In an effort to provide some non-MSM info on this virus, here is the latest update from ProMED.  If there's anything I can clarify, please let me know! 

FYI - I have a teenage daughter at home with a fever, sore throat, headache and body aches, and I am not panicking, but I'm hoping I didn't just jinx my household by typing that!

INFLUENZA A (H1N1) - WORLDWIDE (03)

***********************************

A ProMED-mail post

ProMED-mail is a program of the

In this update:

[1] More on origin

[2] NYC school outbreak

[3] Outbreak history

[4] WHO - update 7

******

[1] More on origin

Date: Wed 29 Apr 2009

Interview with Ruben Donis

--------------------------

Virologist Ruben Donis, chief of the molecular virology and vaccines

branch at the US Centers for Disease Control and Prevention [CDC],

spoke with Science Insider at length last night [28 Apr 2009] about

the swine flu virus causing the current outbreak. CDC's early

analyses raise several provocative possibilities. The stage appears

to have been set for this human outbreak by an outbreak over the past

decade of flu viruses in swine that combine strains from several

species. The 1st infected human may not even have been in North

America, let alone Mexico. Patient samples from Mexico taken over the

past several months reveal that this swine flu clearly exploded in

late March [2009], suggesting that it was not rapidly spreading in

that country, undetected, for very long.

Donis discussed the genetics of the virus -- the clues in this

mystery -- in detail. These include several of its 8 genes, which

code for surface proteins hemagglutinin (H) and neuraminidase (N),

the matrix that surrounds the nucleus, the nucleoprotein itself, and

3 polymerase enzymes called PA, PB1, and PB2.

We know it's quite similar to viruses that were circulating in the

United States and are still circulating in the United States and that

are self-limiting, and they usually only are found in Midwestern

states where there is swine farming. There's only one well-documented

case where the infection spread from one human to another. What we

know is that it is not common that there is sustained transmission in

people. Hemagglutinin, neuraminidase, and matrix, the 3 genes that

have the most public health interest, were sequenced, and then the

whole genome was completed. There similarities of about 94 percent in

the hemagglutinin [H] to the nearest strain we know. It's almost

equidistant to swine viruses from the United States and Eurasia. And

it's a lonely branch there. It doesn't have any close relatives.

The neuraminidase gene has close relatives in Asia. It's also swine.

The matrix gene same as neuraminidase.

For the avian and human sequences we have to step back 10 years to

1998, actually. Chris Olsen is one of the first that saw it, and we

saw the same in a virus from Nebraska and Richard Webby and Robert

Webster in Memphis saw it, too. There were unprecedented outbreaks of

influenza in the swine population. It was an H3 virus. The disease

was not very severe in healthy pigs. Everyone was very curious about

these H3 viruses. Since 1918, normally it's only H1N1 in swine. Then

all of a sudden there's H3N2 in swine in the Midwestern US. When

people analyzed what was inside those viruses, they realized there

were 3 different things. The PB1 gene, that was human. H3 and N2 also

were human. The PA and PB2, the 2 polymerase genes, were of avian

flu. The rest were typical North American swine viruses. Those

strains were the so-called triple reassortants.

The reality is good molecular surveillance in the pigs started in the

1970s. So if there were strains that were not very dominant between

the 1930s and the '70s, we wouldn't have detected them. This triple

reassortant was very successful and took over and dominated the

picture-to the point where the classical H1N1 was almost extinct. H3

was a different subtype, so there was no immunity in the pigs. It was

probably that they had new polymerase genes, too. The neuraminidase

and the matrix are the newest to be seen in North America. They were

not part of the team -- I talk about flu virus as teams of genes.

There are 8 players. They have these 2 new players from Asia.

One little detail we haven't discussed is [that] these Midwestern

viruses were exported to Asia. Korea and many countries import from

the US. Swine flu is economically not such a big deal that many

countries don't check for it. There are some parts of the puzzle I

don't have the answer to [such as the European lineage

contributions]. The genetic lineages of Asia and Europe mix quite a

bit.

[The question of the appearance of this virus in Mexico is

unresolved], but the mixing probably did not occur in Mexico. The

amazing thing is the hemagglutinins we are seeing in this strain are

a lonely branch that has been evolving somewhere and we didn't know

about it.

We have [a] 6 percent or higher percentage difference in

neuraminidases. You have multiple amino acids that differ. And single

amino acid changes can change receptor specificity. When you have so

many changes, you don't know which ones are responsible.

One traditional approach is to take advantage of viral modules that

allow you to assemble different teams, to make reassortants that take

a virus say from North America that doesn't transmit, and you swap

one gene from the virus that does transmit. If the hypothesis is that

hemagglutinin is responsible, you put in the background of the genes

from the old virus. You need an animal model, usually the ferret.

[The current outbreak strains] from Mexico and North America are

very, very similar. Many genes are identical. In the 8 or 9 viruses

we've sequenced, there is nothing different. We've received 300

samples from Mexico, and these cover the span of February, March, and

April [2009]. And you look at flu A, traditionally it's A/H1 or A/H3

or it's B up until the end of March. There are 2 or 3 cases up to

[the] last days of March that are swine. Then in April they

skyrocket. So all the cases in the DF [Mexico City] areas, where most

samples came from, it really transmits very efficiently. Flu is a

seasonal disease that peaks in winter. Maybe this will end in the

United States with the end of the flu season.

--

Communicated by:

ProMED-mail

[It seems irrefutable now that the current human outbreak strain of A

(H1N1) virus was preceded by outbreaks over the past decade of

influenza viruses in swine that combine strains from several species.

The 1st infected human may not even have been in North America, or

even Mexico. The site (or sites) of interaction of the different

strains contributing to the evolution of this unique influenza virus,

and the nature of the selective forces involved, remain unresolved.

The complete version of this interview in its question and answer

format can be viewed at the source URL above. - Mod.CP]

******

[2] NYC school outbreak

Date: Thu 30 Apr 2009

Source: CDC. MMWR Morb Mortal Wkly Rep 2009; 58 (dispatch): 1-3 [edited]

Swine-origin influenza A (H1N1) virus infection in a school - New

York City, April 2009

----------------------------------------------------------------------

On 24 Apr 2009, CDC reported 8 confirmed cases of swine-origin

influenza A (H1N1) virus (S-OIV) infection in Texas and California

(1). The strain identified in US patients was confirmed by CDC as

genetically similar to viruses subsequently isolated from patients in

Mexico (1). Since 24 Apr 2009, the number of cases in the United

States and elsewhere has continued to rise. As of 28 Apr 2009,

approximately half (45) of all US cases of S-OIV infection had been

confirmed among students and staff members at a New York City (NYC)

high school. This report describes the initial outbreak investigation

by the NYC Department of Health and Mental Hygiene (DOHMH) and

provides preliminary details about 44 of the 45 patients (the

remaining patient resides outside of NYC and was not included in the

analysis). The preliminary findings from this investigation indicate

that symptoms in these patients appear to be similar to those of

seasonal influenza. DOHMH will continue monitoring for changes in the

epidemiology and/or clinical severity of S-OIV infection.

Epidemiologic and Laboratory Investigations

Epidemiologic and laboratory investigations

-------------------------------------------

On 23 Apr 2009, DOHMH was notified of approximately 100 cases of mild

(uncomplicated) respiratory illness among students at an NYC school

(high school A) with 2686 students and 228 staff members. During

23-24 Apr 2009, a total of 222 students visited the school nursing

office and left school because of illness. Given initial reports on

24 Apr 2009 of what was later determined to be a large S-OIV outbreak

in Mexico, DOHMH decided to rapidly mobilize staff members to go to

high school A to collect nasopharyngeal swabs from any symptomatic

students. On 24 Apr 2009 (a Friday), DOHMH staff members collected

nasopharyngeal swabs from 5 newly symptomatic students identified by

the school nurse and 4 newly symptomatic students identified at a

nearby physician's office. A decision was made over the weekend 25-26

Apr 2009 not to open the school on Monday 27 Apr 2009. Because of

suspicion that the respiratory disease cases might be caused by

S-OIV, beginning 24 Apr 2009, DOHMH attempted to contact the

remaining 213 students reported by the nursing office to have left

school because of respiratory illness. Some of the most recently

symptomatic at the time of telephone contact were advised to visit a

specified emergency department for nasopharyngeal swab collection.

DOHMH also provided 24 Apr 2009 by DOHMH were identified by CDC as

S-OIV. During 26-28 Apr 2009, 37 (88 percent) of 42 specimens

collected in the emergency department and local physicians' offices

tested positive at CDC for S-OIV, bringing the total number of

confirmed cases to 44.

DOHMH conducted telephone interviews with the 44 patients with

confirmed S-OIV on 27 Apr 2009. Median age of the patients was 15

years (range: 14-21 years). All were students, with the exception of

one student teacher aged 21 years. 31 (70 percent) of the 44 were

female. 30 (68 percent) were non-Hispanic white; 7 (16 percent) were

Hispanic; 2 (5 percent) were non-Hispanic black; and 5 (11 percent)

were of other races. 4 patients reported travel outside NYC within

the United States in the week before symptom onset, and an additional

patient traveled to Aruba in the 7 days before symptom onset. None of

the 44 patients reported recent travel to California, Texas, or

Mexico.

Illness onset dates ranged from 20 Apr to 24 Apr 2009; 10 (23

percent) of the patients had illness onset on 22 Apr 2009, and 28 (64

percent) had illness onset on 23 Apr 2009. The most frequently

reported symptoms were cough (in 43 patients [98 percent]),

subjective fever (42 [9 percent]), fatigue (39 [8 percent]), headache

(36 [82 percent]), sore throat (36 [82 percent]), runny nose (36 [82

percent]), chills (35 [80 percent]), and muscle aches (35 [80

percent]). Nausea (24 [55 percent]), stomach ache (22 [50 percent]),

diarrhea (21 [48 percent]), shortness of breath (21 [48 percent]),

and joint pain (20 [46 percent]) were less frequently reported but

still common. Among 35 patients who reported a maximum temperature,

the mean was 102.2 deg F (39.0 deg C) (range: 99.0-104.0 deg F

[37.2-40.0 deg C]). In total, 42 (95 percent) patients reported

subjective fever plus cough and/or sore throat, meeting the CDC

definition for influenza-like illness (ILI) (2). At the time of

interview on 27 Apr 2009, 37 patients (84 percent) reported that

their symptoms were stable or improving, 3 (7 percent) reported

worsening symptoms (2 of whom later reported improvement), and 4 (9

percent) reported complete resolution of symptoms. Only one reported

having been hospitalized for syncope and released after overnight

observation.

Enhanced surveillance

---------------------

On 26 Apr 2009, DOHMH launched enhanced surveillance for

self-reported ILI among all students, staff members, and family

members of persons at high school A via an online survey. Students

and staff members were recruited via e-mail messages with a link to

the survey, followed by daily reminder e-mails. Active surveillance

at the school was impractical because a decision was made by DOHMH

and the school principal not to reopen the school for the start of

the new school week, 27 Apr 2009. Complete data from this ongoing

survey are not yet available, but preliminary results indicate

widespread influenza-like symptoms, with hundreds of students and

many staff members reporting symptoms that met the case definition

for ILI. Several students participating in the on-line survey (none

of whom had confirmed S-OIV) reported travel to Mexico during the

week before 20 Apr 2009; an undetermined number were symptomatic at

the time of survey participation.

DOHMH also initiated active surveillance for severe, hospitalized

febrile respiratory ILI among NYC residents, and this surveillance is

currently ongoing. On 26 Apr 2009, DOHMH staff members began

contacting all 61 NYC hospitals with medical and/or pediatric

intensive care units by telephone on a daily basis to identify

possible severe cases of S-OIV, defined by the presence of fever

100.4 deg F or higher (38 deg C or higher) and at least one of the

following: acute respiratory distress syndrome, pneumonia, or

respiratory distress. DOHMH physicians review all possible cases;

nasopharyngeal swabs are recommended for cases with no identified

etiology. Specimens are tested for influenza A at the NYC Public

Health Laboratory, and isolates that cannot be subtyped are sent to

CDC for further characterization. Active surveillance identified one

to 2 cases of severe hospitalized ILI per day for which further

testing was recommended. Results of the testing are not yet available.

Enhanced passive surveillance also is ongoing. Doctors are asked via

daily reminders on the Health Alert Network to report any

hospitalized patients with fever and unexplained pneumonia or

respiratory distress to DOHMH. All case reports are reviewed by DOHMH

physicians, who contact providers reporting cases of severe illness

consistent with possible swine influenza and arrange nasopharyngeal

testing if warranted. In addition, DOHMH conducts syndromic

surveillance for the following: emergency department visits for fever

or influenza-like illness; drug sales for oseltamivir and other

prescription drugs for influenza; and school absenteeism.

[Reported by: HT Jordan, MD, MC Mosquera, MD; Swine Flu Investigation

Team, New York City Dept of Health and Mental Hygiene, New York. H

Nair, PhD, AM France PhD, EIS officers, CDC]

MMWR editorial note

-------------------

To date [30 Apr 2009], this school-based outbreak is the largest

cluster of S-OIV cases reported in the United States (2). The

findings from this investigation (in a population known to be at low

risk for severe disease from seasonal influenza) indicate that

symptoms appear to be similar to those of seasonal influenza (3). The

risk for severe disease among higher risk groups is not yet known.

Additional assessment of the extent of illness in NYC is ongoing.

In crafting a local response to S-OIV, DOHMH has relied upon several

years of pandemic preparedness planning, adapted to the specific

characteristics of the current outbreak in NYC. Given the spectrum of

disease observed thus far in NYC, DOHMH has given highest priority to

active surveillance for severe illness in order to assure DOHMH's

ability to rapidly detect any change in the virulence or epidemiology

of the virus that would prompt consideration of changes in current

policy regarding use of antivirals and community control measures.

This decision also was influenced by the need to prioritize use of

the public health laboratory's resources on testing those cases with

clinical or epidemiologic characteristics that, if confirmed to be

S-OIV, might influence a change in the DOHMH's recommendations for

public health control measures. DOHMH's current primary goals are to

assess the severity of disease in infected persons and to maintain

the ability to detect changes in the epidemiology and clinical

presentation of the virus. Aggressive containment in NYC is not a

feasible strategy because the virus originated outside NYC and has

been reported in multiple other locales.

At this time, NYC health-care providers have been advised by DOHMH to

report all patients with severe, unexplained febrile respiratory

illness, and to report patients with mild (uncomplicated) cases of

ILI only if they are associated with a cluster of illness (that is, 3

or more cases of ILI) in an institution. NYC providers have been

advised to test patients with severe, unexplained febrile respiratory

illnesses for influenza A but not to test patients with mild

(uncomplicated) ILI unless they have conditions that increase their

risk for more severe illness (3). DOHMH is recommending treatment

with oseltamivir or zanamivir for 1) hospitalized persons with

suspected, probable, or confirmed illness, or with severe febrile

unexplained respiratory illness pending testing for swine influenza,

or 2) patients with mild (uncomplicated) ILI and underlying

conditions (such as, chronic cardiovascular or renal disorders or

immunosuppression) that increase the risk for more severe illness

because of influenza. DOHMH is recommending treatment for any patient

with mild (uncomplicated) ILI permissively only if started within 48

hours of symptom onset. Antiviral prophylaxis is being recommended

for 1) health-care workers who provided care to patients with

suspected, probable, or confirmed swine influenza without using

appropriate personal protection or 2) asymptomatic household or other

close contacts of ill persons of suspected, probable, or confirmed

swine influenza who are at higher risk for complications of influenza

or are health-care workers themselves. Persons with mild

(uncomplicated) ILI are being advised to stay home for 7 days after

symptom onset or 24-48 hours after symptom resolution, whichever is

longer, and to cover their coughs and sneezes and wash their hands

frequently. But neither testing nor presumptive antiviral therapy are

currently recommended for these persons.

Guidance for health-care providers is available via the DOHMH Health

Additional information from DOHMH on swine influenza is available at

Interim guidance from CDC on treatment and chemoprophylaxis for swine

influenza is available at

Interim guidance on infection control for swine influenza is

available at

Additional information about swine influenza is available at

References

----------

1. CDC: Swine influenza A (H1N1) infections-California and Texas,

April 2009. MMWR 2009; 58: 437-9 [available at

2. CDC: Update: infections with a swine-origin influenza A (H1N1)

virus-United States and other countries, 28 Apr 2009. MMWR 2009; 58:

433-4 [available at

3. CDC: Prevention and control of influenza: recommendations of the

Advisory Committee on Immunization Practices (ACIP), 2008. MMWR 2008;

57(No. RR-7) [available at

--

Communicated by:

ProMED-mail

[Overall the symptoms of infection with the swine-origin influenza

virus appear to be similar to those of seasonal influenza. - Mod.CP]

******

[3] Outbreak history

Date: Thu 30 Apr 2009

Source: CDC. MMWR Morb Mortal Wkly Rep 2009; 58 (dispatch): 1-3 [edited]

Outbreak of swine-origin influenza A (H1N1) virus infection - Mexico,

March-April 2009

----------------------------------------------------------------------

In March and early April 2009, Mexico experienced outbreaks of

respiratory illness and increased reports of patients with

influenza-like illness (ILI) in several areas of the country. On 12

Apr 2009, the General Directorate of Epidemiology (DGE) reported an

outbreak of ILI in a small community in the state of Veracruz to the

Pan American Health Organization (PAHO) in accordance with

International Health Regulations. On 17 Apr 2009, a case of atypical

pneumonia in Oaxaca State prompted enhanced surveillance throughout

Mexico. On 23 Apr 2009, several cases of severe respiratory illness

laboratory confirmed as swine-origin influenza A (H1N1) virus (S-OIV)

infection were communicated to the PAHO. Sequence analysis revealed

that the patients were infected with the same S-OIV strain detected

in 2 children residing in California (1). This report describes the

initial and ongoing investigation of the S-OIV outbreak in Mexico.

Enhanced surveillance

---------------------

On 17 Apr 2009, in response to the increase in reports of respiratory

illness, DGE issued a national epidemiologic alert to all

influenza-monitoring units and hospitals (Table 1 [available at

source URL]). The alert asked hospitals to report all patients with

severe respiratory illness and recommended collection of diagnostic

respiratory specimens from these patients within 72 hours of illness

onset. On 18 Apr 2009, DGE staff visited 21 hospitals throughout the

country to confirm the apparent increase in illness incidence.

After laboratory confirmation of S-OIV infection on 23 Apr 2009, DGE

developed case definitions. A suspected case was defined as severe

respiratory illness with fever, cough, and difficulty breathing. A

probable case was defined as a suspected case in a patient from whom

a specimen had been collected and tested positive for influenza A. A

confirmed case was defined as a probable case that tested positive

for S-OIV by real-time reverse--transcription polymerase chain

reaction (RT-PCR). Health-care officials were contacted and asked to

provide retrospective and ongoing data for persons having illness

consistent with these case definitions and seeking care on or after 1

Mar 2009.

During 1 Mar-30 Apr 2009, a total of 1918 suspected cases were

reported, including 286 probable and 97 confirmed cases [data

supplemented by a figure in the original text]. A total of 84 deaths

were reported. A majority of case-reports were for hospitalized

patients, reflecting the concentration of surveillance efforts within

hospitals. However, DGE also received reports from sites conducting

routine seasonal influenza surveillance of patients with ILI. Of 1069

patients with suspected and probable cases for whom information was

available, 755 were hospitalized, and the remaining 314 were examined

in outpatient settings or emergency departments. Suspected or

probable cases were reported from all 31 states and from the Federal

District of Mexico. The 4 areas with the most cases were Federal

District (213 cases), Guanajuato (141), Aguascalientes (93), and

Durango (77). In other states, the number of suspected or probable

cases ranged from two to 46. Suspected and probable cases were

identified in all age groups. Mexico routinely monitors seasonal

influenza in a network of outpatient facilities throughout the

country. Fifty-one influenza A positive specimens from 6 states were

collected during 4 Jan-11 Mar 2009 in this surveillance network. All

of these specimens tested negative for S-OIV at CDC.

Confirmed cases of S-OIV infection

----------------------------------

As of 30 Apr 2009, DGE surveillance activities, focusing on patients

with severe respiratory disease, had identified 97 patients with

laboratory-confirmed S-OIV infection, including 7 persons who had

died. The 1st of the 97 patients reported onset of illness (any

symptom) on 17 Mar 2009, and the most recent patients reported onset

on 26 Apr 2009. Laboratory confirmation of S-OIV infection for the

most recent 73 of these 97 cases was reported on the evening of 29

Apr 2009. Collection of additional information on these 73 cases is

ongoing. Of the 24 patients for whom demographic and clinical

information is available, 20 (83 percent) were hospitalized, 3 were

examined in outpatient settings, and one had illness that was not

medically attended. Patients ranged in age from less than 1 to 59

years, with 79 percent aged 5 to 59 years; 15 (62 percent) patients

were female. Patients with confirmed S-OIV infection were identified

in 4 states: Federal District (15 cases), Mexico State (7), Veracruz

(one), Oaxaca (one). Of the 7 deaths, 6 occurred in Federal District,

and one occurred in Oaxaca.

Among the 16 patients with complete clinical records, 15 reported

fever, 13 reported cough, 10 reported tachypnea, and 9 reported

dyspnea. In addition, 7 of 16 patients reported either vomiting or

diarrhea. Of these 7 patients, 2 reported vomiting only, 2 reported

diarrhea only, and 3 reported both. 8 of 16 patients were admitted to

intensive-care units; of these, 7 required mechanical ventilation,

and 6 subsequently died after developing acute respiratory distress

syndrome. 12 of 15 patients with radiography records available had

confirmed pneumonia. 3 of the 16 patients had underlying health

conditions. Information on the duration of hospitalization before

death was available for 6 patients and ranged from 1 to 18 days

(median: 9 days).

Prevention and control measures

-------------------------------

On 24 Apr 2009, the Council for General Hygiene convened with the

President of the Mexican Republic and decreed the closure of all

schools in the Federal District and metropolitan area of Mexico City.

Incoming and outgoing airport passengers were informed of the

outbreak and advised to seek care immediately should they experience

symptoms of ILI. Other measures included 1) disseminating educational

messages regarding respiratory hygiene through mass media; 2)

distributing masks and alcohol hand-sanitizer to the public; and 3)

discouraging large public gatherings, including church services,

theater events, and soccer games. On 25 Apr 2009, a national decree

allowed for house-isolation of any person with a suspected case, and

on 27 Apr 2009, school closures were mandated throughout the country.

[Reported by: General Directorate of Epidemiology, Ministry of

Health, Mexico; Pan American Health Organization; World Health

Organization; Public Health Agency of Canada; CDC (United States)]

MMWR editorial note

-------------------

Understanding the epidemiology and clinical profiles of recent cases

of S-OIV infection in Mexico can help inform regional, national, and

global control measures in response to the emergence of S-OIV

infection. Important areas for investigation worldwide include

evidence of person-to-person transmission, the geographic

distribution of disease, the clinical spectrum of disease, and the

effectiveness of mitigation strategies.

Previous instances of human-to-human transmission of other swine

viruses have been reported to result in small clusters of disease and

limited generations of disease transmission (2,3). Several findings

indicate that transmission in Mexico involves person-to-person spread

with multiple generations of transmission. Patients with probable and

laboratory-confirmed disease have presented over a period of 4 weeks.

Limited contact tracing of patients with laboratory-confirmed disease

also has identified secondary cases of ILI.

The clinical spectrum of S-OIV illness is not yet well characterized

in Mexico. However, evidence suggests that S-OIV transmission is

widespread and that less severe (uncomplicated) illness is common.

Patients with confirmed disease have been identified in several

states, and suspected cases have been identified in all states, which

suggests that S-OIV transmission is widespread. In addition, several

countries are reporting S-OIV infection among persons who have travel

histories involving different parts of Mexico in the 7 days before

illness onset. To date [30 Apr 2009], case-finding in Mexico has

focused on patients seeking care in hospitals, and the selection of

cases for laboratory testing has focused on patients with more severe

disease. Therefore, a large number of undetected cases of illness

might exist in persons seeking care in primary-care settings or not

seeking care at all. Additional investigations are needed urgently to

evaluate the full clinical spectrum of disease in Mexico, the

proportion of patients who have severe illness, and the extent of

disease transmission.

To expedite confirmation of disease in additional patients, the World

Health Organization (WHO) Influenza Collaborating Center in Atlanta,

Georgia, has placed the genetic sequence of S-OIV from California in

GenBank. Specific primers for S-OIV have been developed and will be

distributed through the WHO Global Influenza Surveillance Network to

reference laboratories throughout the world. As of 26 Apr 2009, the

National Laboratory for Public Health in Mexico has capacity to

perform PCR for S-OIV.

The epidemiologic characteristics of this outbreak underscore the

importance of monitoring the effectiveness of community mitigation

efforts, non pharmaceutical interventions, and clinical management

practices in anticipation of a possible pandemic.

References

----------

1. CDC: Swine influenza A (H1N1) infection in two children-Southern

California, March-April 2009. MMWR 2009; 58: 400--2 [available at

2. Wells DL, Hopfensperger DJ, Arden NH, et al: Swine influenza virus

infections. Transmission from ill pigs to humans at a Wisconsin

agricultural fair and subsequent probable person-to-person

transmission. JAMA 1991; 265: 478-81 [abstract available at

3. Myers KP, Olsen CW, Gray GC: Cases of swine influenza in humans: a

review of the literature. Clin Infect Dis 2007; 44: 1084-8 [abstract

--

Communicated by:

ProMED-mail

[It would seem that the clinical spectrum of S-OIV illness is still

not yet well characterized in Mexico. However, the evidence suggests

that S-OIV transmission is widespread and that less severe

(uncomplicated) illness is common. - Mod.CP]

******

[4] WHO - update 7

Date: Fri 1 May 2009

Source: WHO Epidemic and Pandemic Alert and Response (EPR) Disease

Outbreak News [edited]

Influenza A (H1N1) - WHO update 7

---------------------------------

The situation continues to evolve rapidly. As of 06:00 GMT, 1 May

2009, 11 countries have officially reported 331 cases of influenza A

(H1N1) infection.

The United States Government has reported 109 laboratory confirmed

human cases, including one death. Mexico has reported 156 confirmed

human cases of infection, including 9 deaths.

The following countries have reported laboratory confirmed cases with

no deaths: Austria (1), Canada (34), Germany (3), Israel (2),

Netherlands (1), New Zealand (3), Spain (13), Switzerland (1), and

the United Kingdom (8).

Further information on the situation will be available on the WHO

website on a regular basis. WHO advises no restriction of regular

travel or closure of borders. It is considered prudent for people who

are ill to delay international travel and for people developing

symptoms following international travel to seek medical attention, in

line with guidance from national authorities.

There is also no risk of infection from this virus from consumption

of well-cooked pork and pork products. Individuals are advised to

wash hands thoroughly with soap and water on a regular basis and

should seek medical attention if they develop any symptoms of

influenza-like illness.

Daily updates will be posted on the Influenza A (H1N1) website at

--

Communicated by:

ProMED-mail Rapporteur Marianne Hopp