25 April 2009

Saturday, 11pm

CDC Confirms Two Swine Flu H1N1 cases in Kansas and WHO Chief Dr. Chan Declares Swine Flu Outbreak in Mexico and USA a “Public Health Emergency of International Concern” per the International Health Regulations (IHR)

Updates on the ongoing rapidly evolving outbreak of swine influenza A (H1N1) infecting humans in at least three US states and parts of Mexico = include:

= I.&n= bsp; = ; Today the US CDC reported on their website late t= oday that there are now 11 lab-confirmed cases in the USA: 2 in Kansas, 2 in Texas, and 7 i= n California. None= of these 11 persons have died, and only 2 have required hospitalization. The 7= ^th patient confirmed in Californ= ia was reported today.

= II.&= nbsp; &nbs= p; Today the Director of the New York City Health Department, Dr. Thomas Freide= n, gave a televised press conference at approximately 4:15pm (seen on CNN) that reported 8 stu= dents at a high school in the Queens borough of NY City had positive lab tests for an Influenza A virus that he suspected could be the same swine flu virus repor= ted from California, Texas, and Mexico; however, lab-confirmation is pending the results of definitive tests at CDC. None of these 8 persons suspected to have swine flu have required hospitalization.

= III.= &nb= sp; Today the World Health Organization (WHO) Director-General, Dr. Margaret Chan, officially declared this swine influen= za A (H1N1) a “Public Health Emergency of International Concern” (PHEIC). This specific term is described in the recent International Health Regulations (IHR 2005), a legally binding document signed by 194 nations th= at went into effect 15 June 2007. The IHR (2005) document is posted on the WHO website. Annex 2 on page 42 of this document addresses the decision process= as to when an event must be reported to the WHO as a potential PHEIC, under Ar= ticle 6 of the IHR. As of today, this declaration specifically means that nations= are to increase their surveillance for this novel swine influenza, according to= the WHO.

= IV.&= nbsp; &nbs= p; Today the WHO’s Expert Advisory Committee m= et and decided not to change the pandemic alert level (currently at level 3), although this decision could change in the near future as more data becomes available day-by-day on the situation with this novel influenza virus.=

= V.&n= bsp; = ; The gene sequences of this novel virus were made public and can be found, along with multiple other useful documents and updates, on the WHO swine influenza website.

= VI.&= nbsp; &nbs= p; Photos appeared online today and on the front pag= e of the New York Times showing persons of the general population in Mexico City weari= ng masks. (To this author such photos were similar to those in Hong Kong during SARS in 2003 and were quite understandable in both situations). Very important “lessons learned” are and will cont= inue to be offered by the response to this outbreak in Mexico and the several US states already involved with case investigations.

= VII.= &nb= sp; Neither the WHO nor US CDC issued any travel restrictions today.

= VIII. &n= bsp; An increasing number of persons were reported to = have been hospitalized in Mexico today for possible swine influenza. Ongoing lab tests and epidemiologic assessments are being carried out. A more accurate case fatality rate (CFR) can be determined through these assessme= nts. Efforts to limit spread of the virus continue to be taken by the Mexican Government. These include, but are not limited to keeping schools, offices,= and museums closed. Public gatherings are being minimized.

Additional data are expected tomorrow, such as the resul= ts of the CDC lab tests on the 8 high school students in New York City with an as-yet unidentified Influenza A virus infection, as well as updates from Mexico, Kansas, Texas, and California.

Follow-up to the WHO’s Director General Dr. Margar= et Chan’s declaration of this swine influenza A (H1H1) outbreak as a “Public Health Event of International Concern (PHEIC) under the Inter= national Health Regulations (IHR) is also anticipated.

Daniel R. Lucey, MD, MPH

EROne Institutes, Department of Emergency Medicine<= /o:p>

Was= hington Hospital Center=

Adjunct Professor of Microbiology and Immunology

Geo= rgetown University Medical Center, Washington, D.C= .=

Website for this posting: www.BePast.org (requires Internet Explorer)

DRL23@Columbus.rr.com