WHO Raises Swine Flu Threat Level to Phase 5

The WHO on Wednesday signaled that a swine flu pandemic is imminent and raised its alert level to Phase 5, one level away from the full pandemic alert, AFP/Google.com reports. "All countries should immediately activate their pandemic preparedness plans," Margaret Chan, director general of the World Health Organization, announced at a news conference in Geneva (AFP/Google.com, 4/30). According to BBC News this includes "heightened surveillance and infection-control measures" (BBC News, 4/30). The New York Times writes, "Dr. Chan emphasized the need for calm, but at times spoke as if a pandemic had already begun, saying, for instance, 'WHO will be tracking the pandemic'" (Grady, New York Times, 4/30).

The Phase 5 designation represents recognition by the WHO that there is human-to-human spread of the virus into at least two countries in one WHO region. According to WHO, "While most countries will not be affected at this stage, the declaration of Phase 5 is 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" (WHO's Epidemic and Pandemic Alert and Response plan).

The decision to raise the alert level was based on the continuing spread of H1N1 or swine flu in the United States and Mexico, with increasing reports of people who have not had contact with recent travelers or visited places high rates of transmission might occur, such as schools or hospitals, according to the New York Times (New York Times, 4/30). The most recent update available on WHO's website says nine countries have reported a total of 148 cases, including 91 in the U.S. with one death and 26 in Mexico with seven deaths. WHO states, "The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5)" (WHO Swine Influence update 5, 4/29). According to Bloomberg, "A swine-flu patient in Spain who hadn't traveled to Mexico may signal a new front of the outbreak, potentially heralding the first influenza pandemic in 41 years" (Kresge/Randall, Bloomberg, 4/30).

WHO's announcement followed the first death from swine flu virus in the United States – a 2-year-old from Mexico who was visiting relatives in Texas (Maugh, Los Angeles Times, 4/30). The WHO does not recommend border closures or commerce or travel bans, the AFP/Google.com reports (AFP/Google.com, 4/30).

Chan expressed confidence that planning in response to the SARS outbreak in 2003 and the potential emergence of bird flu in 2004 had helped the world better prepare for an epidemic, the Los Angeles Times reports. "For the first time in history, we can check the evolution of a pandemic in real time," Chan said (Maugh, Los Angeles Times, 4/30).

Though Chan encouraged drug companies to increase their donations of antiviral drugs to the world's stocks in the face of an imminent pandemic (MacInnis/ Nebehay, Reuters, 4/29), she cautioned that it was too soon for manufacturers to stop making the seasonal flu vaccine in order to make vaccines to protect against the H1N1 virus, Reuters reports (MacInnis/Nebehay, Reuters, 4/29).

Mexico Shuts Down All Non-Essential Government, Business Activity

In growing fears over the spread of swine flu, the Mexican government on Wednesday ordered the suspension of all non-essential federal government and business activity, the Washington Post reports.

The Mexican Health Secretary Jose Cordova said that the WHO's decision to raise the pandemic alert to Phase 5 prompted the May 1-5 partial shutdown. All essential services, such as public transportation, supermarkets, trash collection and hospitals, will remain open. School had already been canceled until May 6.

The Washington Post writes that during a televised address, Mexican President Felipe Calderon encouraged the public to stay in their homes between May 1 and May 5. "There is no safer place to protect yourself against catching swine flu, than in your house," Calderon said (Stevenson/Selsky, Washington Post, 4/30).

Disease Burden In Some Developing Countries Could Worsen Potential for Swine Flu Spread

Health officials on Wednesday warned that people already battling other infections will be more vulnerable to the swine flu, Reuters reports.  While the swine flu outbreak currently pales in comparison to other global epidemics, such as HIV, TB, malaria, cholera and meningitis, experts worry that if the swine flu reaches the millions of people whose immune systems are already weakened by other diseases, the impact could be devastating.  "Many of the world's poorest people are particularly vulnerable to lethal airborne diseases," said Glenn Thomas of the Stop TB Partnership.

"With health budgets already stretched by the global economic downturn, WHO officials are appealing to governments to keep ensuring HIV and tuberculosis patients get the drugs they need to stay strong, and to improve access to medical care and testing facilities in poor areas," Reuters writes (MacInnis, Reuters, 4/29).  According to the New York Times, Chan yesterday "emphasized that developing countries tended to have more severe flu epidemics than rich ones, and said her organization and others would need to make special efforts to help poorer nations" (Grady, New York Times, 4/30).

While there have yet to be confirmed cases of swine flu in Africa, researchers fear that the continent may be unable to identify people with swine flu in time to prevent the spread of the virus because of the many diseases in the region that have similar symptoms, SciDev.Net reports.

''Many African countries have surveillance for epidemics, and some systems work well," said Lucille Blumberg, head of the Johannesburg-based Epidemiology and Surveillance at South Africa's National Institute for Communicable Diseases. The problem is, ''We are overwhelmed with tuberculosis, pneumonia and malaria, all of which present similar symptoms to swine flu'' (Scott/Balile/Twahirwa, SciDev.Net, 4/29).

IRIN on Thursday looked at antiviral drug supplies and general preparedness in southern Africa should there be a swine flu outbreak there (IRIN, 4/30).

Kaiser Family Foundation Global Health Gateway To Track Swine Flu Updates

On our new global health gateway, the Kaiser Family Foundation is monitoring and updating official WHO reports of swine flu cases and swine flu deaths.  In addition, new Global Health Policy Tracker will provide regular updates on what the U.S. government is doing to address the H1N1 virus including congressional hearings, actions by the Obama administration, and more.