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http://www.nytimes.com/2009/04/29/health/29flu.html?ref=global-home
Borders Are Tightened as Flu Cases Rise
By DONALD G. McNEIL Jr.
Published: April 28, 2009
Countries around the world began tightening their border and immigration controls Tuesday as the number of confirmed cases of swine flu continued to rise.
The number of deaths believed attributable to swine flu climbed to as many as 152 on Tuesday ? all of them in Mexico ? as news agencies reported the number of confirmed cases of infection in the United States stood at 50 after further testing at a New York City school.
Other cases have been reported in Ohio, Kansas, Texas and California. In addition, The Associated Press reported that preliminary tests by health officials in New Jersey had identified five ?probable? cases ? four people who were recently in Mexico and one who had been in California.
About 1,600 people in Mexico are now believed to have swine flu.
The World Health Organization raised its global pandemic flu alert level on Monday while recommending that borders not be closed nor travel bans imposed. But in a possible precaution to be taken by other nations, Japan said Tuesday it would no longer allow Mexican travelers to obtain a visa upon arrival.
Health officers at three Japanese airports also were being deployed Tuesday to check passengers before they disembarked from flights coming from Mexico, Canada and the United States. Travelers suspected of having the flu would be quarantined and examined further at medical facilities, news agencies reported, citing the Japanese health minister.
At least eight other countries in Asia were checking air passengers arriving from North America, and China was tightening land border checks as well. Hong Kong, Taiwan and Russia were set to quarantine passengers suspected of having the flu.
On Monday, Indonesia banned all pork products coming from Canada, the United States and Mexico, and said it would destroy any pork products imported before the ban. International health experts said the flu cannot be transmitted from pigs or from eating properly handled pork.
Russia and South Korea each reported a suspected case of swine flue on Tuesday. Tests were ongoing, and South Korea raised its domestic alert level.
The increase of the W.H.O. alert to Level 4 from Level 3 means that there has been sustained human-to-human transmission. The change ?indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable,? said Dr. Margaret Chan, the W.H.O. director general.
The W.H.O.?s emergency committee, after meeting until 10:30 p.m. in Geneva, recommended abandoning efforts to contain the flu?s spread.
?Because the virus is already quite widespread in different locations, containment is not a feasible option,? said Dr. Keiji Fukuda, the deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that ?a pandemic is not inevitable ? the situation is fluid and will continue to evolve.?
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world?s largest pork producer.
Mexico?s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister Jos? ?ngel C?rdova. The case involved a 5-year-old boy who recovered.
But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.
American officials said their response to the epidemic was already aggressive, and the W.H.O.?s decision to raise its pandemic alert to level 4 from level 3 would not change their plans. The W.H.O. decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose.
Pharmacies in New York reported runs on Tamiflu, an antiflu drug ? something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
For now supplies of Tamiflu and Relenza, another antiflu drug, remain adequate, the manufacturers said, but both were increasing production and expressed anxiety that shortages could develop if governments placed huge orders.
The travel issue was the most confusing. On Monday, the European Union appeared to issue and then rescind a ban on travel to the United States, drawing a rebuke from American officials, who themselves later suggested that Americans drop all nonessential travel to Mexico.
None of the American cases have been serious, but Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said he ?would not rest on that fact.?
?I expect that we will see additional cases, and I expect that the spectrum of disease will expand,? he said at a news conference.
Asked why the W.H.O. had waited so long to raise its alert level, Dr. Fukuda said it was done on technical grounds, that there was evidence of sustained human-to-human transmission of a new virus and movement of that virus to new areas. But he conceded that ?the committee is very aware that changes have quite significant political and economic effects on countries.?
The W.H.O. has no power to enforce any policies on member states, but different countries may have their own pandemic flu plans that are triggered by changes in the alert level.
Spain and Scotland became the first countries outside North America to confirm cases. Suspected cases appeared in Brazil, Australia, Israel and New Zealand, but confirmation is slow because most nations? laboratories lack the test kit the C.D.C. is developing for the new virus.
The C.D.C. began sending out the new kits on Monday, meaning that soon some states and foreign countries would be able to make their own diagnoses ? a development that could lead to a sharp increase in confirmed cases.
Confusion regarding Europe?s position on travel arose when the European Union?s health commissioner, Androulla Vassiliou, was questioned on a visit to Luxembourg and said Europeans ?should avoid traveling to Mexico or the United States unless it?s very urgent.?
Early reports of those remarks led both Dr. Besser and Mayor Michael R. Bloomberg of New York City to publicly disagree.
?We don?t think there is any reason not to travel and come to New York,? the mayor said.
Ms. Vassiliou?s office later denied she had issued any travel advisory and said she was only offering her personal opinion. ?She didn?t want to insinuate risk where we?re not sure,? a spokesman said, adding that formal advice would be offered later.
Mayor Bloomberg confirmed that there were now 28 cases in New York, all connected to St. Francis Preparatory School in Fresh Meadows, Queens. He said there had been no suspected cases in any of the city?s intensive-care units. He acknowledged an increase in emergency-room visits, but he said his preliminary information indicated that there were more people who were worried rather than seriously ill.
New York?s public health situation does not now resemble Mexico City?s, the mayor said, and the public does not need to don masks.
In Europe, a spokesman for the Stockholm-based European Center for Disease Prevention and Control said there were about 40 suspected cases beyond the confirmed case in Spain.
The United States pork industry continued trying to allay consumer concerns about their products. Many companies and hog farmers complained that the ?swine flu? name was unfortunate and perhaps inaccurate because, so far, the virus appears to be spreading without any contact with pigs.
?I guess everything has got to have a name,? said Kyle Stephens, who raises show pigs in Amarillo, Tex. ?The biggest thing we are up against is people thinking the worst, instead of checking into it more.?
Borders Are Tightened as Flu Cases Rise
By DONALD G. McNEIL Jr.
Published: April 28, 2009
Countries around the world began tightening their border and immigration controls Tuesday as the number of confirmed cases of swine flu continued to rise.
The number of deaths believed attributable to swine flu climbed to as many as 152 on Tuesday ? all of them in Mexico ? as news agencies reported the number of confirmed cases of infection in the United States stood at 50 after further testing at a New York City school.
Other cases have been reported in Ohio, Kansas, Texas and California. In addition, The Associated Press reported that preliminary tests by health officials in New Jersey had identified five ?probable? cases ? four people who were recently in Mexico and one who had been in California.
About 1,600 people in Mexico are now believed to have swine flu.
The World Health Organization raised its global pandemic flu alert level on Monday while recommending that borders not be closed nor travel bans imposed. But in a possible precaution to be taken by other nations, Japan said Tuesday it would no longer allow Mexican travelers to obtain a visa upon arrival.
Health officers at three Japanese airports also were being deployed Tuesday to check passengers before they disembarked from flights coming from Mexico, Canada and the United States. Travelers suspected of having the flu would be quarantined and examined further at medical facilities, news agencies reported, citing the Japanese health minister.
At least eight other countries in Asia were checking air passengers arriving from North America, and China was tightening land border checks as well. Hong Kong, Taiwan and Russia were set to quarantine passengers suspected of having the flu.
On Monday, Indonesia banned all pork products coming from Canada, the United States and Mexico, and said it would destroy any pork products imported before the ban. International health experts said the flu cannot be transmitted from pigs or from eating properly handled pork.
Russia and South Korea each reported a suspected case of swine flue on Tuesday. Tests were ongoing, and South Korea raised its domestic alert level.
The increase of the W.H.O. alert to Level 4 from Level 3 means that there has been sustained human-to-human transmission. The change ?indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable,? said Dr. Margaret Chan, the W.H.O. director general.
The W.H.O.?s emergency committee, after meeting until 10:30 p.m. in Geneva, recommended abandoning efforts to contain the flu?s spread.
?Because the virus is already quite widespread in different locations, containment is not a feasible option,? said Dr. Keiji Fukuda, the deputy director general.
The W.H.O. also recommended that vaccine makers keep making the seasonal flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take six months.
Dr. Fukuda emphasized that the committee thought that ?a pandemic is not inevitable ? the situation is fluid and will continue to evolve.?
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world?s largest pork producer.
Mexico?s first known swine flu case, which was later confirmed, was from Perote, according to Health Minister Jos? ?ngel C?rdova. The case involved a 5-year-old boy who recovered.
But a spokesman for the plant said the boy was not related to a plant worker, that none of its workers were sick and that its hogs were vaccinated against flu.
American officials said their response to the epidemic was already aggressive, and the W.H.O.?s decision to raise its pandemic alert to level 4 from level 3 would not change their plans. The W.H.O. decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose.
Pharmacies in New York reported runs on Tamiflu, an antiflu drug ? something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
For now supplies of Tamiflu and Relenza, another antiflu drug, remain adequate, the manufacturers said, but both were increasing production and expressed anxiety that shortages could develop if governments placed huge orders.
The travel issue was the most confusing. On Monday, the European Union appeared to issue and then rescind a ban on travel to the United States, drawing a rebuke from American officials, who themselves later suggested that Americans drop all nonessential travel to Mexico.
None of the American cases have been serious, but Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said he ?would not rest on that fact.?
?I expect that we will see additional cases, and I expect that the spectrum of disease will expand,? he said at a news conference.
Asked why the W.H.O. had waited so long to raise its alert level, Dr. Fukuda said it was done on technical grounds, that there was evidence of sustained human-to-human transmission of a new virus and movement of that virus to new areas. But he conceded that ?the committee is very aware that changes have quite significant political and economic effects on countries.?
The W.H.O. has no power to enforce any policies on member states, but different countries may have their own pandemic flu plans that are triggered by changes in the alert level.
Spain and Scotland became the first countries outside North America to confirm cases. Suspected cases appeared in Brazil, Australia, Israel and New Zealand, but confirmation is slow because most nations? laboratories lack the test kit the C.D.C. is developing for the new virus.
The C.D.C. began sending out the new kits on Monday, meaning that soon some states and foreign countries would be able to make their own diagnoses ? a development that could lead to a sharp increase in confirmed cases.
Confusion regarding Europe?s position on travel arose when the European Union?s health commissioner, Androulla Vassiliou, was questioned on a visit to Luxembourg and said Europeans ?should avoid traveling to Mexico or the United States unless it?s very urgent.?
Early reports of those remarks led both Dr. Besser and Mayor Michael R. Bloomberg of New York City to publicly disagree.
?We don?t think there is any reason not to travel and come to New York,? the mayor said.
Ms. Vassiliou?s office later denied she had issued any travel advisory and said she was only offering her personal opinion. ?She didn?t want to insinuate risk where we?re not sure,? a spokesman said, adding that formal advice would be offered later.
Mayor Bloomberg confirmed that there were now 28 cases in New York, all connected to St. Francis Preparatory School in Fresh Meadows, Queens. He said there had been no suspected cases in any of the city?s intensive-care units. He acknowledged an increase in emergency-room visits, but he said his preliminary information indicated that there were more people who were worried rather than seriously ill.
New York?s public health situation does not now resemble Mexico City?s, the mayor said, and the public does not need to don masks.
In Europe, a spokesman for the Stockholm-based European Center for Disease Prevention and Control said there were about 40 suspected cases beyond the confirmed case in Spain.
The United States pork industry continued trying to allay consumer concerns about their products. Many companies and hog farmers complained that the ?swine flu? name was unfortunate and perhaps inaccurate because, so far, the virus appears to be spreading without any contact with pigs.
?I guess everything has got to have a name,? said Kyle Stephens, who raises show pigs in Amarillo, Tex. ?The biggest thing we are up against is people thinking the worst, instead of checking into it more.?