SWINE FLU

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W.H.O. May Raise Alert Level as Swine Flu Cases Leap in Japan

http://www.nytimes.com/2009/05/19/world/asia/19flu.html?ref=global-home
By DONALD G. McNEIL Jr.
Published: May 18, 2009

The number of swine flu cases in Japan soared over the weekend, raising the likelihood that the World Health Organization will soon have to raise its pandemic alert level to 6, the highest level.

On Sunday, the assistant principal of a school in Queens died after being hospitalized with swine flu. It was the sixth flu-related death in the United States and the first in New York State.

In Japan, authorities ordered more than 1,000 schools and kindergartens in and near the cities of Kobe and Osaka to shut down. There were no confirmed cases in Tokyo.

Until Friday, Japan thought it had contained the virus after finding four infected people who had visited North America and flown home. It quarantined them and 50 other passengers, began sending medical workers to meet each flight arriving from North America to take temperatures of those on board and told visitors they would need to have their temperatures recorded daily.

But on Saturday, the authorities confirmed that a 17-year-old student in Kobe who had not been overseas was infected; as of Monday afternoon, there were at least 125 recorded cases throughout Japan.

Kobe residents rushed to hospitals, where doctors in biohazard suits checked people for fever in tents set up in parking lots, Agence France-Presse reported. Transit workers and supermarket employees began wearing masks.

Japanese Prime Minister Taro Aso recorded a video message for broadcast on television calling for calm while urging people to wash their hands, gargle and wear face masks to help prevent the spread of the disease.

"Experts say that if you receive timely treatment, this new flu is not something to be afraid of," Mr. Aso said in the message, Reuters reported.

In Geneva, where health ministers from around the world began an annual meeting of the World Health Assembly on Monday, discussions on preparations for a possible flu pandemic topped the agenda. Health officials said they were monitoring the situation in Japan, but it was not yet clear whether they would raise the pandemic threat level.

In their opening sessions, the ministers agreed to shorten the event to a week from an original 10 days to allow health ministers to return home sooner. The organization’s director-general, Margaret Chan, and the United Nations secretary-general, Ban Ki-moon, will meet top pharmaceutical executives on Tuesday to discuss their ability to make vaccines to fight the strain.

Japan is well known in public health circles for being exceptionally nervous about flu; it has an aging population and a national obsession with cleanliness that makes even Switzerland look messy.

Masks are common on subways because it is considered rude to lack one if you are sneezing. Before the outbreak began last month, Japan used about 60 percent of the world’s stock of the antiviral drug Tamiflu.

If the World Health Organization finds sustained community transmission — that is, infections between people with no connections to travel from North America — it will presumably raise its pandemic alert level to 6, because Japan is outside the W.H.O. Americas region.

The alerts, by definition, measure a new virus’s spread, not its lethality. The lethality can vary from country to country, depending on viral mutations, how prepared each country is, what other diseases its population has, and other factors.

Turkey, India and Chile also reported their first swine flu cases over the weekend.

The patient in Turkey was an American heading to Iraq. India’s case was that of a 23-year-old who arrived in Hyderabad from New York. Chilean officials reported that two of its citizens — two women, 25 and 32 years old — were found to have the flu after returning from a trip to the Dominican Republic.

Late Sunday night, Hong Kong confirmed its third case of swine flu, a 23-year-old man from southern China who had been studying in the United States. He arrived in Hong Kong on Saturday evening on Cathay Pacific Flight 831 from New York.

A spokesman for the Hong Kong health department said the man developed a fever during the flight and was spotted by a thermal scanner at the airport when he left the plane. Authorities put him in an isolation ward at Princess Margaret Hospital and issued a call for other passengers on the flight to report for testing. As of Sunday night, the spokesman said, 22 passengers and a crew member had been quarantined at a camp in rural Hong Kong.

Hong Kong’s first case of flu, on May 1, resulted in the quarantine of hundreds of travelers and hotel guests. The second case occurred last week.

Mark McDonald contributed reporting from Hong Kong and Sharon Otterman from New York.