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CAREC Update on Human Swine Influenza - April 28, 2009
S Coward

By S Coward
Published on 27-Apr-09
April 28, 2009 - On April 27, 2009, the World Health Organization (WHO) Emergency Committee held its second meeting. The Committee considered available data on confirmed outbreaks of human swine influenza A (H1N1) in the United States of America, Mexico, and Canada, as well as reports of possible spread to additional countries. On the advice of the Committee, the WHO Director-General has now raised the level of influenza pandemic alert from the current phase 3 to phase 4:

April 27, 2009 --There have been over 800 cases of severe acute respiratory illness, including approximately 60 deaths reported from Mexico. 

CAREC countries should increase surveillance

April 27, 2009 -- There have been over 800 cases of severe acute respiratory illness, including approximately 60 deaths reported from Mexico. Suspected cases of swine influenza in persons returning from Mexico have also been reported in New Zealand, the United Kingdom and France.

Confirmed cases of a new strain of human swine influenza A (H1N1) have been identified in Mexico (three areas, Districto Federal, Oaxaca, San Luis Potosi); in the United States (California, Texas, Kansas, New York, Ohio) and Canada (Nova Scotia).

There have been no reported cases of human swine influenza or suspected human swine influenza in any CAREC member countries.

The World health Organization (WHO) Director General has issued a statement following the first meeting of the Emergency Committee for the International Health Regulations stating that the current situation constitutes a Public Health Emergency of International Concern (PHEIC). The full statement can be found at: http ://

The WHO is working with health authorities in the affected countries to continue investigations and testing to better understand the epidemiology of the disease and determine its severity and potential for spread. The WHO pandemic alert phase has not changed at this time and remains at Phase 3. The WHO has NOT issued any travel advisories at this time.

The new strain of human swine influenza is sensitive to oseltamavir (Tamiflu®) and zanamivir (Relenza®) and is most effective when administered in the early stages of the disease. It is resistant to Amantidine and Remantidine. The following hygienic measures are recommended:
  • Frequent hand washing with soap and water, especially after sneezing or coughing
  • Cover your nose and mouth when sneezing and coughing, preferably with a tissue that is immediately disposed of following use.
  • Avoid touching eyes, nose or mouth as this spreads germs
  • Avoid close contact with sick persons

Recommendations to CAREC member countries are:

1. Enhance surveillance for fever and respiratory (ARI) cases, including specimen taking, especially among severe or hospitalized cases. The following cases should have a specimen taken and shipped to CAREC (unless otherwise advised) for testing: All severe or hospitalized cases of fever and respiratory illness (SARI cases); the first six ARI cases presenting at a hospital A&E each week; and ALL cases meeting the case definition of a suspected case of human swine influenza as defined below. Please note the following:
  • The specimen of choice is nasopharyngeal swabs or aspirate. Alternatively nasal and throat swabs can be taken. Serum samples are not required at this time.
  • Specimens should be packaged and shipped immediately according to IATA regulations. They should be preserved and transported at 4-8 ÂșC (with icepacks). Please call the CAREC Duty Officer on the emergency phone number (868-463-5857) to notify that specimens have been shipped.
  • Countries should continue to use their existing capacities for testing including rapid testing and immunofluorescence testing. However all specimens, positive and negative, should be sent to CAREC for confirmatory testing.

2. Alert your health care providers of the need for increased vigilance for fever and respiratory symptoms and the need to take specimens. They should maintain a high index of suspicion when dealing with patients presenting with fever and respiratory illness and gather information re travel history to affected areas or close contact with persons who have travelled to those areas.

3. Over the past 2-3 years personal protective equipment (PPE) has been distributed to all countries. Please ensure that you know how to access this PPE should the need arise.

4. Advise persons who have recently travelled to affected areas to consult a doctor immediately if they show signs of flu-like symptoms.

5. Countries should review their influenza pandemic plans and be prepared to implement measures in accordance with the WHO pandemic influenza phases.

Symptoms of human swine influenza are similar to those of regular or seasonal influenza and include fever, lethargy, lack of appetite and coughing. Persons with swine influenza may also have runny nose, sore throat, nausea, vomiting and diarrhea.

At this time the case definitions that are being used for confirmed, probable and suspected cases of swine influenza A (H1N1) for surveillance purposes are as follows:

1. A Confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection by one or more of the following tests:
  • viral culture and sequencing
  • real-time RT-PCR
  • four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies

2. A Probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with an influenza test that is positive for influenza A, but H1 and H3 negative by RT-PCR.

3. A suspected case of swine influenza A (H1N1) virus infection is defined as a fever and respiratory illness (ARI) case with recent travel to an affected area (with confirmed cases of swine influenza A (H1N1)) or close contact with a person with a history of travel to an affected area within 7-10 days of onset of symptoms

The infectious period for confirmed cases is 1 day before onset to 7 days after onset of illness.

A case of Fever and Respiratory Symptoms (Acute Respiratory Infection) is defined as acute febrile illness in a previously healthy person, presenting with cough or sore throat with or without respiratory distress.

CAREC/PAHO is monitoring the situation closely and will provide regular updates on the situation.

Further details on the Swine Influenza situation can be found on the following websites:

Pan American Health Organization website:

World Health Organization (WHO) Swine Influenza Website:

US CDC website at:

UK Health Protection Agency Website: