World health officials urge governments to prepare for pandemic

WASHINGTON — The global threat from the swine flu outbreak reached its highest level yet on Wednesday as the World Health Organization urged government, business and health officials to start planning in earnest for a pandemic, which now appears unavoidable.

With 10 states now reporting confirmed swine flu infections, U.S. officials announced plans to move ahead with developing a vaccine for the influenza strain, which claimed its first U.S. fatality week.

By raising its pandemic alert to Phase 5 from Phase 4, the WHO is sending "a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short," according to the WHO Web site.

While it's unclear if the swine flu threat will emerge into a full-scale deadly pandemic, the outbreak reached Phase 4 on Monday when sustained person-to-person transmissions were confirmed. The Phase 5 designation — one short of the maximum — means that similar transmissions are occurring in at least two countries in the same WHO region. On Wednesday, Germany and Austria became the eighth and ninth countries to report confirmed cases.

"The biggest question is 'How severe will a pandemic be?'," asked Dr. Margaret Chan, the WHO director-general, in a press briefing from Geneva, Switzerland.

The answer is tricky, she said, because flu viruses are notorious for their rapid mutation and unpredictable behavior.

"We do not have all the answers right now, but we will get them," Chan said.

Influenza pandemics historically have struck about three times a century. About 40 million people died in the global flu outbreak of 1918-1919, but some 36,000 people die each year in the U.S. of seasonal flu.

Experience suggests that more affluent countries will see milder cases of the disease, while developing countries can expect more severe and deadly cases, said Dr. Keiji Fukuda, the acting WHO assistant director-general.

The swine flu virus — now also known as the 2009 H1N1 flu — is believed to have caused more than 150 deaths and sickened thousands of people in Mexico.

After infecting only 21 people in five states just four days ago, the virus has now infected 91 people in 10 states, the CDC reported Wednesday.

U.S. officials said the nation is in a "pre-pandemic" period, but Texas health officials say swine flu killed a 22-month-old boy from Mexico City earlier this week at a Houston-area hospital. Lab tests by the Centers for Disease Control and Prevention in Atlanta confirmed the cause of death.

The boy had flown with his family on April 4 from Mexico City to Matamoros, Mexico, to visit relatives in Brownsville, Texas, which is on the Texas-Mexico border. After developing a fever and other flu-like symptoms on April 8, the boy was admitted to a Brownsville hospital where he stayed several days before being transferred to the hospital near Houston where he died.

The boy wouldn't have been infectious on the commercial airline flight and none of his family members or close contacts have become ill, Texas health officials said. Citing privacy concerns and the lack of a public health threat, the boy's name and other details were not released.

President Barack Obama offered his "thoughts and prayers" to the boy's family and Dr. Richard Besser, the acting director of the CDC, said he, too, was moved by the child's death.

"This is quite sad news," Besser said Wednesday. "As a parent, as a pediatrician, I am moved by this and my heart goes out to the family."

Of the 92 confirmed cases nationally, 51 are in New York; 16 in Texas; 15 in California; two each in Massachusetts, Michigan and Kansas and one case in Arizona, Nevada, Indiana and Ohio.

"These numbers are almost out of date by the time I say them, given the activities going on around the country to look for cases and investigate them," Besser said.

The median age for U.S. flu victims is 22, but victims range in age from 8 to 81, Besser said. Roughly two of three confirmed cases involve people under 18.

A U.S. Marine lieutenant at the Marine Corps Air Ground Combat Center at Twentynine Palms, Calif., also has been infected with the swine flu virus, said Jim Lindley, public health director for San Bernardino County.

The unidentified soldier was diagnosed by base doctors with flu-like symptoms before CDC tests confirmed his infection. The soldier has been isolated and is receiving antiviral therapy, said U.S. Marine Commandant Gen. James Conway.

Nearly 40 other Marines the soldier came in contact with before he sought treatment are also being isolated and taking antiviral medication.

Millions of doses of the antiviral drugs, Tamiflu and Relenza, have been shipped to each state from the U.S. strategic national stockpile. Both drugs shorten the course of illness for influenza patients. Indiana and New York already have received their supplies, and all states should have theirs by May 3, Besser said. There's no shortage of the drugs.

"I want to make it clear. These drugs are effective in treating patients who have acquired the 2009 H1N1 flu virus," said Kathleen Sebelius, the new Secretary of Health and Human Services.

At U.S. borders, customs officials are looking for sick travelers and handing out advisories about flu symptoms and when to see a doctor. Those identified as sick are referred to medical help for evaluation.

With the exception of recommending that all non-essential travel to Mexico be curtailed, however, U.S. officials continue to keep the borders to and from Mexico open.

Besser said that restricting international travel is "not an effective way of identifying cases or preventing transmission. So we will continue to put our efforts in those things that we believe will have greatest impact of reducing the spread" of the virus.

On her first full day as HHS Secretary, Sebelius announced plans to move ahead with the development of a vaccine for the virus. The Food and Drug Administration and the CDC are already developing "virus reference strains," with the genetic information needed to develop a vaccine.

The strains, or "seed stocks" will be sent to manufacturers in a few months and vaccine production could begin some time this summer.

The HHS and FDA will monitor the manufacture of the vaccine and provide oversight to make sure the medication is safe and effective. The National Institutes of Health will oversee clinical trials to determine the appropriate dosage and formula. The actual vaccine could be ready for public use by fall.

"We've begun the process. We're in full gear and the process is more speedy than it has ever been before," Sebelius said. "We're committed to ensuring that these vaccines are safe."

Drug manufacturers are now producing vaccine for the annual seasonal flu and don't have the production capacity to manufacture both the swine and seasonal vaccines at the same time.

A coalition of groups known as Rx Response, which represents hospitals, drug manufacturers, pharmacies and pharmacists, have put themselves on "Alert Status" to address any problems that may arise in the pharmaceutical supply chain during the flu outbreak. The group provides a single source for state, local and federal authorities seeking information or assistance on drug-related issues.


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