The Centers for Disease Control and Prevention acting director continued to call for vigilance last week as health officials closely monitored the global flu outbreak.
Still monitoring swine flu situation
Outbreak still spreading, continued tracking needed, CDC acting head says
Richard Besser began the week with encouraging news that initial laboratory results have found the 2009 H1N1 influenza A virus, or swine flu, has not mutated much and lacks factors linked to more severe disease in prior pandemics. At a news conference, he noted the virus appears to be no more severe than seasonal flu. The CDC also said midweek that it no longer recommended schools or childcare facilities close in communities with confirmed cases of the swine flu. The agencys revised guidelines call for those with symptoms to stay home while they are sick and recovering.
But Besser, who continues to serve in an interim capacity at the CDC (May 4, p. 7), also repeatedly stressed the need for efforts to monitor the virus and check its spread, even as he acknowledged the outbreak had not shown signs of slowing.
From the beginning, Ive been trying to stress that this is a marathon and not a sprint, Besser said. We expect this to continue to progress. We expect it to progress around the world. We expect additional countries to be affected. Its very important that we continue to pay attention and study this and learn from this and provide the best guidance we can based on the available science at that time.
The virus, first confirmed in the U.S. in a 10-year-old California boy in mid-April, contains genes from swine, bird and human influenza and as of May 8 has spread across 43 states and 25 countries, the CDC and World Health Organization figures show.
In the U.S., the number of confirmed cases as of May 8 rose to 1,639 with another 850 probable cases. Health officials announced last week that a woman in Texas was the second person to die from the virus in the U.S. The first reported U.S. death was a 23-month old child from Mexico who died in Texas. Globally, the count had climbed to 2,500 confirmed cases as of May 8.
In Mexico, where schools and businesses closed by the outbreak began to reopen last week, the number of confirmed cases rose to 1,123, including 42 deaths.
Besser said that more confirmed cases are expected as the virus moves through communities. As we look at the data so far, were not seeing any sign of this petering out, he told reporters on May 7. And we would not expect that we would at this point. We are still in the upswing of what we call the epidemic curve.
The WHO pandemic alert level, which was raised to five in late April, may again climb should global health officials find sustained transmission in regions where such activity was not previously reported, Besser said. Confirmed cases will also climb as laboratories work though a testing backlog, he said.
Health officials have launched several studies of the virus, Besser said, including the evaluation of a rapid diagnostic test and how it spreads through households and healthcare settings. Meanwhile, the agency has taken steps to prepare for production of a vaccine should health officials decide to do so, he said.
Also last week, the Food and Drug Administration approved a new manufacturing plant for flu virus vaccines owned and operated by Sanofi Pasteur. The plant in Switfwater, Pa., will produce the existing flu vaccine Fluzone but could also be used to manufacture vaccine for the swine flu. Sanofi is approved to produce flu vaccines for the national stockpile. In response to the outbreak, the CDC moved to distribute to states one-fourth of the nations anti-viral stockpile.
Besser said global surveillance of the virus will continue as the Southern Hemisphere enters its flu season. Officials will be watching to see how well the swine flu competes with other flu strains and whether it mutates dangerously, gains factors associated with more severe disease, or grows less susceptible to treatment.
Newly appointed HHS Secretary Kathleen Sebelius, who toured the CDC and met with its staff last week, also stressed the need to aggressively study and better understand the virus. We dont know what will happen over the course of the summer, and we certainly dont know what will happen when we get back into flu season, she said. The U.S. flu season typically lasts between October and May. This is May. Flu season is later this fall.
In New Yorkone of the states with the largest numbers of confirmed casespublic health officials are weighing options to continue flu surveillance that is typically shut down during summer months, said Guthrie Birkhead, the New York State Health Departments deputy commissioner for the office of public health. Among the options: monitoring emergency room patients with respiratory illness; testing for the virus among severely ill hospitalized patients with flulike symptoms and no other explanation for their illness; tracking Medicaid anti-viral flu prescriptions; and asking doctors to send to state laboratories samples from patients with flulike illness. Theres a lot of work to do to prepare, Birkhead said.
Perry Smith, director of the New York State Department of Health Epidemiology Divison, said the state will remain on high alert even if the virus does not appear to mutate dangerously during the Southern Hemispheres upcoming flu season. Flu viruses are totally unpredictable, he said. New York State Health Commissioner Richard Daines said that the state will also move to bolster next flu seasons immunization campaign.
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