First US swine flu death; school closings possible

WASHINGTON President Barack Obama said Wednesday that wider school closings in the U.S. may be necessary in an escalating global health emergency that claimed the first death in the United States and swept Germany onto the roster of afflicted nations. Obama said local schools across America should consider temporarily shutting down if conditions worsen.

Giving an update on a rising menace that has dominated health officials' time and caused spreading anxiety, Obama said, "Every American should know that the federal government is prepared to do whatever is necessary to control this virus."

He said he wanted to extend "my thoughts and prayers" to the family of a 23-month-old Mexican boy who died in Houston, the first confirmed U.S. fatality among more than five dozen infections. Health officials in Texas said the child had traveled with his family from Mexico to Brownsville in south Texas and was brought to Houston after becoming ill and died Monday night.

"This is obviously a serious situation," and "we are closely and continuously monitoring" it, Obama said.

Meanwhile, the commandant of the Marine Corps said a Marine in southern California might have the illness and 39 Marines were being confined until tests come back. General James Conway told a Pentagon briefing an initial test indicated the sick Marine who was not identified might have swine flu but his illness did not appear life-threatening.

Obama said it is the recommendation of public health officials that authorities at schools with confirmed or suspected cases of swine flu "should strongly consider temporarily closing so that we can be as safe as possible."

Obama was underscoring advice that the Centers for Disease Control and Prevention provided earlier to cities and states, and that some schools most prominently in New York City already have followed.

"If the situation becomes more serious and we have to take more extensive steps, then parents should also think about contingencies if schools in their areas do temporarily shut down, figuring out and planning what their child care situation would be," Obama advised.

Obama said the federal government is "prepared to do whatever is necessary to control the impact of this virus." He noted his request for $1.5 billion in emergency funding to ensure adequate supplies of vaccines.

Germany confirmed three cases Wednesday, and Britain and Spain had reported cases earlier. New Zealand's total rose to 14.

There were also 13 cases in Canada, two in Israel, and one in Austria.

Egypt's government ordered the slaughter of all pigs in the country as a precaution, though no swine flu cases have been reported there. Egypt's overwhelmingly Muslim population does not eat pork, but farmers raise some 300,000-350,000 pigs for the Christian minority.

The disease is not spread by eating pork, and farmers were to be allowed to sell the meat from the slaughtered animals.

In the U.S., Obama said the government needs local agencies to help by looking out for any suspected flu cases.

And he advised people to take their own precautions washing hands, staying home if they are sick, and keeping sick kids home.

The world has no vaccine to prevent infection but U.S. health officials aim to have a key ingredient for one ready in early May, the big step that vaccine manufacturers are awaiting. But even if the World Health Organization ordered up emergency vaccine supplies and that decision hasn't been made yet it would take at least two more months to produce the initial shots needed for human safety testing.

"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.

And the U.S. is shipping to states not only enough anti-flu medication for 11 million people, but also masks, hospital supplies and flu test kits.

Dr. Richard Besser, acting head of the Centers for Disease Control and Prevention, was asked Wednesday why the problem seems so much more severe in Mexico than in the United States.

He replied that U.S. officials "have teams on the ground, a tri-national team in Mexico, working with Canada and Mexico, to try and understand those differences, because they can be helpful as we plan and implement our control strategies."

Cuba and Argentina banned flights to Mexico, where swine flu is suspected of killing more than 150 people and sickening well over 2,000. In a bit of good news, Mexico's health secretary, Jose Cordova, late Tuesday called the death toll there "more or less stable."

Mexico City, one of the world's largest cities, has taken drastic steps to curb the virus' spread, starting with shutting down schools and on Tuesday expanding closures to gyms and swimming pools and even telling restaurants to limit service to takeout. People who venture out tend to wear masks in hopes of protection.

The number of confirmed swine flu cases in the United States included 45 in New York, 11 in California, six in Texas, two in Kansas and one each in Indiana and Ohio, but cities and states suspected more. In New York, the city's health commissioner said "many hundreds" of schoolchildren were ill at a school where some students had confirmed cases.

The WHO argues against closing national borders to stem the spread, and the U.S. although checking arriving travelers for the ill who may need care agrees it's too late for that tactic.

Authorities sought to keep the crisis in context: Flu deaths are common around the world. In the U.S. alone, the CDC says about 36,000 people a year die of flu-related causes. The regular flu kills just under 100 U.S. children every winter 73 in the 2006-2007 flu season. Still, the CDC calls the new strain a combination of pig, bird and human viruses for which people may have limited natural immunity.

Hence the need for a vaccine. Using samples of the 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. The hope is to get that ingredient called a "reference strain" in vaccine jargon to manufacturers around the second week of May, so they can begin their own laborious production work, said CDC's Dr. Ruben Donis, who is leading that effort.

Vaccine manufacturers are just beginning production for next winter's regular influenza vaccine, which protects against three human flu strains. The WHO wants them to stay with that course for now it won't call for mass production of a swine flu vaccine unless the outbreak worsens globally. But sometimes new flu strains pop up briefly at the end of one flu season and go away only to re-emerge the next fall, and at the very least there should be a vaccine in time for next winter's flu season, Dr. Anthony Fauci, the National Institutes of Health's infectious diseases chief, said Tuesday.

"Right now it's moving very rapidly," he said of the vaccine development.

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Associated Press writers Lara Jakes in Washington, Mike Stobbe in Atlanta, Patrick McGroarty in Berlin and Maamoun Youssef in Cairo contributed to this report.

Mexico City shuts itself in amid swine flu fears

By JULIE WATSON

Associated Press Writer

The Associated Press

MEXICO CITY Nine-year-old Cecilia Ines Lopez has been watching nine hours of television a day. Her teenage relative has spent so much time on Instant Messenger she complains she has nothing more to say.

For five long days, the only glimpse the girls have caught of their normally bustling neighborhood has been through the barred windows of their cramped cinderblock row house. Their parents like many across Mexico City grounded them when swine flu hit.

"We're like caged lions," Cecilia's grandmother, Constancia Sosa, said Tuesday in the family's tiny living room decorated with ornately carved wooden couches, religious statues, family photos and fake flowers.

"We sit in here all day, listen to the news about how bad things are. One more week of this and we're going to fall into a serious depression or become hysterical."

This city of 20 million people has shut itself in as authorities try to prevent the epidemic from spreading. But with no schools, no movie theaters and no cafes to while away the hours, many are already going stir crazy.

On Tuesday, officials banned Mexico City's 25,000 restaurants from serving customers takeout is still OK and closed gyms, swimming pools and pool halls. Already, night clubs, museums, zoos and movie theaters had been off-limits. And schools have been closed nationwide until at least May 6.

For the six-member Lopez family, their 13-foot-by-13-foot home in a working-class neighborhood has become a bunker. Life has been reduced to painful stretches of boredom and irritation, shattered by bouts of anxiety.

Sosa, 52, has had it with her daughter Ilse. Since school closed, the 16-year-old has been practicing her Mexican folk dances with plenty of foot-stomping in the living room. She also spends her time talking on the phone or instant-messaging friends and is sick of both.

Sosa is also fed up with Cecilia and her 10-year-old sister, who race up and down the stairs as they search for activities to keep themselves occupied. They can't leave the house only Cecilia's father forays out to work, and to pick up food and surgical masks.

Cecilia said it isn't her fault: "I sit here. I go upstairs to see what there is to play with. I get bored. I come down here to see what they're doing. And then I go to sleep."

"Yesterday we watched nine hours of TV," she said, rolling her eyes and slouching into her chair in exasperation.

Outside, the overcrowded city has become almost spacious. Traffic flows easily down broad avenues and normally crowded squares are crisscrossed by the occasional pedestrian.

Even one of the city's main produce market, La Merced, has emptied. Normally, thousands of sweaty bodies jostle against one another among the towering mounds of jalapenos, mangos and squash blossoms. On Tuesday there was hardly a soul, save produce sellers and the occasional health worker taping up posters warning people to steer clear of crowds.

"I'm more scared about the drop in sales than the illness," said Jaime Blas, 50, trying to sell pecans and pumpkin seeds with a surgical mask covering his face. "How are we going to eat?"

Avocado seller Rodrigo Antonio Rebollo, 39, said he has no money for milk, so his three children are getting by on beans and coffee plus some handouts from colleagues who give him produce about to rot.

"A lot of my clients are taco sellers and they're not working either because they also don't have customers," he said.

Few people were eating out already, and on Tuesday the government ordered all restaurants to stop serving sit-down meals because people could catch the flu from the next table.

Augustina Alvarez Cervantes, 55, said the owner of the Mexican restaurant where she waits tables called and told her to shut down until further notice. She was stacking tables and emptying the refrigerator of food that might go bad, and worrying about how she would feed her two daughters and infant grandchild.

"We're left without a paycheck," she said, "but we still have expenses."

Wealthier parents had more options, but their kids were equally restless. Pediatrician Joaquina Lorente has stayed home to field calls from panicked parents as her three little girls quarrel and whine around her.

Lorente, 39, is grateful she has a garden with a swing set. But her children play "school," longing for the day when they can return to classes.

"They're watching a lot of TV," Lorente said. "I used to limit TV but that seems so minor now compared to what we're facing."

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Associated Press writer Peter Orsi contributed to this report.

A timeline of events in the swine flu outbreak

By The Associated Press

A timeline of events in the swine flu outbreak:

  1. December 2005 to January 2009: The Centers for Disease Control and Prevention receives reports of 12 cases of human infection with swine flu. Five of these 12 cases occurred in patients who had direct exposure to pigs and six reported being near pigs. Exposure in one case is unknown.
  2. March 28: Believed to be the date of the earliest onset of the swine flu cases in the U.S., Dr. Nancy Cox of the CDC said in an April 23 press briefing.
  3. April 2: A 4-year-old boy contracted the virus before this date in Veracruz state, Mexican Health Secretary Jose Angel Cordova later said citing test results. A community in Veracruz has been protesting pollution from a large pig farm.
  4. April 6: Local health officials declare a health alert due to a respiratory disease outbreak in the Mexican town of La Gloria in Veracruz state. Health officials record 400 cases of people who sought medical treatment in the previous week in the town. About 60 percent of the town of 3,000 are affected.
  5. April 17: CDC determines that two children in adjacent counties in southern California had illnesses caused by infection with swine flu. Both children became sick in late March.
  6. April 22: CDC confirms three additional cases of swine flu in California and two in Texas, near San Antonio.
  7. April 22: The Oaxaca Health Department indicates that 16 employees at the Hospital Civil Aurelio Valdivieso have contracted respiratory disease.
  8. April 24: Mexico's Minister of Health confirms 20 deaths from swine flu, but 40 other fatalities were being probed and at least 943 nationwide were sick from the suspected flu. Mexico City shuts down schools, museums, libraries, and state-run theaters across the capital.
  9. April 26: The number of confirmed cases in the U.S. climbs to 20 in five states. Mexico reports suspect clinical cases have been reported in 19 of the country's 32 states. Canada confirms six cases.
  10. April 27: The World Health Organization raises its pandemic alert status to Phase 4, meaning there is sustained human-to-human transmission of the virus causing outbreaks in at least one country.
  11. April 28: Cuba suspends flights to and from Mexico, becoming the first country to impose a travel ban. Argentina suspends flights from Mexico for five days.

WHO says swine flu moving closer to pandemic

By PATRICK McGROARTY

Associated Press Writer

BERLIN The World Health Organization warned Wednesday that the swine flu outbreak is moving closer to becoming a pandemic, as the United States reported the first swine flu death outside of Mexico, and Germany and Austria became latest European nations hit by the disease.

In Geneva, WHO flu chief Dr. Keiji Fukuda told reporters that there was no evidence the virus was slowing down, moving the agency closer to raising its pandemic alert to phase 5, indicating widespread human-to-human transmission.

But he said the health body not yet ready to move the pandemic alert level up from its current level of 4, which means the virus is being passed among people. Phase 6 the highest in the scale is for a full-scale pandemic.

As fear and uncertainty about the disease ricocheted around the globe, nations took all sorts of precautions, some more useful than others.

Britain closed a school after a 12-year-old girl was found to have the disease. Egypt slaughtered all its pigs and the central African nation of Gabon became the latest nation to ban pork imports, despite assurances that swine flu was not related to eating pork.

Cuba eased its flight ban, deciding just to block flights coming in from Mexico. And Asian nations greeted returning airport travelers with teams of medical workers and carts of disinfectants, eager to keep swine flu from infecting their continent.

In Mexico City, the epicenter of the epidemic, the mayor said Wednesday the outbreak seemed to be stabilizing and he was considering easing the citywide shutdown that closed schools, restaurants, concert halls and sports arenas.

Swine flu is suspected of killing more than 150 people in Mexico and sickening over 2,400 there.

Dr. Richard Besser, the acting chief of the U.S. Centers for Disease Control and Prevention, said 91 cases have now been confirmed in 10 states, and health officials there reported Wednesday that a 23-month-old Mexican boy had died in Texas from the disease.

Across Europe, Germany confirmed three swine flu cases and Austria one, while the number of confirmed cases rose to five in Britain and ten in Spain.

WHO conducted a scientific review Wednesday to determine exactly what is known about how the disease spreads, how it affects human health and how it can be treated.

Dr. Nikki Shindo, a WHO flu expert, said the review would focus on the large trove of data coming from Mexico and from a school in New York City that has been hard-hit by the outbreak.

Germany's national disease control center, the Robert Koch Institute, said the country's three cases include a 22-year-old woman hospitalized in Hamburg, a man in his late 30s at a hospital in Regensburg, north of Munich, and a 37-year-old woman from another Bavarian town. All three had recently returned from Mexico.

Austria's health ministry said a 28-year-old woman who recently returned from a monthlong trip to Guatemala via Mexico City and Miami has the virus but is recovering.

British Prime Minister Gordon Brown said health officials were ordering extra medicine and "several million more" face masks to deal with the virus.

British media reports, citing an unidentified European surgical mask manufacturer, said the U.K. was seeking 32 million masks to protect its health workers from a possible pandemic.

"We've decided to build stocks of anti-virals, from 35 million to 50 million," Brown said, adding that the government had put in enhanced airport checks and was going to mail swine flu information leaflets to every household in Britain.

In addition to a couple in Scotland who got swine flu on their Mexican honeymoon, new British cases included a 12-year-old girl in the southwest English town of Torbay. Brown said her school had been closed as a precaution.

He said the other two cases were adults in London and in Birmingham. All three had visited Mexico, were receiving anti-viral drugs and were responding well to treatment, Brown said.

French President Nicolas Sarkozy met with Cabinet ministers to discuss swine flu and his health minister said France will ask the European Union to suspend flights to Mexico.

The U.S., the European Union and other countries have discouraged nonessential travel to Mexico. Cuba suspended all regular and charter flights from Mexico to the island but was still allowing airlines to return travelers to Mexico.

New Zealand's number of swine flu cases rose to 14, 13 of them among a school group that recently returned from Mexico. Officials say the swine flu strain infecting the students is the same as that in Mexico. All were responding well to antiviral drugs and in voluntary quarantine at home.

New Zealand has 44 other possible cases, with tests under way.

Mexico was taking drastic measures to fight the outbreak. It closed all archaeological sites and allowed restaurants in the capital to only serve takeout food in an aggressive bid to stop gatherings where the virus can spread. Schools remained closed until at least May 6.

A regional beach soccer championship in Mexico was postponed and all Mexican first-division soccer games this weekend will be played with no audiences. Cruise lines were avoiding Mexican ports and holiday tour groups are canceling holiday charter flights there.

The Philippine health chief appealed to dozens of Filipino legislators to abandon plans to visit Las Vegas to cheer for boxing idol Manny Pacquiao even though Las Vegas is more than 300 miles (480 kilometers) from the Mexican border.

Egypt's government ordered the slaughter of all pigs in the country as a precaution, though no swine flu cases have been reported there. Egypt's overwhelmingly Muslim population does not eat pork, but farmers raise up to 350,000 pigs for its Christian minority.

In Australia, officials were testing more than 100 people with flu symptoms for the virus and the government gave health authorities wide powers to contain contagious diseases.

"(We can make) sure that people are isolated and perhaps detained if they don't cooperate and are showing symptoms," said Health Minister Nicola Roxon.

___

Associated Press Writers around the world contributed to this report.

Mexican boy visiting Texas 1st US swine flu death

By JUAN A. LOZANO

Associated Press Writer

HOUSTON A Mexico City toddler who traveled to the Texas with family to visit relatives is the first confirmed death in the U.S. from swine flu.

The boy, who was nearly 2 years old, arrived in the border city of Brownsville with "underlying health issues" on April 4 and developed flu symptoms four days later, the Texas Department of State Health Services said. He was taken to a Brownsville hospital April 13 and transferred to the following day to a hospital in Houston, where he died Monday night.

The cause of death was pneumonia caused by the flu virus, Cameron County Judge Carlos Cascos said.

Officials did not specify what underlying health issues the boy had before arriving in the U.S.

State health officials declined to identify the boy or his family, citing privacy concerns, medical confidentiality and "the absence of an obvious health threat from the boy to the public at large."

State health officials said the boy would not have been infectious when he flew from Mexico City to Matamoras, across the border from Brownsville. None of his close contacts have developed symptoms.

Carol Wittman, a spokeswoman for Texas Children's Hospital in Houston, would not confirm that the boy was a patient there, but said the hospital planned a news conference Wednesday afternoon and would issue a statement soon.

Health officials in Brownsville are trying to trace his family's trip to find out how long they were in the area, who they visited and how many people were in the group, Cascos said.

The boy's family members "are healthy and well," Houston's health director, Dr. David Persse, said at a Wednesday news conference.

The toddler was about 2 years old. Houston officials said he was 23 months old, but state officials said he was 22 months old and could not immediately explain the discrepancy.

The Centers For Disease Control and Prevention confirmed the death earlier Wednesday.

Children, especially those younger than age 5, are particularly vulnerable to flu and its complications, and every year children die from seasonal flu.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

As of April 18, CDC had received reports of 55 seasonal flu-related deaths in children during the current seasonal flu season.

Swine flu is suspected of killing more than 150 people and sickening more than 2,400 in Mexico. U.S. health officials have confirmed 91 cases in 10 states.

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Associated Press writers Terry Wallace in Dallas and Christopher Sherman in McAllen, and AP Medical Writers Lindsay Tanner in Chicago and Mike Stobbe in Atlanta contributed to this story.

CDC: US swine flu cases jump to 91 in 10 states

The Associated Press

WASHINGTON The U.S. now has 91 confirmed cases of the new swine flu in 10 states.

Dr. Richard Besser, the acting chief of the Centers for Disease Control and Prevention, says thus far only five of those cases needed hospitalization, including a Mexican toddler who became the first death recorded in the U.S., in Texas.

The increase is not surprising. For days, CDC officials have said they expected to confirm more cases and more severe illnesses as they intensively hunt down this new virus.

Until now the government had known of outbreaks in just five states. But the new information shows cases in five more: Massachusetts, Michigan, Arizona, Nevada and Indiana.

CDC: First Tamiflu stockpile shipments arriving

The Associated Press

WASHINGTON The government says the first shipments of the drug Tamiflu from the federal stockpile arrived in New York state, New York City and Indiana Wednesday morning, and all states will get their share by Sunday.

As a precaution, the government has decided to ship to the states enough medication to treat 11 million people just in case the new swine flu takes off.

But don't worry about supplies. Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention, says no states are having any shortages there's plenty in regular pharmacies for now.

At least 5 hospitalized in US with swine flu

By SARA KUGLER

Associated Press Writer

NEW YORK At least five people were in U.S. hospitals with swine flu as the number of cases nationwide rose to 66 on Tuesday and a federal health official warned that deaths were likely.

Most of the nation's confirmed cases were in New York City, where the health commissioner said "many hundreds" of schoolchildren were ill with what was "most likely swine flu." The city announced 45 confirmed cases, all affiliated with a Catholic high school.

Richard Besser, acting director of the federal Centers for Disease Control and Prevention, noted that although ordinary human flu accounts for 36,000 deaths every year, he was concerned by this strain.

"I fully expect we will see deaths from this infection," Besser said at an Atlanta news conference.

New York City Health Commissioner Thomas Frieden said that hundreds of students at St. Francis Preparatory in Queens had developed symptoms consistent with swine flu, although many hadn't been tested to confirm it. Some students there recently went on a spring break trip to Mexico.

There were indications that the outbreak may have spread beyond St. Francis, with officials closing a school for autistic children down the road. Two suspected cases were hospitalized in New York, one has been released and the other is doing well, officials said.

"It is here and it is spreading," Frieden said. "We do not know whether it will continue to spread."

Mayor Michael Bloomberg said that 82 of 380 students at P.S. 177, a school for autistic children, have called in sick. A third school in Manhattan is being evaluated because students there are sick, Frieden said.

The CDC and states say the U.S. has 66 confirmed cases across six states, with 45 in New York, 11 in California, six in Texas, two in Kansas and one each in Indiana and Ohio.

At least five people have been hospitalized in the U.S., including three in California and two in Texas, Besser said.

The increase is not surprising. For days, CDC officials have said they expected to see more confirmed cases and more severe illnesses. Health officials across the country have stepped up efforts to look for cases, especially among people with flu-like illness who had traveled to Mexico.

CDC officials also had warned that updates in the number of confirmed cases would at time be disjointed, as different states announce new information before the CDC's national count is updated.

A handful of schools around the country have closed over swine flu fears and some people are wearing masks, but it's mostly business as usual in the U.S., even at border crossings into Mexico.

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