GENEVA, April 28, 2009 — The World Health Organisation (WHO) raised its pandemic alert level over the deadly swine flu virus to phase 4 yesterday, indicating the infection could spread between humans to cause “community-level outbreaks”.
Experts held four hours of emergency talks on whether to raise the alert level from phase 3 due to the outbreak which has killed up to 149 people in Mexico and spread to the United States, Canada and Europe.
“This can be interpreted as a significant step towards pandemic influenza, but also it is a phase which says that we are not there yet,” acting WHO Assistant Director-General Keiji Fukuda told a teleconference.
“At this time, we think that we have taken a step in that direction but a pandemic is not considered inevitable at this time. The situation is fluid.”
The scale of alert levels goes from 1 to 6. The system was set at phase 3 in 2005 when WHO introduced it to monitor bird flu. The pandemic alert level has never before been raised.
In a statement, the Geneva-based United Nations agency said that “containment of the outbreak is not feasible. The current focus should be on mitigation measures”.
He said that of the confirmed human swine flu cases in Mexico, seven had come from patients who died and another 12 from people with severe respiratory disease.
The experts felt the overall picture “appeared consistent with sustained human-to-human transmission”.
More information was needed on this before considering whether to raise the alert level to phase 5, according to the American influenza expert.
Closing borders and imposing travel restrictions would not do any good at this point, he said.
“In an age of global travel, where people move around in airplanes so quickly, there is no region to which this virus could not spread,” Fukuda said.
“If we move into a pandemic situation, then by definition it means that all countries around the world would be at risk from pandemic influenza,” he said.
The WHO also said production of seasonal influenza vaccine should continue – particularly as the southern hemisphere is entering winter – but in the meantime it would concentrate on developing a vaccine from the new strain.
It would take 4-6 months to develop the vaccine and make the first batch available, and several more months to produce large quantities, according to Fukuda. — Reuters
NEW YORK, April 27 — Following are facts about Swine Flu that has just broken out in Mexico and the United States, creating fears of another pandemic.
Swine FluWhat is Swine Influenza?Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine 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 influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can re-assort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, 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.
Swine Flu in HumansCan 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 (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 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.
How common is swine flu infection in humans?In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the US, but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.
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.
Can people catch swine flu from eating pork?No. Swine influenza viruses are not transmitted by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.
How does swine flu spread?Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs 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 influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.
What do we know about human-to-human spread of swine flu?In September 1988, a previously healthy 32-year-old pregnant woman was hospitalised for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.
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 can human infections with swine influenza be diagnosed?To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.
What medications are available to treat swine flu infections in humans?There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.
What other examples of swine flu outbreaks are there?Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is 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 Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).
Is the H1N1 swine flu virus the same as human H1N1 viruses?No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.
Swine Flu in PigsHow does swine flu spread among pigs? Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.
What are signs of swine flu in pigs? Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.
How common is swine flu among pigs? H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 per cent of animals showing antibody evidence of infection. In the US studies have shown that 30 per cent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 per cent of pigs in the north-central US have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.
While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.
Is there a vaccine for swine flu? Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.
** NEW YORK, April 27 — On the cold afternoon of February 5, 1976, an Army recruit told his drill instructor at Fort Dix that he felt tired and weak but not sick enough to see military medics or skip a big training hike.
Within 24 hours, 19-year-old Pvt David Lewis of Ashley Falls, Massachusetts, was dead, killed by an influenza not seen since the plague of 1918-19, which took 500,000 American lives and 20 million worldwide.
Two weeks after the recruit’s death, health officials disclosed to America that something called “swine flu” had killed Lewis and hospitalised four of his fellow soldiers at the Army base in Burlington County.
The ominous name of the flu alone was enough to touch off civilian fear of an epidemic. And government doctors knew from tests hastily conducted at Dix after Lewis’ death that 500 soldiers had caught swine flu without falling ill.
Any flu able to reach that many people so fast was capable of becoming another worldwide plague, the doctors warned, raising these questions:
Does America mobilise for mass inoculations in time to have everybody ready for the next flu season? Or should the country wait to see if the new virus would, as they often do, get stronger to hit harder in the second year?
Thus was born what would become known to some medical historians as a fiasco and to others as perhaps the finest hour of America’s public health bureaucracy.
Only young Lewis died from the swine flu itself in 1976. But as the critics are quick to point out, hundreds of Americans were killed or seriously injured by the inoculation the government gave them to stave off the virus.
According to his sister-in-law, John Kent of President Avenue in Lawrence went to his grave in 1997 believing the shot from the government had killed his first wife, Mary, long before her time.
Among other critics are Arthur M. Silverstein, whose book, “Pure Politics and Impure Science,” suggests President Gerald Ford’s desire to win the office on his own, as well as the influence of America’s big drug manufacturers, figured into the decision to immunise all 220 million Americans.
Still, even the partisan who first branded Ford’s programme a fiasco, says now that it happened because America’s public health establishment identified what easily could have been a new plague and mobilised to beat it amazingly well.
To understand the fear of the time you have to know something about the plague American soldiers seemed to bring home with them after fighting in Europe during World War I.
The Great Plague, as it came to be called, rivalled the horrid Black Death of medieval times in its ability to strike suddenly and take lives swiftly. In addition to the half million in America, it killed 20 million people around the world.
It got its name because it was a brand of flu usually found in domestic pigs and wild swine. It was long thought to have come, like so many flus, out of the Chinese farm country, where people and domestic pigs live closely together.
Recent research has shown, however, that the post-WWI flu was brought to Europe by American troops who had been based in the South before they went to war. Medical detectives, still working on the case in the 1990s, determined that a small group of our soldiers took swine flu to Europe and that it spread to the world from there.
How the swine flu got to Fort Dix in 1976 still hasn’t been tracked down. At the time, Dix military doctors knew only that a killer flu had made it to the base and that they were lucky more men hadn’t died or been sickened seriously.
Weeks after Lewis died, doctors from the Centres for Disease Control and other federal public health officials were meeting in Washington, trying to decide if they should recommend the government start a costly programme of mass inoculations.
One doc later told the authors of “The Epidemic that Never Was” that he and others in on the meetings realised there was “nothing in this for the CDC except trouble,” especially because a decision had to be made fast to get the immunisations manufactured by the fall.
“...The obvious thing to do was immunise everybody,” the doctor said.
“But if we tried to do that ... we might have to interrupt a hell of a lot of work on other diseases.”
The doctors knew they faced complaints if the epidemic broke out and vaccines weren’t ready, as well as criticism if they spent millions inoculating people for a plague that didn’t happen.
“As for ‘another 1918,’ I didn't expect that,” the doctor continued in the book. “But who could be sure? It would wreck us. Yet, if there weren’t a pandemic, we’d be charged with wasting public money, crying wolf and causing all the inconvenience for nothing ... It was a no-win situation.”
By mid-March, CDC Director Dr David J. Sencer had lined up most of the medical establishment behind his plan to call on Ford to support a US$135 million (RM486 million) programme of mass inoculation.
On March 24, one day after a surprise loss to Ronald Reagan in the North Carolina Republican presidential primary, Ford decided to make the announcement to the American public.
Congress still had to appropriate the money, of course, and that wasn’t going to be easy. Even before official congressional consideration of the plan was taken up, there were forces arguing against it.
Another big hurdle was the drug makers, who were insisting the government take liability for any harmful side effects from the vaccine. During congressional hearings in the spring and early summer, lawmakers heard some naysayers who noted that the swine flu of last winter never got beyond Dix and that only one death had been reported.
The president and his experts prevailed, however, and on Aug 12 Congress put up the money to get the job done. The mighty task was put into the hands of a charismatic 33-year-old physician for the Department of Health, Education and Welfare, Dr W. Delano Meriwether, a world-class sprinter who still competed in track meets.
Now he was in a race for life, or so he thought. Meriwether was given until the end of the year to get all 220 million Americans inoculated against swine flu.
By Oct 1, the makers had the serums ready and America’s public health bureaucracy had lined up thousands of doctors, nurses and paramedics to give out the shots at medical centres, schools and firehouses across the nation.
Jim Florio, then an ambitious rookie Democratic congressman supporting Jimmy Carter for president, didn’t use the situation to take a shot at Ford. He lined up and was the first Jersey resident to take the inoculation.
Within days, however, several people who had taken the shot fell seriously ill. On Oct 12, three elderly people in the Pittsburgh area suffered heart attacks and died within hours of getting the shot, which led to suspension of the programme in Pennsylvania.
Jersey pressed on with inoculations, however. Through the fall, even as more bad reports about the side effects of the vaccine came out, thousands of mostly older people in Greater Trenton lined up outside health centres, schools and firehouses to get the shot, sometimes waiting for an hour.
One of them was Lawrence’s Mary Kent, a 45-year-old mother of two teenage boys who couldn’t tie the ribbons on Christmas presents only days after she got her shot at the Trenton War Memorial in early December.
On Dec 16, increasingly concerned about reports of the vaccine touching off neurological problems, especially rare Guillain-Barre syndrome, the government suspended the programme, having inoculated 40 million people for a flu that never came.
By year’s end, Jack Kent knew his wife was seriously ill and started reading all about the side effects of the president’s flu inoculation, especially nerve problems like those his wife was experiencing.
Even before Mary Kent died an invalid at age 51 in January 1982, Kent had joined the hundreds of Americans who filed suit against the government on behalf of children left without a parent due to fatal side effects from the swine flu vaccine.
Kent’s sister-in-law, also named Mary Kent, recalled the other day that Jack Kent died in 1997 still angrily blaming the government for giving his wife Guillian-Barre, leading to her death.
The swine flu case of 1976 forever reduced confidence in public health pronouncements from the government and helped foster cynicism about federal policy makers that continues to this day.
Citing the swine flu fiasco, for instance, one scholar recently authored a report suggesting the threat of AIDS has been similarly overblown.
Yet Joseph Califano, one of the earliest to use the word “fiasco” in describing the swine flu affair, came to the conclusion that it all couldn’t have been avoided. Califano, whom President Carter appointed Secretary of Health, Education and Welfare after beating Ford in the November election, said the doctors had no choice but to err on the side of the caution.
In “The Epidemic That Never Was,” Califano said that faced with the threat of another killer plague with the potential to end millions of lives, the doctors were right to seek an inoculation programme. — The Trentonian/
www.capitalcentury.com **
KUALA LUMPUR, April 27 — Malaysia has the vaccine for swine flu which can be used to stop the spread of the disease to this country.
Veterinary Services director-general Datuk Dr Abd Aziz Jamaluddin said the H1N1 vaccine should be injected into pigs as a preventive measure following reports of 81 people killed by the swine flu in Mexico.
He told Bernama that the department was only waiting for the directive from the health ministry to carry out vaccination on the livestock.
He believed that the H1N1 vaccine was also used by pig farms in other countries as a preventive measure against swine flu.
Dr Abd Aziz also disclosed that Health Minister Datuk Seri Liow Tiong Lai had issued a directive to all State Veterinary Services directors to monitor pig farms in their respective states as a precaution and to report on any sign of swine flu infection.
“Stern action will be taken against them if they fail to do this. They must also ensure that all the pig breeders follow instructions like their workers must wear masks,” he said.
Dr Abd Aziz said state livestock breeders’ associations were required to cooperate with the Veterinary Services Department by reporting on any symptom of swine flu.
“If their workers have similar symptoms for influenza, high fever, sore throat and body aches, they must be given leave and undergo medical examination immediately.”
Dr Abd Aziz said so far the department had not received any report of swine flu symptoms in the country, while the disease also had the potential of being spread to birds but the possibility was remote.
“Avian flu can spread through food like by eating chicken, swine flu cannot be spread by eating pork but through human contact,” he said.
More information on the swine flu can be obtained by calling 03-88810200 or 03-88810300, or by visiting website www.moh.gov.my. — Bernama
**
KUALA LUMPUR, April 27 — In light of the swine flu outbreak in Mexico, the Federation of Livestock Farmers’ Association of Malaysia (FLFAM) has strongly urged the government to stop pork imports until the situation is resolved.
FLFAM market development manager and veterinarian Dr Kaw Eng Sun today advised the government to temporarily stop importing any pig breeding stocks from the United States, Canada and Mexico along with any pork products from around the world including Vietnam and China.
“Under the circumstances, we should reduce or better still stop the import of pork products for the time being as the outbreak affects not just pork eaters but everyone else.
“We don’t import pork products from Latin America but we do import some from Vietnam and China. We might be importing breeding stocks from the Americas. We should stop this immediately.
“We also have more than enough locally-produced pork to satisfy the local market. Our pork have always been closely monitored by the Veterinary Department to ensure they are safe for consumption,” Dr Kaw told Bernama.
According to him, the swine-flu spreads faster than avian flu, having killed 81 people within a week whereas avian flu killed hundreds within months.
“Avian flu spreads quickly in rural areas where humans are infected by the birds themselves. However, swine flu spreads among humans as a result of virus mutation and it seems to hit urban areas,” said Dr Kaw who was quite puzzled by the epidemic’s speed.
From what he knows, he said those killed by the swine flu had been found with liquid in their lungs.
He suspects this to be the result of the human antibody and white cell reaction against the flu which roots in the human lungs.
“When our white cells and antibodies react to a virus or a foreign item in the body, they bring liquid along with them. Once the lungs have been filled with liquid, we will die as it cannot process air anymore. This could be the case here,” he contemplated.
As the flu’s vector is still human, Dr Kaw advised the government to also monitor closely people entering the country.
Malaysia Airports Holdings Berhad (MAHB) senior operations general manager Datuk Azmi Murad when contacted said MAHB was doing all it could to assist the government in preventing this virus from entering Malaysia.
“We have prepared a special docking bay for planes from high-risk departure points such as New York, Los Angeles and Mexico. The docking bay will be placed near the health examination points.
“We have also prepared a special waiting lounge for the planes’ passangers as well. And we have begun examining passangers from the high-risk areas this morning at 7.15,” Azmi said. — Bernama
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