US swine flu cases rise as feds call health emergency

Apr 26, 2009 (CIDRAP News) – Federal officials, speaking at a White House briefing on the swine influenza outbreak today, said the Department of Health and Human Services (HHS) is declaring a public health emergency, as the Centers for Disease Control and Prevention (CDC) confirmed 9 more human cases.

The new cases include 8 students from a New York City preparatory school, announced yesterday as suspected cases, and a patient from Ohio, the CDC said on its swine flu update Web page today. The Ohio Department of Health (OHD) said today that the Ohio patient is a 9-year-old who has a mild illness and is recovering at home. The new cases push the US total to 20 patients in five states.

The New York City Department of Health and Mental Hygiene said its investigation of illnesses at a Bronx daycare center so far shows no evidence of swine flu and that its surveillance system hasn't detected an increase in influenza-like illnesses in the city. Saint Francis Preparatory School, the Queens school where the 8 New York patients are students, announced on its Web site that the school will be closed Apr 27 and 28.

Calls for preparedness
John Brennan, the president's homeland security adviser, said an interagency body of federal officials is meeting daily to regularly update President Obama and to help coordinate the national response to the swine flu outbreak. He said Janet Napolitano, secretary of the Department of Homeland Security (DHS) is the lead federal official, according to the nation's pandemic influenza plan.

Despite the involvement of many federal agencies in disease response activities, Brennan said each American has a role to play. "Clearly we all have individual responsibilities, such as good hygiene, if you're feeling sick stay home, and using commonsense measures," he said.

Richard Besser, MD, acting CDC director, warned that the United States over time may see more severe disease emerge from the swine flu outbreak. "Viruses are unpredictable and variable over time. What we say and what we learn will change," he said.

In addition to frequent hand washing and staying home when sick, he advised people who are ill to avoid air travel and public transportation.

People should start thinking of their own personal preparedness, Besser said. "They need to think about what they would do if this ramps up in their community," he said. Closing schools if students are found to have swine flu is a smart decision, he said. "We view the public as partners."

Besser said the CDC will be releasing additional guidance later today to help communities and schools respond to additional cases. In addition, discussions are under way on the steps that would be needed to quickly produce a vaccine against this strain of swine flu.

At a separate news conference, Dr. Anne Schuchat of the CDC said developing and producing a specifically matched vaccine will take several months.

One possibility under discussion is to include a swine flu antigen in the next seasonal flu vaccine, noted Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. The new virus could replace one of the three strains in the vaccine, or it could even be added, resulting in a quadrivalent (four-strain) vaccine.

Federal response steps
Napolitano said the public health emergency declaration is a routine measure that allows the federal government to free up state and local personnel and resources to respond to the outbreak. She said it also allows the government to release to states 25% of the 50 million antiviral treatment courses in the Strategic National Stockpile. The Department of Defense will also preposition its 7-million course antiviral stockpile.

Napolitano said the US Department of Agriculture (USDA) is monitoring and testing the nation's food supply for swine flu–related issues. "Everything looks fine," she said, adding that the USDA is screening and testing livestock to monitor any developments.

US Customs and Border Patrol is ensuring that employees working at its border stations have enough personal protective equipment, and the department's agents are conducting passive surveillance among patients arriving from Mexico at US borders, Napolitano said.

Passengers are being asked if they're sick, and those that report illness are referred for further screening. Similar measures have been implemented at the Transportation Security Administration.

At a separate CDC news briefing this afternoon, the CDC's Schuchat said the agency is preparing "yellow cards" to give to travelers at airports. The cards will contain information about signs and symptoms suggesting possible swine flu.

Unpredictability stressed
Schuchat stressed the unpredictability and fluidity of the swine flu situation. "We do think this virus is spreading from person to person, and we're taking steps aggressively to try to slow the spread," she said. "We are expecting things to change, and we want you to expect change as well."

In response to questions, she said it is "premature" to conclude that the disease in Mexico is different from the one in the United States, even though Mexico has had a number of deaths. "We don't have many infected people, and we don't have great information yet," she said. Though the United States has had no deaths attributed to the virus yet, "I do fear that we will have deaths here," she added.

In response to a question, Schuchat said the CDC believes that "person to person to person" (tertiary) transmission is going on. But the agency has not yet estimated how many additional cases can be expected to result from each case.

She said some of the US cases have involved US residents who traveled to Mexico, but she wasn't sure how many. The two case-patients in Kansas are a married couple, one of whom got sick after a trip to Mexico, and the spouse became ill 2 days later.

In reiterating CDC advice about self-protective steps people can take, Schuchat said, "If you're having symptoms after a trip to Mexico, that's a good time to go to the doctor and get tested." Symptoms that may suggest swine flu include a high fever, muscle aches, cough, sore throat, and possibly vomiting and diarrhea—though these could indicate many other possibilities as well, she noted.

She repeated earlier CDC assessments that the H1N1 strain in the seasonal flu vaccine is unlikely to offer protection against the new swine H1N1 strain. From the latest tests, "it doesn't look like there are cross-reacting antibodies from seasonal H1N1 to this particular strain," she said.

Commenting on the age distribution of swine flu cases, Schuchat said US patients range from about 7 years to 54 years. In Mexico, "What we know so far is that many of the patients are in their 20s, 30s, and 40s, but we're still lining up information about which have an illness actually caused by this virus." Tests have shown that some of the sick people in Mexico actually had a seasonal flu virus, she said.

Though it appears there have been few if any swine flu cases in older people, "It's really too soon for us to conclude that older persons are spared," Schuchat said.

International developments
Elsewhere, two Canadian provinces today reported a total of 6 confirmed swine flu cases, according to reports from Canwest News Service and Reuters. Nova Scotia health officials said that 2 of its 4 confirmed cases were students attending the same private school who recently visited Mexico. Robert Strang, Nova Scotia's chief public health officer, said the patients' illnesses were mild.

In British Columbia, a spokesman for the province's Centre for Disease Control told Reuters today that officials have confirmed 2 cases.

Israel's health ministry today reported its first swine flu case, in a man who had recently traveled to Mexico and returned with influenza symptoms, Kuwait News Agency (KUNA) reported. He is hospitalized and is in isolation, the report said.

According to media reports, health authorities in several countries, including France, Spain, and New Zealand, are testing several travelers who reported flu-like symptoms after traveling to Mexico.

Mexican officials have closed schools through May 6, though many schools were closed anyway during the lead-up to the Cinco de Mayo holiday. The US Embassy in Mexico City has suspended all visa and nonessential citizen services from Apr 27 until Apr 30 as a precautionary measure to protect clients and staff, according to an Apr 25 State Department warden message.

See also:

Apr 26 NYC Department of Health press release

Saint Francis Preparatory school Web site

Apr 26 Ohio Department of Health press release

Apr 25 State Department warden message

CDC swine flu investigation page

CDC swine flu information

This week's top reads