Tuesday, April 28, 2009

News Clipping Archives

 

Maryland / Regional

Local, state health officials on alert for swine flu (Annapolis Capital)

AVOIDING A PROBLEM (Annapolis Capital)

WHO Raises Swine Flu Pandemic Alert Level (Baltimore WJZ/AP)

Key Facts about Swine Influenza (Swine Flu) (CBS Broadcasting)

Local Officials Prepare For Arrival of Swine Flu (Washington Post)

Md. braces for swine flu, opens command center (Examiner)

Flu spread raises alarm (Baltimore Sun)

Maryland prepared to deal with swine flu, officials say (Baltimore Sun)

CDC: 'Fully expect we will see deaths' (Frederick News-Post)

Two local scientists named to National Academy of Sciences (Baltimore Sun)

 

National / International

Obama Seeks to Ease Fears on Swine Flu (New York Times)

Swine Flu Spreading, but Officials Say Travel Restrictions Do Little to Help (Washington Post)

Inside Out (Washington Post)

US wants ingredient in swine flu vaccine by May (Washington Post)

Swine flu's ground zero? Residents say nearby farm (Washington Post)

Prostate cancer vaccine extends survival in study (Washington Post)

 

Opinion

Paying for special ed (Baltimore Sun Editorial)

Where Will the Swine Flu Go Next? (New York Times Commentary)

 

 

Maryland / Regional

 

Local, state health officials on alert for swine flu

Command center opened in Baltimore

 

By Shantee Woodards

Annapolis Capital

Tuesday, April 28, 2009

 

The disease that has shut down Mexico and sickened dozens hasn't hit Maryland yet, but officials are already taking precautions.

 

The state Department of Health and Mental Hygiene opened a command center in Baltimore yesterday as part of its response to the disease. Meanwhile, the county Department of Health has loaded information about swine flu onto its Web site and submitted bilingual fact sheets to the Hispanic Health Network, an organization of 25 Spanish-speaking churches in the area. And school administrators sent students home yesterday with notes about how to prevent the disease's spread.

 

County hospitals also are taking action. Baltimore Washington Medical Center officials are encouraging hospital visitors with certain flulike symptoms to stay home, and Anne Arundel Medical Center has set up a command post from which updates can be provided to the public.

 

At this point, the health tips are similar to the advice any kindergarten teacher would give: Wash your hands often and cover your mouth whenever you cough or sneeze.

 

"They're all important things," said Elin Jones, spokeswoman for the Department of Health. "We say them over and over again for a reason."

 

Gov. Martin O'Malley noted the spread of the disease from Mexico to several U.S. states and Canada means "we anticipate ... there probably will be a case in Maryland, eventually."

 

The governor, who spoke at the command center, urged Marylanders to help fight the spread of swine flu.

 

"Number one, make sure you wash your hands or keep that hand sanitizer nearby," the governor said, noting that the disease is spread mostly by hand-to-hand contact.

 

State Health Secretary John Colmers said "common sense ought to prevail, that's the single most important thing. If you're sick, stay at home."

 

The national Centers for Disease Control and Prevention has 50 confirmed cases of the disease in the United States. There have been no deaths reported in the five states with cases of the disease, but it has proved fatal for approximately 50 people in Mexico.

 

The disease is also suspected as the cause of death in about 100 other fatalities in Mexico. Now that President Barack Obama has declared it a public health emergency, the CDC has released portions of its Strategic National Stockpile - including antiviral drugs and protective equipment - to help states respond.

 

Swine influenza, or swine flu, is a respiratory disease of pigs that is caused by type A influenza viruses. Human infections are rare, but they can happen, CDC officials said.

 

People contract the virus from contact with infected pigs or areas where the pigs have been, or they catch it from an infected person. The disease then spreads the same way as seasonal flu, through the coughing or sneezing of infected people. Human sufferers have symptoms that are consistent with regular influenza, such as fever, cough, body aches, chills and fatigue.

 

Health officials said it is important to remain calm. It is possible that this swine influenza has been going around undetected for some time, said Dr. Mary Clance, an epidemiologist at AAMC. In the 2007-2008 flu season, about a third of the type A virus strains were not placed in a subtype.

 

AAMC officials have been providing ongoing updates to the state about their surveillance of the illness.

 

"This is not a situation for anyone to panic at all," Clance said.

 

Clance added that the 2001 terrorist attacks have led to hospitals being better prepared for emergency situations like this. With the CDC releasing some of its resources, "we can test our system to tell if we're in a real pandemic situation, how things should be operating," Clance said. "It's a nice live testing of the system for the hospital personnel and the state."

 

Currently, BWMC has patients with flulike symptoms and the staff members treating them wearing masks. Patients who have visited any of the areas impacted by swine flu are being given heightened attention, said Dr. Chirag Chaudhari, who specializes in emergency medicine at BWMC.

 

Anyone exhibiting certain symptoms - a temperature greater than 100 degrees, sore throat, vomiting and runny nose - should not be visiting patients at the hospital.

 

"We're trying to stay on top of it by educating patients when they come in," said Allison Eatough, BWMC spokeswoman. "If you are seeking health care (and have flulike symptoms), then we would want you to come. But if you have an aunt on a floor and are planning to come back and see her and you experience these symptoms, we're asking you refrain from seeing them."

 

The county Department of Health is providing information about swine flu at 410-222-7343 and on its Web site, www.aahealth.org.

 

The Associated Press contributed to this report.

 

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AVOIDING A PROBLEM

 

Preventing swine flu:

• Cover your nose and mouth with a tissue when you cough or sneeze, then throw away the tissue.

• Wash hands often with soap and water, especially after coughing or sneezing. Alcohol-based cleaners are also effective.

• Avoid touching your eyes, nose or mouth because this is how germs are spread.

• Avoid close contact with sick people.

• If you get sick with influenza, stay home from work or school to avoid infecting others.

 

Emergency warning signs for children:

• Fast breathing or trouble breathing.

• Bluish skin color.

• Not drinking enough fluids.

• Not waking up or not interacting.

• Being so irritable that the child does not want to be held.

• Flu-like symptoms improve but then return with fever and worse cough.

• Fever with a rash.

 

Emergency warning signs for adults:

• Difficulty breathing or shortness of breath.

• Pain or pressure in the chest or abdomen.

• Sudden dizziness.

• Confusion.

• Severe or persistent vomiting.

 

- Centers for Disease Control and Prevention

 

Copyright 2009 Annapolis Capital.

 

WHO Raises Swine Flu Pandemic Alert Level

 

By Mary Bubala

Baltimore WJZ/AP

Tuesday, April 28, 2009

 

World health officials raised a global alert to an unprecedented level as swine flu was blamed for more deaths in Mexico and the epidemic crossed new borders, with the first cases confirmed Tuesday in the Middle East and the Asia-Pacific regions.

 

Mary Bubla reports There are no cases yet in Maryland, but precautions are being taken. 

 

Flanked by some of the top doctors in the state, Governor O'Malley delivered a message about swine flu.

 

"Right now, we are watching this; we are monitoring this, and we are taking appropriate actions in conjunction with all our public health officials, so we anticipate because of this, that there will probably be a case in Maryland," said O'Malley.

 

With the swine flu having already spread to at least six other countries, local officials here are prepared for the worst.

 

"In Maryland, we have been planning for public health emergencies for years, and we have tested and trained ourselves for various scenarios following an all-hazards approach. So regardless of the public health emergency is, we're going to be ready for it," said Secretary John Colmers, Department of Health.

 

Authorities around the globe are like firefighters battling a blaze without knowing how far it extends.

 

"At this time, containment is not a feasible option," said Keiji Fukuda, assistant director-general of the World Health Organization, which raised its alert level on Monday.

 

New Zealand reported Tuesday that 11 people who recently returned from Mexico contracted the virus. Tests conducted at a World Health Organization laboratory in Australia had confirmed three cases of swine flu among 11 members of the group who were showing symptoms, New Zealand Health Minister Tony Ryall said.

 

Officials decided that was evidence enough to assume the whole group was infected, he said. Those infected had suffered only "mild illness" and were expected to recover, Public Health Director Mark Jacobs said. There are 43 more suspected cases in the country, officials said.

 

The Israeli Health Ministry on Tuesday confirmed the region's first case of swine flu in the city of Netanya. The 26-year-old patient recently returned from Mexico and had contracted the same strain, Health Ministry spokeswoman Einav Shimron.

 

Dr. Avinoam Skolnik, Laniado Hospital's medical director, said the patient has fully recovered and is in "excellent condition" but will remain hospitalized until the Health Ministry approves his release.

 

Another suspected case has been tested at another Israeli hospital but results are not in, the ministry said. Meanwhile, a second case was confirmed Tuesday in Spain, Health Minister Trinidad Jimenez said, a day after the country reported its first case. The 23-year-old student, one of 26 patients under observation, was not in serious condition, Jimenez said.

 

With the virus spreading, the U.S. prepared for the worst even as President Barack Obama tried to reassure Americans. At the White House, a swine flu update was added to Obama's daily intelligence briefing. Obama said the outbreak is "not a cause for alarm," even as the U.S. stepped up checks of people entering the country and warned U.S. citizens to avoid nonessential travel to Mexico.

 

"We are proceeding as if we are preparatory to a full pandemic," said Homeland Security Secretary Janet Napolitano. The European Union health commissioner suggested that Europeans avoid nonessential travel both to Mexico and parts of the United States. Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus.

 

Mexico, where the number of deaths believed caused by swine flu rose by 50 percent on Monday to 152, is suspected to be ground zero of the outbreak. But Mexican Health Secretary Jose Angel Cordova late Monday said no one knows where the outbreak began, and implied it may have started in the U.S.

 

"I think it is very risky to say, or want to say, what the point of origin or dissemination of it is, given that there had already been cases reported in southern California and Texas," Cordova told a press conference.

 

It's still not clear when the first case occurred, making it impossible thus far to determine where the breakout started. Dr. Nancy Cox of the Atlanta-based Centers for Disease Control and Prevention has said she believes the earliest onset of swine flu in the United States happened on March 28. Cordova said a sample taken from a 4-year-old boy in Mexico's Veracruz state in early April tested positive for swine flu. However, it is not known when the boy, who later recovered, became infected.

 

The World Health Organization raised the alert level to Phase 4, meaning there is sustained human-to-human transmission of the virus causing outbreaks in at least one country. Monday was the first time it has ever been raised above Phase 3.

 

Putting an alert at Phases 4 or 5 signals that the virus is becoming increasingly adept at spreading among humans. Phase 6 is for a full-blown pandemic, characterized by outbreaks in at least two regions of the world.

 

Fifty cases -- none fatal and most of them mild -- were confirmed in the United States. Including the New Zealand, Israeli and new Spanish reports, there were 92 confirmed cases worldwide on Tuesday. That included six in Canada, one in Spain and two in Scotland.

 

Symptoms include a fever of more than 100, coughing, joint aches, severe headache and, in some cases, vomiting and diarrhea.

 

Amid the alarm, there was a spot of good news. The number of new cases reported by Mexico's largest government hospitals has been declining the past three days, Cordova said, from 141 on Saturday to 119 on Sunday and 110 Monday.

 

In a bid to prevent mass contagion, Mexico canceled school nationwide until May 6, and the Mexico City government is considering a complete shutdown, including all public transportation. The Cinco de Mayo parade celebrating Mexico's defeat of a French army on May 5, 1862 and Mexico City's traditional May 1 parade were canceled. More than 100 museums nationwide were closed.

 

At Mexico City's international airport, families grimly waited for flights out of the capital or country, determined to keep their masks on until they touched ground somewhere else.

 

Three games involving Mexico City soccer clubs were played with no spectators over the weekend. Decio de Maria, secretary general of the Mexican soccer federation, said plans for future matches would be announced on Wednesday.

 

"The idea is to look for the fewest number of games that have to be played behind closed doors," he said. "If it's necessary, we'll play all the matches behind closed doors. We don't foresee canceling any games."

 

Many residents of Mexico City wore blue surgical masks, though the CDC said most masks offer little protection. Many victims have been in their 30s and 40s -- not the very old or young who typically succumb to the flu. So far, no deaths from the new virus have been reported outside Mexico.

 

It could take four to six months before the first batch of vaccines are available, WHO officials said. Some antiflu drugs do work once someone is sick.

 

Napolitano, the U.S. Homeland Security chief, said Washington is dispatching people and equipment to affected areas and stepping up information-sharing at all levels of government and with other nations.

 

Richard Besser, the CDC's acting director, said his agency is aggressively looking for evidence of the disease spreading and probing for ways to control and prevent it.

 

Flu deaths are nothing new in the United States. The CDC estimates that about 36,000 people died of flu-related causes each year, on average, during the 1990s in the United States. But the new flu strain is a combination of pig, bird and human viruses that humans may have no natural immunity to.

 

Besser said that so far the virus in the United States seems less severe than in Mexico. Only one person has been hospitalized in the U.S.

 

"I wouldn't be overly reassured by that," Besser told reporters at CDC headquarters in Atlanta, sounding a cautionary note.

 

The best way to keep the disease from spreading, Besser said, is by taking everyday precautions such as frequent handwashing, covering up coughs and sneezes, and staying away from work or school if not feeling well.

 

WHO spokesman Peter Cordingley singled out air travel as an easy way the virus could spread, noting that the WHO estimates that up to 500,000 people are on planes at any time.

 

Governments in Asia -- with memories of previous flu outbreaks -- were especially cautious. Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the 2003 SARS crisis and were checking for signs of fever among passengers from North America. South Korea, India and Indonesia also announced screening.

 

Teams of doctors, nurses and government officials boarded flights arriving in Japan from Mexico, the U.S. and Canada to check passengers for signs of the flu, Japanese Health Ministry official Akimori Mizuguchi said.

 

World stock markets fell Tuesday as investors worried that any swine flu pandemic could derail a global economic recovery.

 

© 2009 CBS Broadcasting Inc. All Rights Reserved.

 

Key Facts about Swine Influenza (Swine Flu)

Questions & Answers

 

CBS Broadcasting

Tuesday, April 28, 2009

 

Swine Flu

What is Swine Influenza?

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

 

How many swine flu viruses are there?

Like all influenza viruses, swine flu viruses change constantly. Pigs can be infected by avian influenza and human influenza viruses as well as swine influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Over the years, different variations of swine flu viruses have emerged. At this time, there are four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1. However, most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

 

Swine Flu in Humans

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

 

How common is swine flu infection in humans?

In the past, CDC received reports of approximately one human swine influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, 12 cases of human infection with swine influenza have been reported.

 

What are the symptoms of swine flu in humans?

The symptoms of swine flu in people are expected to be similar to the symptoms of regular human seasonal influenza and include fever, lethargy, lack of appetite and coughing. Some people with swine flu also have reported runny nose, sore throat, nausea, vomiting and diarrhea.

 

Can people catch swine flu from eating pork?

No. Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160°F kills the swine flu virus as it does other bacteria and viruses.

 

How does swine flu spread?

Influenza viruses can be directly transmitted from pigs to people and from people to pigs. Human infection with flu viruses from pigs are most likely to occur when people are in close proximity to infected pigs, such as in pig barns and livestock exhibits housing pigs at fairs. Human-to-human transmission of swine flu can also occur. This is thought to occur in the same way as seasonal flu occurs in people, which is mainly person-to-person transmission through coughing or sneezing of people infected with the influenza virus. People may become infected by touching something with flu viruses on it and then touching their mouth or nose.

 

What do we know about human-to-human spread of swine flu?

In September 1988, a previously healthy 32-year-old pregnant woman was hospitalized for pneumonia and died 8 days later. A swine H1N1 flu virus was detected. Four days before getting sick, the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine.

 

In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection but no serious illnesses were detected among this group. Additional studies suggest that one to three health care personnel who had contact with the patient developed mild influenza-like illnesses with antibody evidence of swine flu infection.

 

How can human infections with swine influenza be diagnosed?

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

 

What medications are available to treat swine flu infections in humans?

There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

 

What other examples of swine flu outbreaks are there?

Probably the most well known is an outbreak of swine flu among soldiers in Fort Dix, New Jersey in 1976. The virus caused disease with x-ray evidence of pneumonia in at least 4 soldiers and 1 death; all of these patients had previously been healthy. The virus was transmitted to close contacts in a basic training environment, with limited transmission outside the basic training group. The virus is thought to have circulated for a month and disappeared. The source of the virus, the exact time of its introduction into Fort Dix, and factors limiting its spread and duration are unknown. The Fort Dix outbreak may have been caused by introduction of an animal virus into a stressed human population in close contact in crowded facilities during the winter. The swine influenza A virus collected from a Fort Dix soldier was named A/New Jersey/76 (Hsw1N1).

 

Is the H1N1 swine flu virus the same as human H1N1 viruses?

No. The H1N1 swine flu viruses are antigenically very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

 

Swine Flu in Pigs

How does swine flu spread among pigs?

Swine flu viruses are thought to be spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

 

What are signs of swine flu in pigs?

Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

 

How common is swine flu among pigs?

H1N1 and H3N2 swine flu viruses are endemic among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection. In the U.S. studies have shown that 30 percent of the pig population has antibody evidence of having had H1N1 infection. More specifically, 51 percent of pigs in the north-central U.S. have been shown to have antibody evidence of infection with swine H1N1. Human infections with swine flu H1N1 viruses are rare. There is currently no way to differentiate antibody produced in response to flu vaccination in pigs from antibody made in response to pig infections with swine H1N1 influenza.

 

While H1N1 swine viruses have been known to circulate among pig populations since at least 1930, H3N2 influenza viruses did not begin circulating among US pigs until 1998. The H3N2 viruses initially were introduced into the pig population from humans. The current swine flu H3N2 viruses are closely related to human H3N2 viruses.

 

Is there a vaccine for swine flu?

Vaccines are available to be given to pigs to prevent swine influenza. There is no vaccine to protect humans from swine flu. The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

 

Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA

800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day - cdcinfo@cdc.gov

 

© 2009 CBS Broadcasting Inc. All Rights Reserved.

 

Local Officials Prepare For Arrival of Swine Flu

 

By Ashley Halsey III and Lori Aratani

Washington Post

Tuesday, April 28, 2009

 

Against a backdrop of 30 state emergency workers in matching polo shirts receiving computer reports from health centers and hospitals, Maryland health authorities said yesterday it is virtually inevitable that swine flu will surface in the Washington region.

 

"It's not a matter of if, it's a matter of when," said David Paulson of the state Department of Health and Mental Hygiene. "It's just too darn infectious, and we have too many people in this area who travel."

 

Gov. Martin O'Malley (D) trooped into the swine flu command center in Baltimore with a phalanx of health officials yesterday to underscore the coordination and communication efforts of state and regional officials as they seek to identify and deal with an illness that has not yet surfaced here.

 

O'Malley said the state has stockpiled 276,000 courses of antiviral medication and has access to 200,000 from the federal Centers for Disease Control and Prevention. In Richmond, where another state command center opened, Gov. Timothy M. Kaine (D) said that it was not certain that swine flu would hit Virginia but that the state had enough medication on hand to treat 770,000 cases and that drugs for treating 280,000 more were on their way from the CDC.

 

In the District, health department spokeswoman Dena Iverson said the city is carefully monitoring reports from health systems and also expects to receive antiviral medicine from the CDC.

 

In all three jurisdictions, health officials were rolling out crisis management plans developed, tested and honed in the aftermath of Sept. 11, 2001, attacks coupled with the deadly anthrax attacks later that year. "We have been planning for a situation like this for many years," Kaine said, echoing exactly the words of Maryland Health Secretary John M. Colmers.

 

Both states are using computer-linked reporting from hospital emergency rooms and health centers to provide almost immediate data on flulike symptoms. In addition, Maryland is using its system for monitoring over-the-counter sales in pharmacies to watch for any uptick in the sale of remedies used for respiratory problems.

 

Sheliah Roy, a spokeswoman for Sibley Memorial Hospital, which is making masks and hand wipes available to people coming to the emergency room, said that as of mid-morning yesterday five people had come to the District hospital to be tested for swine flu, but no cases had been confirmed.

 

At Dulles International Airport, some passengers arriving on United Airlines' afternoon flight from Mexico City wore surgical masks as they cleared customs.

 

"It was very strange in the plane," said Iasas Lagums of Harrisonburg. "And in the restaurant in the [Mexico City] airport, even the pilots wore masks."

 

Frank Calia, an infectious-disease specialist who chairs the department of medicine at the University of Maryland School of Medicine, said that swine flu will surface within three days of contact with someone else who has the illness.

 

Whatever their personal precautions, travelers found a measured response by U.S airports. So far, Transportation Security Administration and customs agents are doing nothing to screen passengers from Mexico other than watching them for obvious flu symptoms.

 

The airlines have instituted the same "passive surveillance" program, instructing ticket agents to alert security or CDC officials if they encounter sick passengers.

 

In an effort to reach out to immigrant communities, officials have also done interviews on Spanish radio and television, emphasizing the importance of hand washing and other strategies to keep the virus at bay.

 

The growing anxiety was particularly palpable yesterday in Riverdale, where so many Mexican immigrants have settled in recent years that most shop signs in the Prince George's County town are painted red and green, like the Mexican flag.

 

About 10 patients have called to request vaccination shots from Centro Medico Riverdale, a private health clinic serving mostly Mexicans, according to medical assistant Brenda Martinez. Though she tells callers that the only shots available are against regular flu, several have made appointments anyway.

 

"This is definitely a sign of concern," said Martinez. "Normally we would never get requests for flu shots this late in year."

 

Elizabeth Duarte, 31, one of the patients seated in the clinic's waiting area late yesterday morning, was trying a different strategy: "Yesterday I bought four bottles of that disinfectant hand gel to keep in different places all around my house," said Duarte, who is Guatemalan but was worried because most of her co-workers at a nearby McDonald's are Mexican.

 

Jaime Susunaga, 50, a Mexican-born butcher at the El Super Store supermarket at the nearby Plaza del Alamo strip mall, said he has been searching for a surgical mask since Saturday.

 

"People can laugh at me, but if I can find a mask, no one is taking it off me," he said, shouting to be heard over a Mexican cumbia tune playing on his stereo at the back of the store. "You just don't know if someone around here has just gotten back from Mexico and is carrying the virus."

 

Staff writers Steve Hendrix, N.C. Aizenman, Anita Kumar and Michael Birnbaum contributed to this report. Comments: health@washpost.com.

 

Copyright 2009 Washington Post.

 

Md. braces for swine flu, opens command center

 

Examiner

Tuesday, April 28, 2009

 

BALTIMORE (Map, News) - Hand-washing, covering your mouth when you sneeze and staying home when you're sick are simple ways to avoid spreading the swine flu, which hasn't hit Maryland but probably will, state officials said Monday.

 

Gov. Martin O'Malley noted the disease has spread from Mexico to several U.S. states and Canada and "we anticipate because of this there probably will be a case in Maryland, eventually."

 

The governor, who spoke at a command center the state opened earlier Monday as part of its response to the disease, urged Marylanders to help fight the spread of swine flu.

 

"Number one, make sure you wash your hands or keep that hand sanitizer nearby," the governor said, noting the disease is spread mostly by hand-to-hand contact.

 

 

 The virus is suspected in up to 149 deaths in Mexico, the epicenter of the outbreak with more than 1,600 cases suspected. Meanwhile, 40 cases - none fatal - have been confirmed in the United States and six in Canada.

 

State Health Secretary John Colmers said "common sense ought to prevail, that's the single most important thing," Colmers said. "If you're sick, stay at home."

 

"If you're sick enough that you're beginning to get worried" see a doctor, the health secretary added.

 

Colmers and others said the situation could change, but right now the disease is mostly causing concern in the United States.

 

The swine flu that has appeared in the United States appears to be milder than the disease that has struck in Mexico and appears to respond well to antiviral medications, Colmers said, adding tests in a few Maryland cases are pending, but no cases have been reported in the state.

 

Frances Phillips, deputy secretary for Public Health Services, said hospitals and pharmacies have "no shortage whatsoever" of antivirals through their normal, commercial distribution system, and the state has its own stockpile as well as access to a federal stockpile.

 

Dr. Frank Calia of the University of Maryland Medical Center said there was no reason to be concerned about contact with Mexican immigrants because the virus has an incubation period of one to three days, meaning only those who have recently traveled to an area where the disease is prevalent would be at risk of transmitting the disease.

 

Phillips said the command center will help coordinate the state's response, making sure, for example, that doctors have the supplies necessary for getting samples to state labs for testing if a patient arrives at their office with suspicious symptoms.

 

Phillips said the center will not field calls from the public, but the medical community to ensure "there isn't any gap in terms of communications and expertise anywhere in the state."

 

http://www.examiner.com/a-1984195~Md__braces_for_swine_flu__opens_command_center.htm

 

 

Copyright 2008 The Associated Press. All rights reserved.

 

Flu spread raises alarm

Health officials advise against travel to Mexico, where scores have died

 

By Kelly Brewington and Stephanie Desmon

Baltimore Sun

Tuesday, April 28, 2009

 

Officials advised Monday against most travel to Mexico, the center of an outbreak of swine flu suspected of killing almost 150 people there and sickening at least 50 through its spread to the United States.

 

The acting director of the Centers for Disease Control and Prevention said cases of the virus in the U.S. have been mild - none has been reported in Maryland - but warned that more serious cases could emerge.

 

"I wouldn't rest on the fact that we have only seen cases in this country that are less severe," Dr. Richard Besser told reporters.

 

He said officials were reacting "aggressively," including releasing 11 million courses of anti-viral drugs from a national strategic stockpile and sending kits to some states to enable them to test for the disease locally.

 

On Monday, a day after federal authorities announced a public health emergency, President Barack Obama told a group of scientists that while the outbreak is a cause for concern, it is "not a cause for alarm."

 

Later in the day, the State Department issued an alert advising U.S. citizens to avoid nonessential travel to Mexico.

 

Maryland health officials said they are working with hospitals and health departments, bracing for what they predict will be the inevitable stricken patient.

 

"We will have a case here in Maryland," said state health Secretary John M. Colmers. "I don't think there's any doubt of that. What we don't know is how extensive it will be and whether or not it will be as virulent as what we are seeing in Mexico. That's why we must continue to monitor the situation."

 

Worries about the outbreak set doctors' phone lines ablaze, led to reports of runs on surgical masks in some cities and roiled the economy, sending stocks lower on fears that the tourism industry could be further hobbled by restrictions brought on by swine flu.

 

Globally, the World Health Organization raised its alert level but stopped short of calling the outbreak a pandemic.

 

In Mexico, the illness has infected about 2,000 people and is suspected of claiming about 150 lives, although not all deaths have been confirmed as resulting from flu. It has shut schools, closed churches and emptied streets in Mexico City. One case has been confirmed in Spain and one is suspected in France, prompting European officials to warn citizens against visiting the U.S. and Mexico.

 

The CDC's Besser called that warning, in the case of the U.S., "quite premature."

 

Domestic cases have been reported in New York, Texas, California, Ohio, New Jersey and Kansas, according to the CDC. As of Monday, a total of 28 confirmed cases were from one New York City school.

 

Officials know that this flu appears to be spreading from person to person, but they are not sure how virulent it is. Younger people in Mexico have died from it, but not the babies and older people who are most endangered by seasonal flu.

 

This year's flu shots are ineffective against the strain, but CDC scientists are considering whether to develop a vaccine that includes the strain for the fall, a difficult undertaking.

 

"Over the course of the next week or two, we'll know a whole lot more," Besser said.

 

The new virus is part human, part avian and part porcine. "It has a mix of new genes," said Dr. Ruth Karron, director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. "It's a virus that humans have not previously been exposed to, so there's no immunity to this flu. We're broadly susceptible to this flu."

 

Flu experts have been on high alert in recent years, trying to prepare for the next unanticipated strain.

 

"We were all thinking about bird flu," Karron said. "We were looking to Asia for the development of the next pandemic strain, and here we have a swine flu outbreak in the Americas. It's not where we were expecting to see it."

 

Still, she said, past outbreaks have made the country "much better prepared."

 

At the Johns Hopkins Medical campus, a team of about 75 people has been working around the clock for the past 56 hours, drawing on existing disaster plans to devise a strategy for dealing with swine flu, said Dr. Gabe Kelen, director of Hopkins' Office of Critical Event Preparedness and Response.

 

But preparing for the unknown is tricky, particularly in a vast medical complex, said Kelen. Among the decisions the hospital must make: how to screen patients, protect health care workers and determine whether there is enough anti-viral supply, and, if a higher level of preparedness is needed, how to get that message out.

 

Public health officials appear to be taking measured steps and choosing their words carefully, he said.

 

"We want to be prepared should this turn out ugly, but we don't want to alarm anyone either," he said. "We are being pre-emptive within reason."

 

The hospital has begun preparing for the possibility of infections here. Admitted patients and visitors to the emergency room and outpatient clinics were being screened for symptoms of the influenza-like illness.

 

Colmers and Gov. Martin O'Malley tried to assure the public in a news conference Monday that Maryland is prepared to deal with any cases that emerge, using its pandemic flu preparedness plan as a guide. The state has a supply of about 265,000 courses of anti-viral medication, said Colmers. If a shortage arises, it can tap into an additional 200,000 from the federal stockpile, he said.

 

A command center was established at the health department's Baltimore headquarters Monday, with dozens of members of the state emergency response team typing away on laptops that communicate with local hospitals and health departments to keep track of flu-like symptoms. The surveillance system also monitors over-the-counter medicine sales in local drugstores.

 

Local government health workers are also on alert, with county agencies publishing updates on their Web sites and monitoring hospitals in their area.

 

Officials are warning people with flu symptoms who have also visited an infected area, or have been in close contact with someone who has, to stay home and call their doctor. If symptoms worsen - including shortness of breath, sudden dizziness or confusion, pain or pressure in the chest or abdomen and severe or persistent vomiting - people should seek medical attention and possible testing for swine flu, officials said.

 

Dr. Charles Haile, chief of infectious diseases at Greater Baltimore Medical Center in Towson, said his patients aren't yet worried about this disease, but he is. There are some similarities to the pandemic Spanish flu of 1917-1918, he said, which killed an estimated 50 million people. That flu also began in the spring, disappeared over the summer and then struck again once cold weather returned, he said.

 

He thinks the same thing is likely with this swine flu, which is hitting as the flu season ends. "If that's the case," he said, "there is sufficient time to develop a vaccine and have it available in the Northern Hemisphere."

 

Baltimore Sun reporters Tyeesha Dixon, Larry Carson and Mary Gail Hare contributed to this article.

 

Swine flu

Government officials are urging people not to panic over the swine flu, but they also advise caution for those who have recently traveled to Mexico or who are in contact with someone who has. Here are some things you should know, according to the Centers for Disease Control and Prevention:

 

Q: How can I protect myself?

A: Wash your hands often with soap and water, especially after you cough or sneeze. Avoid touching your eyes, nose or mouth. Avoid sick people; if you are sick, stay home.

 

Q: What if I get sick? Two anti-viral drugs - marketed as Tamiflu and Relenza - appear to be effective against this strain of the flu. If you get sick, the drugs can make the illness milder, make you feel better faster and might prevent serious complications. For treatment, anti-viral drugs work best if started as soon after getting sick as possible; they might not work if started more than 48 hours after illness starts.

 

Q: How dangerous is it?

A: Experts don't know how deadly swine flu is because they don't know how many people have been infected. The World Health Organization says the overall mortality rate is 1 percent to 4 percent.

 

Q: Should I avoid travel to Mexico?

A: The CDC is advising against any nonessential travel to Mexico, while the European Union's health commissioner is advising against travel to the United States or Mexico.

 

Copyright 2009 Baltimore Sun.

 

Maryland prepared to deal with swine flu, officials say

No cases reported in state, but leaders vow vigilance, say stockpile of antiviral medicines available

 

By Kelly Brewington and Stephanie Desmon

Baltimore Sun

Tuesday, April 28, 2009

 

Officials advised Monday against most travel to Mexico, the center of an outbreak of swine flu suspected of killing almost 150 people there and sickening at least 48 through its spread to the United States.

 

The acting director of the Centers for Disease Control and Prevention said cases of the virus in the U.S. have been mild -- none has been reported in Maryland -- but warned that more serious cases could emerge.

 

"I wouldn't rest on the fact that we have only seen cases in this country that are less severe," Dr. Richard Besser told reporters.

 

He said officials were reacting "aggressively," including releasing 11 million courses of anti-viral drugs from a national strategic stockpile and sending kits to some states to enable them to test for the disease locally.

 

On Monday, a day after federal authorities announced a public health emergency, President Barack Obama told a group of scientists that while the outbreak is a cause for concern, it is "not a cause for alarm."

 

Later in the day, the State Department issued an alert advising U.S. citizens to avoid nonessential travel to Mexico.

 

Maryland health officials said they are working with hospitals and health departments, bracing for what they predict will be the inevitable stricken patient.

 

"We will have a case here in Maryland," said state health Secretary John M. Colmers. "I don't think there's any doubt of that.

 

What we don't know is how extensive it will be and whether or not it will be as virulent as what we are seeing in Mexico. That's why we must continue to monitor the situation."

 

Worries about the outbreak set doctors' phone lines ablaze, led to reports of runs on surgical masks in some cities and roiled the economy, sending stocks lower on fears that the tourism industry could be further hobbled by restrictions brought on by swine flu.

 

Globally, the World Health Organization raised its alert level but stopped short of calling the outbreak a pandemic.

 

In Mexico, the illness has infected about 2,000 people and is suspected of claiming about 150 lives, although not all deaths have been confirmed as resulting from flu. It has shut schools, closed churches and emptied streets in Mexico City. One case has been confirmed in Spain and one is suspected in France, prompting European officials to warn citizens against visiting the U.S. and Mexico.

 

The CDC's Besser called that warning, in the case of the U.S., "quite premature."

 

Domestic cases have been reported in New York, Texas, California, Ohio and Kansas, according to the CDC. Twenty cases confirmed Monday were from the same New York City school where other cases had been found.

 

Officials know that this flu appears to be spreading from person to person, but they are not sure how virulent it is. Younger people in Mexico have died from it, but not the babies and older people who are most endangered by seasonal flu.

 

This year's flu shots are ineffective against the strain, but CDC scientists are considering whether to develop a vaccine that includes the strain for the fall, a difficult undertaking.

 

"Over the course of the next week or two, we'll know a whole lot more," Besser said.

 

The new virus is part human, part avian and part porcine. "It has a mix of new genes," said Dr. Ruth Karron, director of the Center for Immunization Research and the Johns Hopkins Vaccine Initiative at the Johns Hopkins Bloomberg School of Public Health. "It's a virus that humans have not previously been exposed to, so there's no immunity to this flu. We're broadly susceptible to this flu."

 

Flu experts have been on high alert in recent years, trying to prepare for the next unanticipated strain.

 

"We were all thinking about bird flu," Karron said. "We were looking to Asia for the development of the next pandemic strain, and here we have a swine flu outbreak in the Americas. It's not where we were expecting to see it."

 

Still, she said, past outbreaks have made the country "much better prepared."

 

At the Johns Hopkins Medical campus, a team of about 75 people has been working around the clock for the past 56 hours, drawing on existing disaster plans to devise a strategy for dealing with swine flu, said Dr. Gabe Kelen, director of Hopkins' Office of Critical Event Preparedness and Response.

 

But preparing for the unknown is tricky, particularly in a vast medical complex, said Kelen. Among the decisions the hospital must make: how to screen patients, protect health care workers and determine whether there is enough anti-viral supply, and, if a higher level of preparedness is needed, how to get that message out.

 

Public health officials appear to be taking measured steps and choosing their words carefully, he said.

 

"We want to be prepared should this turn out ugly, but we don't want to alarm anyone either," he said. "We are being pre-emptive within reason."

 

The hospital has begun preparing for the possibility of infections here. Admitted patients and visitors to the emergency room and outpatient clinics were being screened for symptoms of the influenza-like illness.

 

Colmers and Gov. Martin O'Malley tried to assure the public in a news conference Monday that Maryland is prepared to deal with any cases that emerge, using its pandemic flu preparedness plan as a guide. The state has a supply of about 265,000 courses of anti-viral medication, said Colmers. If a shortage arises, it can tap into an additional 200,000 from the federal stockpile, he said.

 

A command center was established at the health department's Baltimore headquarters Monday, with dozens of members of the state emergency response team typing away on laptops that communicate with local hospitals and health departments to keep track of flu-like symptoms. The surveillance system also monitors over-the-counter medicine sales in local drugstores.

 

Local government health workers are also on alert, with county agencies publishing updates on their Web sites and monitoring hospitals in their area.

 

Officials are warning people with flu symptoms who have also visited an infected area, or have been in close contact with someone who has, to stay home and call their doctor. If symptoms worsen -- including shortness of breath, sudden dizziness or confusion, pain or pressure in the chest or abdomen and severe or persistent vomiting -- people should seek medical attention and possible testing for swine flu, officials said.

 

Dr. Charles Haile, chief of infectious diseases at Greater Baltimore Medical Center in Towson, said his patients aren't yet worried about this disease, but he is. There are some similarities to the pandemic Spanish flu of 1917-1918, he said, which killed an estimated 50 million people. That flu also began in the spring, disappeared over the summer and then struck again once cold weather returned, he said.

 

He thinks the same thing is likely with this swine flu, which is hitting as the flu season ends. "If that's the case," he said, "there is sufficient time to develop a vaccine and have it available in the Northern Hemisphere."

 

Baltimore Sun reporters Tyeesha Dixon, Larry Carson and Mary Gail Hare contributed to this article.

 

Copyright 2009 Baltimore Sun.

 

CDC: 'Fully expect we will see deaths'

 

By Mike Stobbe

Frederick News Post

Tuesday, April 28, 2009

 

A U.S. health official said at least five people are hospitalized with swine flu in the United States and deaths are likely.

 

"I fully expect we will see deaths from this infection," as swine flu cases are investigated, said Richard Besser, acting director of the federal Centers for Disease Control. He said he did not know about a newspaper report of two deaths in two southern California hospitals in which the victims seemed to be suffering from swine flu symptoms.

 

"I would say I'm very concerned," Besser said. "We are dealing with a new strain of influenza, we're dealing with a strain of influenza that appears to be moving through our community."

 

Based on the latest lab analysis, Besser said new flu infections are still occurring. He noted, however, that ordinary human flu accounts for about 36,000 deaths every year in the U.S.

 

He said hospitalizations nationwide include three in California and two in Texas.

 

Besser said the country has 64 confirmed cases in five states, with 45 in New York, one in Ohio, two in Kansas, six in Texas and 10 in California. At least four other cases have been reported by states.

 

Press Association

 

iCopyright © 2009 Associated Press.

 

Two local scientists named to National Academy of Sciences

 

By Frank Roylance

Baltimore Sun

Tuesday, April 28, 2009

 

Two Maryland scientists were elected Tuesday as members of the National Academy of Sciences, the prestigious body organized by Congress in 1863 to advise lawmakers on matters of science and technology.

 

They are Adam Riess, an astrophysicist at Johns Hopkins University who was the lead author on the first paper to describe the surprising discovery in 1998 that the expansion of the universe is accelerating; and John D. Weeks, a University of Maryland chemist and biochemist studying the interaction of materials at the molecular level.

 

Riess and Weeks were among 72 new members elected Tuesday. Active membership now includes 2,150 U.S. scientists and engineers, plus 404 non-voting foreign associates. Although chartered by Congress, the academy is a private body dedicated to "the furtherance of science and its use for the general welfare."

 

Copyright 2009 Baltimore Sun.

 

Local Officials Prepare For Arrival of Swine Flu

 

By Ashley Halsey III and Lori Aratani

Washington Post

Tuesday, April 28, 2009

 

Against a backdrop of 30 state emergency workers in matching polo shirts receiving computer reports from health centers and hospitals, Maryland health authorities said yesterday it is virtually inevitable that swine flu will surface in the Washington region.

 

"It's not a matter of if, it's a matter of when," said David Paulson of the state Department of Health and Mental Hygiene. "It's just too darn infectious, and we have too many people in this area who travel."

 

Gov. Martin O'Malley (D) trooped into the swine flu command center in Baltimore with a phalanx of health officials yesterday to underscore the coordination and communication efforts of state and regional officials as they seek to identify and deal with an illness that has not yet surfaced here.

 

O'Malley said the state has stockpiled 276,000 courses of antiviral medication and has access to 200,000 from the federal Centers for Disease Control and Prevention. In Richmond, where another state command center opened, Gov. Timothy M. Kaine (D) said that it was not certain that swine flu would hit Virginia but that the state had enough medication on hand to treat 770,000 cases and that drugs for treating 280,000 more were on their way from the CDC.

 

In the District, health department spokeswoman Dena Iverson said the city is carefully monitoring reports from health systems and also expects to receive antiviral medicine from the CDC.

 

In all three jurisdictions, health officials were rolling out crisis management plans developed, tested and honed in the aftermath of Sept. 11, 2001, attacks coupled with the deadly anthrax attacks later that year. "We have been planning for a situation like this for many years," Kaine said, echoing exactly the words of Maryland Health Secretary John M. Colmers.

 

Both states are using computer-linked reporting from hospital emergency rooms and health centers to provide almost immediate data on flulike symptoms. In addition, Maryland is using its system for monitoring over-the-counter sales in pharmacies to watch for any uptick in the sale of remedies used for respiratory problems.

 

Sheliah Roy, a spokeswoman for Sibley Memorial Hospital, which is making masks and hand wipes available to people coming to the emergency room, said that as of mid-morning yesterday five people had come to the District hospital to be tested for swine flu, but no cases had been confirmed.

 

At Dulles International Airport, some passengers arriving on United Airlines' afternoon flight from Mexico City wore surgical masks as they cleared customs.

 

"It was very strange in the plane," said Iasas Lagums of Harrisonburg. "And in the restaurant in the [Mexico City] airport, even the pilots wore masks."

 

Frank Calia, an infectious-disease specialist who chairs the department of medicine at the University of Maryland School of Medicine, said that swine flu will surface within three days of contact with someone else who has the illness.

 

Whatever their personal precautions, travelers found a measured response by U.S airports. So far, Transportation Security Administration and customs agents are doing nothing to screen passengers from Mexico other than watching them for obvious flu symptoms.

 

The airlines have instituted the same "passive surveillance" program, instructing ticket agents to alert security or CDC officials if they encounter sick passengers.

 

In an effort to reach out to immigrant communities, officials have also done interviews on Spanish radio and television, emphasizing the importance of hand washing and other strategies to keep the virus at bay.

 

The growing anxiety was particularly palpable yesterday in Riverdale, where so many Mexican immigrants have settled in recent years that most shop signs in the Prince George's County town are painted red and green, like the Mexican flag.

 

About 10 patients have called to request vaccination shots from Centro Medico Riverdale, a private health clinic serving mostly Mexicans, according to medical assistant Brenda Martinez. Though she tells callers that the only shots available are against regular flu, several have made appointments anyway.

 

"This is definitely a sign of concern," said Martinez. "Normally we would never get requests for flu shots this late in year."

 

Elizabeth Duarte, 31, one of the patients seated in the clinic's waiting area late yesterday morning, was trying a different strategy: "Yesterday I bought four bottles of that disinfectant hand gel to keep in different places all around my house," said Duarte, who is Guatemalan but was worried because most of her co-workers at a nearby McDonald's are Mexican.

 

Jaime Susunaga, 50, a Mexican-born butcher at the El Super Store supermarket at the nearby Plaza del Alamo strip mall, said he has been searching for a surgical mask since Saturday.

 

"People can laugh at me, but if I can find a mask, no one is taking it off me," he said, shouting to be heard over a Mexican cumbia tune playing on his stereo at the back of the store. "You just don't know if someone around here has just gotten back from Mexico and is carrying the virus."

 

Staff writers Steve Hendrix, N.C. Aizenman, Anita Kumar and Michael Birnbaum contributed to this report. Comments: health@washpost.com.

Copyright 2009 Washington Post.

 

National / International

 

Obama Seeks to Ease Fears on Swine Flu

 

By Robert Pear and Gardiner Harris

New York Times

Tuesday, April 28, 2009

 

WASHINGTON — The Obama administration dispatched high-level officials from several agencies Monday to allay concerns about swine flu and to demonstrate that it was fully prepared to confront the outbreak even as the president said there was “not a cause for alarm.”

 

Janet Napolitano, the secretary of homeland security, and Dr. Richard E. Besser, the acting director of the Centers for Disease Control and Prevention, said the administration was prepared to respond to any further spread of the swine flu virus.

 

Homeland security officials said they expected the outbreak to spread. “We are proceeding as if we are preparatory to a full pandemic level,” Ms. Napolitano said.

 

As the administration responds to its first domestic emergency, it is building on concrete preparations made during the tenure of President George W. Bush that have won praise from public health experts. But its actions are also informed by what Mr. Bush learned in his response to Hurricane Katrina: that political management of a crisis, and of public expectations, can be as important as the immediate response.

 

In a speech at the National Academy of Sciences on Monday, Mr. Obama said only a few words about swine flu. “This is, obviously, a cause for concern and requires a heightened state of alert,” he said. “But it’s not a cause for alarm.”

 

But behind the scenes at the White House, aides said the president was directing his administration to be ready in case an alarm needed to be sounded. A full report on the swine flu was added to Mr. Obama’s daily intelligence briefing, with updates given to him throughout the day.

 

Aides said they were mindful that how the president conducted himself in this period, both substantively and stylistically, would be long remembered. But they adamantly rejected the idea that this situation was at all comparable to that of the hurricanes that devastated the Gulf Coast in 2005.

 

Finding the right mix of alarm and reassurance is a delicate task for an elected official.

 

Eric Toner, a senior associate at the Center for Biosecurity at the University of Pittsburgh Medical Center, said: “It can be very dangerous to overreact. And it can be very dangerous to underreact.” So far, Mr. Toner said, Obama administration officials “have managed to get it just right.”

 

Other public health experts also endorsed the administration’s response to the outbreak that emerged from Mexico. They gave much of the credit to President Bush, whose administration did extensive planning for such an emergency.

 

“We’re seeing a payoff of the original investment made in pandemic preparedness by the Bush administration,” said Jeffrey W. Levi, executive director of Trust for America’s Health. The term pandemic refers to a widespread outbreak of an infectious disease.

 

Frances Fragos Townsend, who was assistant to President Bush for homeland security and counterterrorism, noted that the Department of Health and Human Services had devised a detailed plan for responding to the threat of pandemic flu in 2005 and 2006.

 

On his summer vacation in 2005, Mr. Bush read “The Great Influenza,” a history of the 1918 pandemic by John M. Barry.

 

Mr. Obama also displayed interest in pandemic flu in 2005. Within months of taking office as a senator, he introduced a bill to step up preparations, saying: “We are in a race against time. The nation’s health officials have made some progress in preparing for pandemic influenza. Yet we have much work to do.”

 

The swine flu outbreak has been linked to 149 deaths in Mexico. In the United States, the number of confirmed cases grew to 50 on Monday.

 

While experts praised the Obama administration’s initial response, many warned that a more extensive outbreak of swine flu could tax the nation’s public health capabilities.

 

“If this gets worse, you’ll see the weakness of our system,” said Dr. Jeffrey P. Koplan, a former director of the Centers for Disease Control and Prevention. “In an event like this, where everyone’s well-being is dependent on everyone else’s, we will both feel and see the problems our system creates.”

 

Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, said federal officials reported six years ago that hospitals would need far more beds, ventilators and personal protective equipment to respond to a pandemic. Hospitals never got nearly enough extra equipment, Dr. Redlener said.

 

“We will pay a very heavy price for this if we get the big one,” he said.

 

The White House press secretary, Robert Gibbs, said Monday that the administration was not at a disadvantage because of vacancies in top federal health positions.

 

“Our response is in no way hindered or hampered,” Mr. Gibbs said. When pressed to say whether White House officials would prefer to have a full team in place, he said, “We’d rather not have a swine flu.”

 

Dr. June E. Osborn, former dean of the School of Public Health at the University of Michigan, said the Obama administration appeared to be responding effectively, even without a secretary of health and human services.

 

Mr. Obama’s nominee for health secretary, Gov. Kathleen Sebelius of Kansas, is waiting for Senate confirmation. Senate action has been delayed in part by Republican questions about Ms. Sebelius’s views on abortion.

 

On Tuesday, the Senate is scheduled to begin debate on the nomination, under an agreement that will require 60 votes for confirmation.

 

Twenty positions at the Department of Health and Human Services are filled by the president, subject to Senate confirmation. Mr. Obama has nominated people to fill five of those positions, and none have been confirmed.

 

Dr. Besser, the acting director of the Centers for Disease Control, brings his experience as a past director of the Office for Terrorism Preparedness and Emergency Response at the centers to his task of dealing with the swine flu threat.

 

Ms. Napolitano said her agency went into the crisis with more than a dozen vacancies in senior positions, including the commissioner for customs and border patrol, the assistant secretary for health affairs and the under secretary for intelligence analysis. She said those jobs were being handled by career civil servants, working from detailed contingency plans inherited from the Bush administration.

 

Dr. Nicole Lurie, director of the public health preparedness program at the RAND Corporation, said, “The federal government has come together with a pretty good, unified response” to the swine flu outbreak.

 

From the Hurricane Katrina experience, Dr. Lurie said, federal officials learned “the importance of coordinating the government response, communicating with the public and mobilizing equipment” as fast as possible.

 

In recent years, she said, federal, state and local officials have conducted many exercises so they would be prepared to respond to emergencies.

 

Since 2005, federal and state governments have spent more than $1.5 billion to stockpile Tamiflu and Relenza, antiviral medicines recommended by the government to treat infection with the swine flu virus.

 

Ginger Thompson and Jeff Zeleny contributed reporting.

 

Copyright 2009 New York Times.

 

Swine Flu Spreading, but Officials Say Travel Restrictions Do Little to Help

CDC Raised Number of Confirmed Cases to 64

 

By Rob Stein and William Branigin

Washington Post

Tuesday, April 28, 2009

 

Health authorities in the United States and around the world reported new confirmed cases of swine flu today, but international health officials said there was little point in imposing border or travel restrictions or otherwise trying to contain the virus.

 

The U.S. Centers for Disease Control and Prevention (CDC) in Atlanta said 64 laboratory-confirmed cases of swine flu have now been reported in five states -- up from 40 confirmed cases yesterday -- with most of the illnesses found among students at a single high school in New York City. Other cases have been confirmed in California, Kansas, Ohio and Texas, the CDC said. The CDC tally did not include some cases confirmed by state officials, including one reported by the Indiana state health department today, which said a young adult in the northern part of Indiana had contracted the virus but was not seriously ill.

 

"The human swine flu outbreak continues to grow in the United States and internationally," the CDC said in its latest bulletin. "Today, CDC reports additional cases of confirmed swine influenza and a number of hospitalizations of swine flu patients. Internationally, the situation is more serious too, with additional countries reporting confirmed cases of swine flu."

 

Earlier today, cases of swine flu were confirmed in Israel and New Zealand, the first definitive proof that the dangerous new virus has spread to the Middle East and Asia-Pacific regions.

 

The World Health Organization raised its official tally of confirmed swine flu cases today from 73 to 79, adding a second case in Spain and confirming two cases in Britain and three in New Zealand.

 

The WHO tally has lagged behind national counts of swine flu cases because of the Geneva-based organization's reporting requirements.

 

All the new confirmed WHO cases are associated with people who traveled to Mexico, officials said.

 

"These are direct travel-related infections right now," said Keiji Fukuda, the WHO's assistant director general for health security and environment. "These are really critical to identify. Right now it's critical to identify every case. It helps us to monitor what the potential spread of the virus is worldwide and how the epidemic is moving."

 

While the number of new cases is rising, it is far too early to say a pandemic is beginning, Fukuda said.

 

"The evolution into a pandemic cannot be considered inevitable, but of course we are taking this possibility very seriously," he said. "Countries should really take this opportunity to prepare themselves for the possibility for a pandemic."

 

The WHO, which yesterday raised its pandemic threat level from 3 to 4, two levels below a full-scale pandemic, will not meet today to consider another increase, a spokesman said at a news conference.

 

The level 4 alert could prompt health authorities in some circumstances to launch massive efforts to contain an outbreak, but Fukuda said the virus had spread too widely to make that realistic.

 

"At this time, containment is not a feasible option," Fukuda said. "This virus has already spread quite far."

 

"With the virus being widespread," he said, "closing borders or restricting travel really has very little effect in stopping the movement of this virus."

 

Instead, the alert was designed to prompt countries to intensify efforts to minimize the spread of the virus by identifying new cases and clusters quickly and taking other measures.

 

"Given the current situation, the current focus of efforts should be on mitigation efforts," he said.

 

Fukuda urged people who are sick not to travel and said travelers who become ill should seek medical attention.

 

The agency also said it would work to develop a swine flu vaccine as quickly as possible, but it rejected proposals to try to deploy a swine flu vaccine instead of the vaccine already in development for the next regular flu season.

 

While the WHO recommended against closing international borders, it said individual countries were free to set their own policies. "Countries are free to do as they wish," said WHO spokesman Timothy O'Leary.

 

In China, officials reported no confirmed cases of swine flu on the mainland, but state media said a Hong Kong woman who developed flu-like symptoms after returning from a trip to the United States is being tested. The 27-year-old woman was admitted to a hospital on Sunday and is stable, the local Center for Health Protection said. The government has designated three Beijing area hospitals to handle any patients who report flu-like symptoms.

 

Chinese Premier Wen Jiabao was briefed today by several government agencies on steps to bolster defenses against an outbreak in China, including examinations at the border of all travelers from affected regions. The government also banned the import of pork products from Mexico and the states of Texas, California and Kansas.

 

The U.S. government denounced the ban and similar actions by several other countries, saying the virus is not transmitted by consuming meat and warning that the restrictions "may result in serious trade disruptions without cause."

 

U.S. Trade Representative Ron Kirk and Agriculture Secretary Tom Vilsack issued a joint statement to stress that "the American food supply is safe."

 

"Swine influenza viruses are not spread by food," the CDC said on its Web site. "You cannot get swine influenza from eating pork or pork products."

 

In Spain, Health Minister Trinidad Jimenez announced the country's second confirmed case of swine flu: a 24-year-old man in Valencia who was examined earlier in Madrid but returned to the hospital after his symptoms persisted. Jimenez said the first swine flu patient is recovering and is likely to be released soon.

 

The French Foreign Ministry, meanwhile, said that "because of a flu epidemic" it strongly advised against travel to Mexico "except for imperative reasons."

 

Britain, the Netherlands and Italy issued similar notices. The European Union as a whole has not advised against travel to specific destinations, but the E.U. health commissioner yesterday discouraged unnecessary travel to parts of North America that have experienced outbreaks of swine flu.

 

At the epicenter of the outbreak, in Mexico, the situation continued to deteriorate. Although the number of confirmed deaths remained at 20, the suspected death toll rose to 152, and at least 1,995 people had been hospitalized with pneumonia. Yesterday, Mexican officials announced they were shutting schools nationwide. The capital, Mexico City, where most of the cases have been reported, had already been brought to a virtual standstill by measures intended to contain the outbreak.

 

New Zealand's health ministry said today that three people who tested positive for the virus had been part of a school group that recently visited Mexico, Reuters reported. Officials told the news service that they were awaiting test results for the other eight people in the group but expected them to test positive as well.

 

The 26-year-old man found to be suffering from the virus in Israel also had just returned from Mexico, officials said. Matilda Schwartz, spokeswoman for Laniado Hospital in Netanya, said the patient remained in isolation. She said he was in good condition and improving. A second person remains under observation in a hospital in the town of Kfar Saba, north of Tel Aviv, officials said. U.S. and state health officials, meanwhile, said yesterday that the number of confirmed cases had more than doubled to 45 and recommended that Americans put off unnecessary travel to Mexico. "This is out of an abundance of caution," said Richard E. Besser, acting director of the CDC in Atlanta.

 

"We want to be aggressive and take bold action to minimize the impact on people's health from this infection," Besser said during a briefing with reporters.

 

Most of the new U.S. cases were tied to an outbreak at a Catholic high school in New York, where more than 100 students got sick last week after several returned from a spring break trip to Mexico. Eight students were confirmed to have swine flu on Sunday, and at least 20 more were determined Monday to have the virus as well, New York officials said. The new cases are the result of additional testing and not a sign that the infection is still spreading there, Besser said. He added that all the cases were mild, except for one that required hospitalization, and that all the students had recovered.

 

In addition to the cases confirmed by the CDC, several states have reported swine flu cases that have not yet been included in the federal agency's tallies.

 

New Jersey officials reportedly identified five new suspected cases. Eleven have been confirmed in California, including two that required hospitalization, along with three in Texas, two in Kansas and one in Ohio. Confirmed or suspected cases have prompted officials in New York, Texas, California, South Carolina and Ohio to close schools.

 

In addition government efforts to contain the disease, Besser urged businesses to begin making contingency plans for workers calling in sick and said individuals should help reduce the chances that the virus will spread by taking common-sense steps, such as staying home from work or school if they are sick, washing hands frequently and covering mouths if they sneeze or cough.

 

"Hopefully this outbreak would not progress, but leaning forward and thinking about what you would do is one of the most important things individuals and communities can undertake right now," he said.

 

In Maryland, Virginia and the District, health officials activated plans developed in the aftermath of the 2001 terrorist and anthrax attacks. They are monitoring reports from hospitals and clinics and readying hundreds of thousands of doses of medication. Maryland officials said it was inevitable that the flu would hit the Washington region given how infectious it is and the large number of travelers who pass through the area.

 

Correspondents Joshua Partlow in Mexico, Jill Drew in Beijing, Edward Cody in Paris and Howard Schneider in Jerusalem and staff writers Debbi Wilgoren, Anthony Faiola, Spencer S. Hsu, Michael D. Shear and Ashley Halsey III in Washington contributed to this report.

 

Copyright 2009 Washington Post.

 

Inside Out

Unlike Standard Colonoscopy, an Invasive Procedure Performed Under Anesthesia to Find And Remove Polyps, Virtual Colonoscopy Involves a Simple Scan. But Is It as Effective?

 

By Sandra G. Boodman

Washington Post

Tuesday, April 28, 2009

 

When Eric Rowe turned 50, the question was not whether the Washington lawyer would be screened for colon cancer, but how. His wife had undergone a colonoscopy, the gold-standard exam that costs about $1,500, but Rowe's internist recommended an alternative that was less invasive and expensive: a virtual colonoscopy, which uses three-dimensional images from a CT scan to detect benign polyps or cancers.

 

"It sounded good to me," said Rowe, pleased that he could schedule the $800 procedure for 7:45 a.m. at a downtown medical building. Unlike standard colonoscopy, generally performed under anesthesia, in which a long, flexible scope is inserted into the rectum and snaked through the large intestine to find and snip out polyps, the new procedure doesn't require a ride home or a day off. Rowe planned to be at his desk an hour or so later.

 

Invented 16 years ago by a radiologist who got the idea while playing video games on a flight simulator during advanced training at Johns Hopkins, virtual colonoscopy has become an increasingly popular alternative to standard, or optical, colonoscopy, which is typically performed by a gastroenterologist. Initially regarded as a high-tech novelty, the new procedure has in recent months received key endorsements as a first-line screening test from influential medical groups, notably the American Cancer Society, after several large studies found it to be effective at finding large polyps.

 

Like other mass screening tests including mammography, the overarching question is whether the benefits of virtual colonoscopy outweigh the risks.

 

Its supporters, many of them radiologists who read CT scans, tout virtual colonoscopy as a more palatable alternative that has the potential to boost low rates of screening. One of the most common and deadliest malignancies, colon cancer can be prevented -- or even cured -- if detected early. Currently about half of Americans over 50 are screened for the disease; some shun traditional colonoscopy, which is the only way to remove polyps, because of its invasive nature.

 

"This is a really good test that's going to find way more cancer than optical colonoscopy," said Mark Klein of Washington Radiology Associates, who has performed more than 1,200 virtual colonoscopies since 2002, Rowe's among them. "Is it perfect? No. But no test is."

 

The prospects for significant expansion of the procedure, which is covered by a growing number of insurance companies, have collided with a large and unexpected roadblock. In February, officials at the Centers for Medicare & Medicaid Services (CMS) announced a preliminary decision not to cover the procedure as a mass screening test for Medicare recipients.

 

CMS officials, who are scheduled to issue their final ruling May 12, cited reservations expressed by the U.S. Preventive Services Task Force, an independent panel of health experts, and concluded that there is insufficient evidence that virtual colonoscopy would benefit Medicare recipients. CMS cited concerns about radiation exposure and the number of patients who would require follow-up colonoscopies to remove polyps, as well as the inability of CT scans to reliably detect small or flat growths.

 

Medicare's decision has sparked a furious lobbying campaign. More than 40 members of Congress have signed letters urging federal officials to reconsider, and the dispute has split doctors in the same specialty: the American Gastroenterological Association favors Medicare coverage, while the American College of Gastroenterology does not.

 

In many ways, the debate mirrors some of the complexities inherent in overhauling health care, a top priority of the Obama administration. At issue is whether virtual colonoscopy will enhance quality or whether it is, in the words of one physician blogger, "a proxy for high-tech excesses."

 

"CMS made the right decision," said John Petrini, a Santa Barbara, Calif., gastroenterologist who heads the American Society for Gastrointestinal Endoscopy. Why, he asks, should patients undergo two tests when one is sufficient?

 

Klein disagrees. "They got it completely wrong," he said. "Some people will die from that decision, completely unnecessarily," because they won't get a standard colonoscopy.

 

Through a Peephole

One of the benefits of virtual colonoscopy is its ability to detect other cancers and abnormalities -- tumors in the kidney, liver or lungs, and aortic aneurysms -- because of its crisp images involving a wider area of the body. Klein likens the visualization to seeing who's ringing a doorbell: Optical colonoscopy involves peering through a peephole, while virtual colonoscopy means opening the door.

 

Proponents say CT scan technology also makes it easier for doctors to find polyps and cancers on the right side of the colon, which can be missed in optical colonoscopy for anatomical reasons.

 

"It is a double-edged sword," said David Vining, a professor of diagnostic radiology at M.D. Anderson Cancer Center in Houston, who invented virtual colonoscopy. Incidental findings can trigger a cascade of expensive, invasive, anxiety-provoking tests that in most cases will reveal something benign. But Vining said that in about 5 percent of patients, virtual colonoscopy can find a serious problem such as cancer "that can be easily treated and cured" and might otherwise be discovered at a much later stage, when treatment is more difficult and its outcome less favorable.

 

The preventive services task force found that 7 to 16 percent of patients who undergo virtual procedures will have a finding "of potential clinical significance," but the panel said it is not known whether discovery "results in better outcomes for patients; it is possible that they result in extra follow-up testing without associated benefit." And it is up to the radiologist to determine whether an abnormality is benign or merits further investigation.

 

Unlike optical colonoscopy, in which all polyps are removed, many radiologists do not report most growths smaller than about five millimeters, believing they are usually harmless and slow-growing.

 

"Who knows whether those polyps turn into cancer?" said M.D. Anderson gastroenterologist G.S. Raju, adding that some researchers believe there is a subset of small polyps that are aggressive and malignant.

 

Rosemarie Blair of Newark, Del., believes virtual colonoscopy saved her life. After a 37-year-old friend died of colon cancer several months ago, the 60-year-old legal secretary made an appointment for a virtual colonoscopy, which is covered by her insurer. She had never undergone the traditional test because, she said, "I was scared of being put to sleep."

 

The doctor found two polyps, which were removed a few hours later because the center she went to offers same-day optical colonoscopy. Two days later, Blair's internist called: The radiologist had spotted something suspicious on her kidney. An ultrasound revealed early-stage kidney cancer; Blair, who had not experienced any symptoms, underwent surgery in March to remove her right kidney. Doctors told her that because it was caught early, unlike most kidney cancers, she does not need chemotherapy or radiation, and her chances of a complete recovery are excellent.

 

But incidental findings are no reason to choose virtual colonoscopy, proponents emphasize. "You don't get [it] to look at the rest of your body," said Brooks Cash, chief of medicine at the National Naval Medical Center in Bethesda.

 

For the past few years, patients at the Navy's flagship hospital have been able to choose either form of colonoscopy and, if necessary, have both procedures the same day. So far, Cash said, more than 7,000 patients have undergone virtual colonoscopy -- about 40 percent of the total. Most surprising to Cash, a gastroenterologist, is that 37 percent of patients Navy officials surveyed said they wouldn't have been screened without virtual colonoscopy.

 

"We don't view it as a replacement or better than colonoscopy, but as another screening tool," he said. "It's an uncomfortable test and there's no sedation, but people do prefer it because of the convenience factor."

 

Exposure to radiation from virtual colonoscopy, which is supposed to be repeated every five years, remains a concern; studies have found that multiple CT scans can increase the risk of cancer. Cash said he does not consider radiation exposure from virtual colonoscopy to be a problem. The amount from one test, he said, is "less than an airline pilot would get in one year of flying."

 

But Petrini in Santa Barbara says he has "serious concerns," because one virtual test is equivalent in radiation dose to 250 chest X-rays.

 

Virtual colonoscopy does not eliminate one of the most frequently cited impediments to screening: the dreaded prep. Patients undergoing both kinds of colonoscopy must drink a large quantity of vile-tasting, bowel-cleansing liquid before the test. And unless a practice offers same-day optical colonoscopy -- and most don't -- patients who need a follow-up procedure to remove polyps must drink it twice.

 

Clean Bill of Health

At Washington Radiology Associates, one of the few local practices offering virtual colonoscopy, the demand for the procedure has increased in the past year, a reflection of growing referrals from primary care physicians.

 

One recent weekday morning Rowe, the first patient of the day, listened intently as Klein explained that a technician would first insert a small, flexible tube into his rectum so that carbon dioxide could be pumped in to inflate his colon, enhancing its visibility. This can cause some transitory cramping, he told Rowe, but few patients find it painful. "There's no danger of you exploding," he quipped. Rowe smiled wanly.

 

The lawyer climbed onto the table and lay motionless on his back, then his stomach, as rapid-fire X-rays of his colon were shot, then assembled into three-dimensional images on the computer. Back in the darkened reading room Klein immediately sees that a portion of Rowe's colon did not distend sufficiently, which occurs in about 10 percent of cases. Rowe, who had been sitting in a waiting area, gets back on the table for another go-round.

 

The radiologist then spends the next 20 minutes reading the scan. The experience is reminiscent of watching an Imax movie as Klein "flies" through Rowe's colon, which resembles an orange cave with low-hanging walls. Using the computer mouse, Klein swoops in to inspect possible abnormalities: a potential polyp turns out to be just pooled fluid.

 

"I'm pretty much 95 percent sure he's fine," Klein says, methodically zeroing in on six areas flagged by the specialized software. "He probably hasn't had the best diet -- a lot of cheeseburgers," he adds, noting the many diverticula, pouches in the intestine that are common as people age and may be related to a low-fiber diet.

 

The last check is of Rowe's liver, lungs and spine: Klein notes some degeneration of Rowe's spine indicative of arthritis. He heads off to find Rowe, who has stayed to get the results, instead of returning to his office to await a phone call.

 

"There are no polyps, no tumors, and the rest of your body is fine as far as we can tell," Klein says, mentioning the diverticulosis and osteoarthritis, of which Rowe was already aware.

 

Later that day, Rowe said he felt "pretty good" -- pleased with the test and his ability to go to work afterward. "I'll probably do another one in five years," he said.

 

Copyright 2009 Washington Post.

 

US wants ingredient in swine flu vaccine by May

 

Associated Press

By Lauran Neergaard

Washington Post

Tuesday, April 28, 2009

 

WASHINGTON -- U.S. scientists hope to have a key ingredient for a swine flu vaccine ready in early May, but are finding that the novel virus grows slowly in eggs _ the chief way flu vaccines are made.

 

Even if all goes well, it still will take a few months before any shots are available for the first required safety testing, in volunteers.

 

"We're working together at 100 miles an hour to get material that will be useful," Dr. Jesse Goodman, who oversees the Food and Drug Administration's swine flu work, told The Associated Press.

 

Using samples of the new swine flu, taken from people who fell ill in Mexico and the U.S., scientists are engineering a strain that could trigger the immune system without causing illness.

 

"We're about a third of the way" to that goal, Dr. Ruben Donis of the Centers for Disease Control and Prevention said in an interview Tuesday.

 

The hope is to have that ingredient _ called a "reference strain" in vaccine jargon _ to manufacturers around the second week of May, so that they can begin their own laborious production work, Donis said.

 

But, "this is biology, not mathematics," he cautioned.

 

To further speed the vaccine hunt, the CDC has shipped a raw sample of the new virus to one manufacturer _ Gaithersburg, Md.-based MedImmune LLC, which sells the only flu vaccine given via a nasal spray instead of a shot. MedImmune thus uses a slightly different approach to creating influenza strains suitable for that spray, Donis explained.

 

Health authorities are struggling to rein in the swine flu epidemic that has sparked a global crisis since discovery of the never-before-seen strain just last week _ and the world learned that travelers to Mexico, where dozens may have died, were carrying the bug home.

 

Standard anti-flu drugs can treat the illness. But the world has no vaccine that prevents this new strain, a mix of pig, human and bird viruses that people presumably have little natural immunity to. And if the virus ultimately spreads enough to spark a pandemic _ which hasn't happened yet and may not _ a vaccine would be key to mitigating the disaster.

 

Vaccine manufacturers are just beginning production for next winter's regular influenza vaccine, which protects against three human flu strains. Monday, the World Health Organization said factories should stay with that course for now _ it won't call for mass production of a swine flu vaccine unless the outbreak worsens globally.

 

Think of flu viruses as wearing coats, changeable proteins on their surface that trigger the immune system to mount an attack. Those proteins give flu strains their main identity: This new swine flu is part of the Type A/H1N1 family _ the "H" being a version of the protein hemagglutinin and the "N" is the protein neuraminidase. Matching those H and N components forms the basis of a vaccine.

 

First researchers had to grow enough virus samples, culled from a handful of patients, to work with. Influenza virus traditionally is grown by injecting it into fertilized chicken eggs, but this novel virus didn't grow easily there. There's an alternative, growing it in vats of cells instead, but most flu vaccine manufacturers today still rely on eggs.

 

"There is a little bit of concern there," said CDC's Donis, whose laboratory eventually created three samples that did grow in eggs, just slowly. More work is under way to try to improve that.

 

Next, using a technique called reverse genetics, scientists are selecting genes for the swine flu's H and N antigens to create a customized strain and look for signs that it will prompt a good immune response. Then manufacturers would get the strain to start their own production supply, which could take another two months.

 

"It's worth taking that time at the very beginning to really make sure you've got exactly what you want," said MedImmune senior director Dr. Kathleen Coelingh. "We've got to get this right."

 

But those initial pilot lots will go straight into human safety tests already being planned, Goodman said. Flu vaccine in general is very safe. But in 1976, thousands claimed side effects from a swine flu vaccine administered after an outbreak at Fort Dix, N.J., that never spread.

 

For now, manufacturers are studying production options. Sanofi Pasteur, the world's largest flu vaccine maker, just opened a new U.S. factory but if necessary could keep its older one open as well just for swine flu vaccine production, said spokesman Len Lavenda. It also produces vaccine at a factory in France.

 

At Novartis AG, spokesman Eric Althoff said the company is studying which of its two technologies for vaccine-making would be better. The Swiss drugmaker can make vaccines both in eggs and in cell culture.

 

AP Business Writer Linda A. Johnson in Trenton, N.J., contributed to this report.

 

© 2009 The Associated Press.

 

Swine flu's ground zero? Residents say nearby farm

 

Associated Press

By Olga R. Rodriguez

Washington Post

Tuesday, April 28, 2009

 

LA GLORIA, Mexico -- The people in this town of 3,000 high in the Veracruz mountains believe their community is ground zero for the swine flu epidemic, even if health officials deny it.

 

The town is home to Mexico's earliest confirmed case of swine flu, a 4-year-old boy who was among more than 450 residents who complained of respiratory problems. They blame contamination spread by pig waste at nearby breeding farms co-owned by a U.S. company. But the company says it found no sign of swine flu on its farms, and Mexican authorities haven't determined how or where the swine flu outbreak began.

 

As early as February, residents began complaining of unusually strong flu symptoms. They blamed a farm that lies upwind, five miles (8.5 kilometers) to the north. By late March, roughly one-sixth of the community of 3,000 began suffering from severe respiratory infections.

 

Local health officials and Federal Health Secretary Jose Angel Cordova downplayed claims that the swine flu epidemic could have started in La Gloria, noting that of 30 mucous samples taken from respiratory patients there, only 4-year-old Edgar Hernandez's came back positive. That confirmation that the boy's virus was H1N1 _ a strange new mix of pig, bird and human flu virus _ wasn't made until last week, when signs of the outbreak elsewhere prompted a second look at his sample.

 

Cordova insists the rest of the community had suffered from H2N3, a common flu.

 

Animal health expert Peter Roeder, a consultant to the UN's Food and Agriculture Organization, said many possibilities exist for how the virus first jumped to humans, and that it could have happened months or even a year ago.

 

Roeder said it's possible someone tending the pigs could have passed a human influenza virus to a pig already infected with another type of swine flu, and then that pig could have also come into contact with a bird virus. Then, the new H1N1 virus formed could have been transmitted back to the workers.

 

But that's just a theory _ and no one has any evidence that it happened in La Gloria.

 

"It's all surmise," Roeder said by phone from the Philippines. "The only thing that we know is that we have a virus that is transmitting between people and it is causing some concern, and it has some characteristics derived from swine viruses, avian viruses and human viruses. And that's all we know for sure."

 

Still, Jose Luis Martinez, a 34-year-old resident of La Gloria, said he made the connection the minute he learned about the outbreak on the news and heard a description of the symptoms: fever, coughing, joint aches, severe headache and, in some cases, vomiting and diarrhea.

 

"When we saw it on the television, we said to ourselves, 'This is what we had,'" he said Monday. "It all came from here. ... The symptoms they are suffering are the same that we had here."

 

Martinez and Bertha Crisostomo, a liaison between the villagers and the municipal government of Perote to which La Gloria belongs, say half of the people from the town live and work in Mexico City most of the week, and could easily have spread the swine flu in the capital, where the largest number of cases have been reported.

 

The new swine flu strain suspected in 152 deaths in Mexico has now spread to at least six countries, and crossed new borders Tuesday with the first cases confirmed in the Middle East and the Asia-Pacific region.

 

Granjas Carroll de Mexico, half-owned by Virginia-based Smithfield Foods, Inc., has 16 farms in the area. Smithfield spokeswoman Keira Ullrich said the company has found no clinical signs or symptoms of the presence of swine influenza in its swine herd or its employees working at its joint ventures anywhere in Mexico.

 

But residents say they have been bothered for years by the fetid smell of one the farms, which lies upwind of the community, and they suspect their water and air has been contaminated by waste. Local health workers intervened in early April, sealing off the town of La Gloria and spraying to kill flies people said were swarming around their homes.

 

When Associated Press journalists on Monday entered a Granjas Carroll farm that has been the focus of community complaints, the cars were sprayed with water. Manager Victor Ochoa required the visitors to shower and don white overalls, rubber boots, goggles and masks and step through disinfectant before entering any of the 18 warehouses where 15,000 pigs are kept.

 

Ochoa showed the journalists a black plastic lid that covered a swimming pool-size cement container of pig feces to prevent exposure to the outside air.

 

"All of our pigs have been adequately vaccinated and they are all taken care of according to current sanitation rules," Ochoa said. "What happened in La Gloria was an unfortunate coincidence with a big and serious problem that is happening now with this new flu virus."

 

Martinez insists that most of the eight farms near La Gloria do not follow the same sanitary rules, instead leaving waste to decompose in the open air and with no filters to protect it from seeping into groundwater. He alleged that they also let some of their dead pigs decompose in cement cellars whose doors are left open aboveground.

 

Ochoa denied Martinez's claims and offered to take reporters to any of his company's 16 farms.

 

"Pick a number a number between one and 16, and I'll take you there," he said.

 

Martinez said residents have been fighting for years to force the company to improve their pig-waste management.

 

Mexican Agriculture Department officials said Monday that its inspectors found no sign of swine flu among pigs around the farm in Veracruz, and that no infected pigs have been found yet anywhere in Mexico. But Ochoa, the farm manager, said no one from the government has inspected his farm for swine flu.

 

Dr. Alejandro Escobar Mesa, deputy director for the control and prevention of disease for the state of Veracruz, blames the local epidemic of common flu in La Gloria on a combination of viral and bacterial illnesses, caused by an unusually dry climate.

 

"The dust dries up the mucous membranes and facilitates environmental conditions for the transmission of illnesses," Escobar said.

 

But residents here say they are certain that Edgar Hernandez was not the only swine flu victim in their town. Concepcion Llorente, a first-grade teacher in La Gloria, says authorities still owe the town some answers.

 

"They said that what we had here was an atypical flu, but if the boy tested positive for swine flu, where did he get it from?" she said.

 

AP Medical Writer Margie Mason and AP writers Mark Stevenson and Lisa J. Adams in Mexico City contributed to this report.

 

© 2009 The Associated Press.

 

Prostate cancer vaccine extends survival in study

 

Associated Press

By Marilynn Marchione

Washington Post

Tuesday, April 28, 2009

 

CHICAGO -- An experimental treatment added four months to the lives of men with advanced prostate cancer in a study that tested an entirely new approach to fighting the disease, doctors reported Tuesday.

 

Dendreon Corp.'s Provenge vaccine trains the immune system to fight tumors. It's called a "vaccine" even though it treats disease rather than prevents it.

 

Doctors have been trying to develop such a therapy for decades, and this is the first to meet a preset goal for improving survival in late-stage testing.

 

"There have been a lot of false starts, but this is a real start," said Dr. Paul Schellhammer, a urologist at Eastern Virginia Medical School in Norfolk, Va., who led the study. Results were reported Tuesday at an American Urological Association conference in Chicago.

 

Seattle-based Dendreon paid for the study, and Schellhammer owns stock in the company. Dendreon shares fell sharply, and then trading was halted leading up to the release of the data. Shares fell $9.74, or 45.2 percent, to $11.81. The reason was not immediately clear.

 

Four months may not sound like a lot, but it is longer than the three months afforded by Taxotere, the only chemotherapy approved for men in this situation. Doctors hope for even greater benefit if they give the drug earlier in the course of the disease. Dendreon would give no cost estimate for Provenge, but other such biotech drugs cost several thousand dollars a month.

 

It remains to be seen if side effects will keep Provenge from winning federal Food and Drug Administration approval. Two years ago, the FDA went against its advisers and delayed a decision, asking for more proof of safety and effectiveness.

 

The new study involved 521 men whose cancer had spread and wasn't responding to standard hormone treatments. Two-thirds were given Provenge, a treatment that is customized for each patient.

 

Doctors collect special blood cells from each patient that help the immune system recognize cancer as a threat. They are mixed with a protein found on most prostate cancer cells and another substance to rev up the immune system. The resulting "vaccine" is given back to the patient as three infusions two weeks apart.

 

The other one-third of men in the study had a dummy infusion.

 

Median survival was 26 months in men given Provenge and 22 months in the others. Three-year survival rates were 32 percent for the Provenge group and 23 percent for the others _ a 38 percent improvement.

 

Strokes and other brain-related problems were no more common with Provenge _ a worry raised by earlier studies. However, four men given Provenge suffered lung clots, though none were fatal. High blood pressure was twice as common with Provenge. Overall, the rate of serious side effects was the same in each group.

 

Improving survival "is the gold standard" for any treatment, and Provenge appears to do that, said Dr. Ira Sharlip, a urologist from the University of California in San Francisco and a spokesman for the urological association.

 

Dr. Otis Brawley, the American Cancer Society's chief medical officer, said the FDA had been right to ask for more study. Seeing the new results, he said, "I would vote for approval" as long as it didn't harm men's quality of life.

 

One patient said it did not hurt his. Thomas Robbins, 74, of Forest City, N.C., was diagnosed in 2002 with prostate cancer that was growing despite hormone treatment.

 

"They wanted to give me chemo," but he feared its side effects and enrolled in the Provenge study instead. He learned afterward that he had been one of those given the vaccine.

 

"Did it help me? I can't 100 percent guarantee, but I think it did," he said.

 

Advocacy groups cheered the results. Scott Riccio, founder of Accelerate Progress, called them "compelling."

 

"For the first time, we have real clinical validation that cancer can be fought by stimulating the body's immune system," he said in a statement. "Hundreds of thousands of men fighting prostate cancer will now have real hope that a safe and effective new option will be available to them in their fight for life."

 

Thomas Farrington, a prostate cancer survivor and founder of the Prostate Health Education Network, said: "Prostate cancer patients finally have hope for a better life. We are in desperate need of groundbreaking new treatments like Provenge."

 

Prostate cancer is the most common non-skin cancer in American men. An estimated 186,000 new cases and 28,660 deaths from it occurred last year.

 

On the Net:

Urology group:http://www.AUAnet.org

 

© 2009 The Associated Press.

 

Opinion

 

Paying for special ed

Our view: Public schools must provide better services for kids with special needs

 

Baltimore Sun Editorial

Tuesday, April 28, 2009

 

One of the most vexing and heart-rending decisions parents of children with disabilities must make involves what to do when the public schools aren't working for them. The federal Individuals With Disabilities Education Act requires local school districts to devote substantial resources to special-ed programs, and Congress and the courts have made it clear that every child has a right to a "free appropriate public education." But when the public schools fail to meet a child's needs, many parents seek help from private institutions - and hope the state will pick up the tab.

 

This week, the U.S. Supreme Court will hear arguments over when school districts are obliged to pay for educating children with special needs in private settings. Parents say their children can't wait for the public schools to improve and nonpublic placements offer more experienced teachers and staff and a better learning environment. Public school officials counter that funding private school tuitions drains resources from special-ed students who remain in the system; they say parents should be required to give public schools a chance before asking local governments to pony up for expensive nonpublic placements.

 

In Baltimore, for example, there are nearly 14,000 students with disabilities, of whom 746 require placements in private schools and institutions at a total cost of $46,193,781 - a significant chunk of the school system's $1.1 billion budget. But it also has been involved in a lengthy federal lawsuit over the quality of programming for children with special needs, and improvements have been slow to come.

 

One way to reduce the number of private placements of children with special needs is to improve the overall quality of teaching in both the special-education programs and the general curriculum. Baltimore already has begun upgrading instructional quality by offering greater opportunities for staff development and incentives to retain experienced teachers. Improving the overall quality of instruction, especially in the earlier grades, means fewer kids needing special ed later on because most kids who currently require nonpublic placements have histories of severe behavior problems that prevent them from realizing their potential. Fewer kids needing special ed also would free up resources to more effectively serve those who still have problems.

 

Whatever the court decides in this case, funding special education will remain a problem until some form of comprehensive education reform is enacted. Private institutions will never be able to make up for the failures of large numbers of public school special-ed programs that don't work. What's needed are across-the-board improvements in public education that also include raising the quality of instruction and services offered to children with special needs.

 

Copyright 2009 Baltimore Sun.

 

Where Will the Swine Flu Go Next?

 

By John M. Barry

New York Times Commentary

Tuesday, April 28, 2009

 

New Orleans

 

AS the swine flu threatens to become the next pandemic, the biggest questions are whether its transmission from human to human will be sustained and, if so, how virulent it might become. But even if this virus were to peter out soon, there is a strong possibility it would only go underground, quietly continuing to infect some people while becoming better adapted to humans, and then explode around the world.

 

What happens next is chiefly up to the virus. But it is up to us to create a vaccine as quickly as possible.

 

Influenza viruses are unpredictable because they are able to mutate so rapidly. That capacity enables them to jump easily from species to species, infecting not only pigs and people but also horses, seals, cats, dogs, tigers and so on. An avian virus responsible for the 1918 pandemic jumped first from birds to humans, then from humans to swine (as well as other animals). Now, and not for the first time, pigs have given a virus back to humans.

 

Mutability makes even existing, well-known flu viruses unpredictable. A new virus, formed by a combination of several existing ones as this virus is, is even less predictable. After jumping to a new host, influenza can become more or less virulent — in fact, different offshoots could go in opposite directions — before a relatively stable new virus emerges.

 

Influenza pandemics have occurred as far back in history as we can look, but the four we know about in detail happened in 1889, 1918, 1957 and 1968. The mildest of these, the so-called Hong Kong flu in 1968, killed about 35,000 people in the United States and 700,000 worldwide. Ordinary seasonal influenza, in comparison, now kills 36,000 Americans a year, because the population has a higher proportion of elderly people and others with weak immune systems. (If a virus like the Hong Kong flu hit today, it would probably kill more people for the same reason.)

 

The worst influenza pandemic, in 1918, killed 675,000 in the United States. And although no one has a reliable worldwide death toll, the lowest reasonable number is about 35 million, and some scientists believe it killed as many as 100 million — at a time when the world’s population was only a quarter of what it is today. The dead included not only the elderly and infants but also robust young adults.

 

What’s important to keep in mind in assessing the threat of the current outbreak is that all four of the well-known pandemics seem to have come in waves. The 1918 virus surfaced by March and set in motion a spring and summer wave that hit some communities and skipped others. This first wave was extremely mild, more so even than ordinary influenza: of the 10,313 sailors in the British Grand Fleet who became ill, for example, only four died. But autumn brought a second, more lethal wave, which was followed by a less severe third wave in early 1919.

 

The first wave in 1918 was relatively mild, many experts speculate, because the virus had not fully adapted to humans. And as it did adapt, it also became more lethal. However, there is very good evidence that people who were exposed during the first wave developed immunity — much as people get protection from a modern vaccine.

 

A similar kind of immune-building process is the most likely explanation for why, in 1918, only 2 percent of those who contracted the flu died. Having been exposed to other influenza viruses, most people had built up some protection. People in isolated regions, including American Indian reservations and Alaskan Inuit villages, had much higher case mortality — presumably because they had less exposure to influenza viruses.

 

The 1889 pandemic also had a well-defined first wave that was milder than succeeding waves. The 1957 and 1968 pandemics had waves, too, though they were less well defined.

 

In all four instances, the gap between the time the virus was first recognized and a second, more dangerous wave swelled was about six months. It will take a minimum of four months to produce vaccine in any volume, possibly longer, and much longer than that to produce enough vaccine to protect most Americans. The race has begun.

 

John M. Barry, a visiting scholar at the Tulane/Xavier Center for Bioenvironmental Research, is the author of “The Great Influenza.”

 

Copyright 2009 New York Times.

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