dangerous than regular flu

TUESDAY, May 19 (HealthDay News) -- The World Health Organization may declare a full-fledged swine flu pandemic in the coming days now that the virus has swept through Japan, a former WHO infectious disease adviser said.

Since rapid human-to-human transmission is now occurring in a region outside North America, where a majority of the almost 10,000 cases worldwide have occurred, the international agency may have to raise its pandemic alert to the highest level of 6, which hasn't happened since 1968, Bloomberg News reported Monday night.

"Japan is definitely having human-to-human transmission," Hitoshi Oshitani, who advised the agency during the SARS outbreak several years ago in Asia, said in a telephone interview with the news service. "The WHO will have to take the Japanese cases into consideration when deciding whether to raise the pandemic alert."

But many countries, including Britain, China and Japan, are urging the WHO to consider how deadly a virus might be -- not just the extent of its spread -- before declaring a pandemic, the Associated Press reported. Officials from these countries cited the potential economic impact of a swine flu pandemic declaration, as well as decisions that would need to be made regarding vaccination.

In the United States, while most cases of swine flu continue to be no worse than seasonal flu, the death rate from the new H1N1 virus is slightly higher than that seen with seasonal flu, U.S. health officials said Monday.

"Our best estimate right now is that the fatality [rate] is likely a little bit higher than seasonal influenza, but not necessarily substantially higher," Dr. Anne Schuchat, the U.S. Centers for Disease Control and Prevention's interim deputy director for science and public health program, said during an afternoon teleconference.

In addition, unlike seasonal flu, which typically strikes hardest at the very young and the elderly, the new H1N1 swine flu is largely affecting children, teens and young adults, with more hospitalizations of younger people, Schuchat said.

"The hospitalizations that we are tracking have this disproportionate occurrence among younger persons," she said. "That's very unusual to have so many people under 20 requiring hospitalization in some of those intensive-care units."

Schuchat added that the spread of the swine flu is far from over and could continue through the summer. "H1N1 is not going away, despite what you've heard," she said.

The heat and humidity of summer months are less conducive to the spread of influenza virus, Schuchat said. "This is certainly a possibility -- it's not something I can predict. Most years, the seasonal influenza strains have very reduced circulation in the summer months. Unfortunately, we don't know if we are going to get a break this summer with this [H1N1] virus."

On Sunday night, an assistant principal at a New York City public school became the sixth person in the United States to die from the disease that was first identified last month. On Monday, ABC News reported that New York City health officials announced the closure of three more school buildings for Tuesday, bringing the total number of schools closed due to swine flu to 16.

Health officials said Sunday that the assistant principal's death was not surprising, because even a normal flu season kills an estimated 36,000 Americans every year.

The assistant principal, Mitchell Wiener, who worked at an intermediate school in Queens, had a history of medical problems that might have left him vulnerable to complications from swine flu. His family said he had gout, but the condition was being controlled with medication, The New York Times reported.

New York City's health commissioner, Dr. Thomas R. Frieden, who was just selected Friday by President Barack Obama to lead the Centers for Disease Control and Prevention, said, "We are now seeing a rising tide of flu in many parts of New York City." But he added: "Nothing we've seen so far suggests that it [swine flu] is more dangerous to someone who gets it than the flu that comes every year. We should not forget that the flu that comes every year kills about 1,000 New Yorkers," the Times reported.

On Monday, the CDC was reporting 5,123 U.S. cases of swine flu in 48 states, and six deaths. For the most part, the infections continue to be mild and recovery is fairly quick.

The World Health Organization on Tuesday was reporting 9,830 diagnosed cases in 40 countries, including at least 79 deaths, mostly in Mexico, believed to be the source of the outbreak.

Testing has found that the swine flu virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza, according to the CDC.

The swine flu is a highly unusual mix of swine, bird and human flu viruses. Experts worry that, if the new flu virus mutates, people would have limited immunity to fight the infection.

The CDC is concerned with what will happen as this new virus moves into the Southern Hemisphere, where the flu season is about to start. The agency is also preparing for the virus' likely return in the fall to the Northern Hemisphere.

Meanwhile, the World Health Organization opened its annual meeting Monday in Geneva, Switzerland, with swine flu and the possibility of a vaccine dominating the agenda, the AP reported.

The WHO's director-general, Dr. Margaret Chan, was expected to review experts' recommendations on which companies should produce a vaccine, how much they should make and how it could best be distributed, the news service said.

One factor complicating a decision is that most flu vaccine companies can only make limited amounts of both seasonal flu vaccine and pandemic vaccine, such as that needed for swine flu, and not at the same time. The producers also can't make large quantities of both types of vaccine because that would exceed manufacturing capacity, the AP said.

Also Monday, health officials were examining new swine flu cases in Spain, Great Britain and especially Japan, where more than 130 people -- most of them teenagers -- have been infected, prompting the government to close 2,000 schools and cancel public events. Many of the new cases were transmitted in-country, meaning those infected had not traveled overseas recently, the AP said.

U.S. Human Cases of H1N1 Flu Infection
(As of May 18, 2009, 11:00 AM ET)
States # of
confirmed and
probable cases
61 cases
3 cases
476 cases
1 death
553 cases
56 cases
53 cases
65 cases
101 cases
24 cases
21 cases
8 cases
696 cases
81 cases
66 cases
34 cases
14 cases
57 cases
12 cases
34 cases
143 cases
158 cases
38 cases
3 cases
19 cases
4 cases
28 cases
30 cases
New Hampshire
19 cases
New Jersey
15 cases
New Mexico
68 cases
New York
254 cases
North Carolina
12 cases
North Dakota
3 cases
13 cases
32 cases
94 cases
56 cases
Rhode Island
8 cases
South Carolina
36 cases
South Dakota
4 cases
82 cases
556 cases
3 deaths
91 cases
1 cases
21 cases
294 cases
1 death
Washington, D.C.
13 cases
613 cases
5,123 cases
5 deaths
*includes the District of Columbia
**One case is resident of Ky. but hospitalized in Ga.

Source: U.S. Centers for Disease Control and Prevention

More information

For more on swine flu, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: May 18, 2009, teleconference with Anne Schuchat, M.D., Interim Deputy Director for Science and Public Health Program, U.S. Centers for Disease Control and Prevention; May 15, 2009, teleconference with Daniel Jernigan, M.D., Influenza Division, U.S. Centers for Disease Control and Prevention; Associated Press; The New York Times; ABC News

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