New U.S. swine flu cases spread pandemic fears

http://www.msnbc.msn.com/id/30398682

New U.S. swine flu cases spread pandemic fears
2 cases found in Kansas and 8 more likely in NYC
April 25, 2009

At least two cases of the human swine influenza have been confirmed in Kansas and one more in California, bringing the U.S. total to 11 and stoking fears that the virus could trigger a pandemic.

At least eight students at a New York City high school probably have swine flu, but health officials said Saturday they don’t know whether they have the same strain of the virus that has killed scores of people in Mexico.

A strain of the flu has killed as many as 81 people and sickened more than 1,300 across Mexico. The World Health Organization chief said Saturday the strain has “pandemic potential” and it may be too late to contain a sudden outbreak.

Kansas health officials said Saturday they had confirmed swine flu in a married couple living in the central part of the state after the husband visited Mexico. The couple, who live in Dickinson County, were not hospitalized, and the state described their illnesses as mild.

Dr. Jason Eberhart-Phillips, the state health officer, said, “Fortunately, the man and woman understand the gravity of the situation and are very willing to isolate themselves.”

The man traveled to Mexico last week for a professional conference and became ill after he returned home. His wife became ill later. Their doctor suspected swine flu, but it wasn’t confirmed until flu specimens were flown to the federal Centers for Disease Control and Prevention in Atlanta.

NBC News has also learned there are suspected cases in Minnesota.

Puzzling differences across border

Swine flu is a respiratory disease of pigs caused by type A flu viruses. Human cases of swine flu are uncommon but can happen in people who are around pigs and can be spread from person to person. Symptoms of the flu include a fever of more than 100 degrees, body aches, coughing, a sore throat, respiratory congestion and, in some cases, vomiting and diarrhea.

Health officials are puzzled over why the swine flu engulfing Mexico been deadly there, but not in the United States?

Nearly all those who died in Mexico were between 20 and 40 years old, and they died of severe pneumonia from a flu-like illness believed caused by a unique swine flu virus.

The 11 U.S. victims cover a wider age range, as young as 9 to over 50. All those people either recovered or are recovering; at least two were hospitalized.

"So far we have been quite fortunate," said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention on Saturday, just hours before three new U.S. cases were confirmed.

Still, it may be too late to contain the sudden outbreak, warned the CDC, which has stepped up surveillance across the United States. "We are worried," Schuchat said.

“We don’t think we can contain the spread of this virus,” said Schuchat, interim deputy director for the Science and Public Health Program. “We are likely to find it in many other places.”

Health experts worry about a flu that kills healthy young adults — a hallmark of the worst global flu epidemics. Deaths from most ordinary flu outbreaks occur among the very young and very old.

They are also concerned because people appear to have no immunity to the virus, a combination of bird, swine and human influenzas. Also, the virus presents itself like other swine flus, but none of the U.S. cases appears to involve direct contact with pigs, said Eberhart-Phillips, who called the strain “a completely novel virus.”

“It appears to be able to transmit easily between humans,” Eberhart-Phillips said. “It’s something that could potentially become very big, and we’re only seeing, potentially, the very beginning of a widespread outbreak.”

Specialty drug maker Baxter International Inc. is working with the World Health Organization to develop a vaccine.

New York health officials said more than 100 students at the private St. Francis Preparatory School, in Queens, had come down with a fever, sore throat and other aches and pains in the past few days. Some of their relatives also have been ill.

New York City Health Commissioner Thomas Frieden said nose and throat swabs had confirmed that eight students had a non-human strain of influenza type A, indicating probable cases of swine flu, but the exact subtypes were still unknown.

Samples had been sent to the CDC for more testing. Results were expected Sunday.

Parent Elaine Caporaso’s 18-year-old son Eddie, a senior at the school, had a fever and cough and went to a hospital where a screening center had been set up.

“I don’t know if there is an incubation period, if I am contaminated,” Caporaso told the Daily News. “I don’t want my family to get sick, and I don’t want to get anybody else sick.”

The symptoms in the New York cases have all been mild, Frieden said, but the illnesses have caused concern because of the deadly outbreak in Mexico.

Frieden said that if the CDC confirms that the students have swine flu, he will likely recommend that St. Francis Preparatory remain closed on Monday “out of an abundance of caution.”

“You could say, 'All you’ve got is a lot of kids with mild illness. Why close a school?”’ Frieden said.

One factor, he said, is that the illness appears to be moving efficiently from person to person, affecting as many as 100 to 200 people in a student body of 2,700.

“We’re very concerned about what may happen,” he said, although he noted that the pattern of illness appeared different from in Mexico, where much larger groups of people have become much sicker. Overall, flu cases have been declining in the city in recent weeks, he said.

“If we were to see, as they have in Mexico City, a large number of people becoming seriously ill with flu, that would be a very different situation from what we have now,” he said.

New York Gov. David Paterson on Saturday directed the state Department of Health to mobilize its infectious-diseases, epidemiology and disaster preparedness workers to monitor and respond to possible cases of the flu. He said 1,500 treatment courses of the antiviral drug Tamiflu had been sent to New York City.

The city health department has asked doctors to be extra vigilant in the coming days and test any patients who have flu-like symptoms and have traveled recently to California, Texas or Mexico.

Investigators also were testing children who fell ill at a day care center in the Bronx, Frieden said. And two families in Manhattan had contacted the city, saying they had recently returned ill from Mexico with flu-like symptoms.

Frieden said New Yorkers having trouble breathing due to an undiagnosed respiratory illness should seek treatment but shouldn’t become overly alarmed. Medical facilities in the part of Queens near St. Francis Prep, he said, had already been flooded with people overreacting to the outbreak.

Texas school closing

The Texas health department announced Saturday that Byron Steele High School in Cibolo, near San Antonio, will temporarily close as local health and school officials work to keep the virus from spreading.

Swine flu was confirmed earlier this month in two students from the school, and a third student is listed as a probable case with confirmatory lab test results pending. The original two have recovered, and the third is recovering.

"The purpose is to reduce the risk to students, staff and the community," said Sandra Guerra, M.D., the public health authority for Guadalupe County, Texas.

Past flu pandemics

1918:

The Spanish flu pandemic that started in 1918 was possibly the deadliest outbreak of all time. It was first identified in the U.S., but became known as the Spanish flu because it received more media attention in Spain than in other countries, which were censoring the press during World War I. The 1918 flu was an H1N1 strain — different from the one currently affecting Mexico and the U.S. — and struck mostly healthy young adults. Experts estimate it killed about 40 to 50 million people worldwide.

1957:

The 1957 pandemic was known as the Asian flu. It was sparked by an H2N2 strain and was first identified in China. There were two waves of illness during this pandemic; the first wave mostly hit children while the second mostly affected the elderly. It caused about 2 million deaths globally.

1957:

The most recent pandemic, known as the Hong Kong flu, was the mildest of the three pandemics this century. It was first spotted in Hong Kong in 1968 and it spread globally over the next two years. The people most susceptible to the virus were the elderly. About 1 million people are estimated to have been killed by this pandemic, an H3N2 flu strain.