Swine Flu Outbreak Information

Updated 11:30 P.M. -----------------------------------------------------------------------------------------------
CDC Resources -----------------------------------------------------------------------------------------------

Swine Flu Related Links



- First confirmed death from swine flu in the US - a 22-month-old boy in Texas

- Cases confirmed in 11 states (CDC said 10, then Maine announced cases later today), up from 5 yesterday

- WHO raises pandemic alert level to 5 (on a scale of 1-6) - the second increase this week

- Case confirmed in a Marine at Twentynine Palms in California; 30 Marines quarantined

- Switzerland reportedly confirms its first case of swine flu (AFP)

- Germany, Austria & New Zealand confirmed their first cases of swine flu Wednesday

- The number of children who will be out of school on Thursday because of the swine flu:  approx. 160,000  - including 80,000 in Fort Worth, TX

- Lessons of 1918, the deadliest flu pandemic in history - from former CDC Director Dr. Julie Gerberding (now an ABC consultant)

- Gallup poll shows 78% of Americans are not worried about swine flu; only 1% to 3% are changing their daily lives because of it

- Debate over closing the border - Sen. John McCain argues for it; DHS and CDC say no


WHO has confirmed 114 cases in seven countries (Mexico, US, Canada, New Zealand, the UK, Israel and Spain) - and today two more countries (Germany and Austria) reported they had confirmed cases there too.
WHO confirms 8 deaths - 7 in Mexico and one in the US.

Confirmed: The World Health Organization is confirming 26 cases in Mexico, which includes 7 confirmed deaths from swine flu (same as yesterday)
Suspected: Nearly 2,500 suspected cases and 159 deaths possibly related

From a WHO official in Geneva: "Of the 26 lab-confirmed cases in Mexico, seven died, 11 had severe respiratory illness and did not die and eight had mild cases. All I know about the seven who died is that at least some of them were previously healthy young adults."   It took 7 days for Mexico to confirm its first cases of swine flu, according to the Pan-American Health Organization/World Health Organization. April 16 - Mexico reports increase in cases of acute respiratory infections near La Gloria in Veracruz.  April 23 - Mexico reports first lab confirmation.  (The US reported its first confirmed cases in California on April 18.)  (Miguel Marquez)

Mexico public closures: Schools nationwide remain closed. Restaurants, gyms, sports clubs, swimming pools, pool halls, theaters and other public places in Mexico City also remain closed. The city is still evaluating whether to close the subway system that provides 5-million trips a day. 


Confirmed: CDC confirms 91 cases in 10 states as of 11am Wednesday (up from 64 cases in 5 states yesterday).  5 people hospitalized (including the child who died in Texas).  Maine also reported 3 confirmed cases on Wednesday, not yet included in the CDC tally. It would be the 11th state, bringing the total to 94 cases.

CDC tally by state:
NY                  51 cases
TX                   16
CA                  14
* MA            2                    
* MI              2
* AZ              1
* NV             1
* IN               1
KS                   2
OH                 1
* = state added to the list on Wednesday

The CDC warns these numbers will be almost instantly outdated as more test results come in from around the country. 

This victim in the US was a 22-month-old boy with underlying health problems who died on Monday.  The patient was from Mexico and traveled to Houston for treatment.  It was not discovered that the child was suffering from swine flu until after his death, but health officials do not think that would have made a difference in the outcome.  (Lisa Stark/Gina Sunseri)  The state's health director called it "highly likely" that the boy contracted the disease in Mexico before his trip to the U.S. None of his family has shown any symptoms.

Texas Department of State Health Services release:
Swine influenza has been confirmed in a 22-month-old boy from Mexico City who died earlier this week in a Houston-area hospital.  The boy, who had several underlying health problems, had traveled with his family to visit relatives in Texas.
Swine flu was confirmed in laboratory testing done by the U.S. Centers for Disease Control and Prevention in Atlanta.  The Texas Department of State Health Services was notified of the finding earlier today.
Preliminary illness investigation information indicates that on April 4 the boy had traveled with his family on a commercial flight from Mexico City to Matamoras, Mexico, for a visit with relatives in Brownsville, just across the Mexico-Texas border.
The boy developed a fever on April 8 followed by other influenza-like symptoms.  He was admitted to a Brownsville hospital a few days later and the next day was transferred to a Houston-area hospital by a medical transport service.
Though an illness investigation continues, state health officials said the boy would not have been infectious on the Mexico-to-Matamoras flight and that none of the boy's known close contacts has subsequently become ill with influenza-like symptoms.


NEW YORK:  CDC confirms 51 cases (up from 45 on Tuesday and 28 on Monday)
NOTE: NYC officials say they have stopped trying to test everyone who gets sick, just focusing on those with the most severe cases.  So the "confirmed" number will fall further and further behind the actual number of people who are ill.

Five schools are now closed in New York City due to either confirmed cases of swine flu or concern over flu like symptoms.

  1. PS 177 in Queens closed after dozens of autistic students came down with suspected swine flu. At least one of the sick students at PS 177 has siblings at St. Francis Prep. St. Francis, where the NY outbreak began, remains closed. The principal, Brother Leonard Conway, says that he's been getting reports from parents that students who were ailing on Thursday and Friday are getting better.  28 cases were confirmed at the school and many others were ill.
  1. Three Catholic schools in Brooklyn, Bishop Kearney, St. Brigid's School and Good Shepherd School, also closed.  But the city health commissioner says: "We did not recommend they close, we did not feel it was warranted to close."   According to the Daily News, each had at least one child sick and will be closed for the rest of the week.


  1. Overall, NYC school attendance is about average - not affected by the scare. (Rich Esposito)

The new cases confirmed Wednesday include a 19-month-old boy in the Bronx and a woman in Brooklyn who were hospitalized (Mayor Bloomberg mentioned them as suspected cases on Tuesday).  Both of those cases have links to recent trips to Mexico.

"Many hundreds" sick - NYC health commissioner Thomas Frieden says "many hundreds" of students and teachers at St. Francis Prep in Queens were sick and in many cases spread the illness to family members.  Cases were mostly mild - Mayor Bloomberg says "it looks like the normal flu we see every year." 

CALIFORNIA:  The Pentagon says one of the confirmed cases in California is a Marine at the Marine Corps Ground Combat Center Twentynine Palms, California. The Marine will continue to be treated as an outpatient and will remain isolated at his barracks.  He is doing well, and his condition continues to improve.  This Marine had been actively social with approximately 30 other Marines and, as a precaution those Marines are being quarantined as well. The quarantine will last for 5 days. At the end of the 5 day period, if they display no flu-like symptoms they will be returned to full duty. None of these Marines display symptoms at this time.

TEXAS:  Gov. Rick Perry made an official disaster declaration on Wednesday, to allow access to further  state emergency resources.  Fort Worth closing all schools until May 8 - 80,000 students attend.   Texas officials are postponing all public high school athletic and academic competitions until May 11 because of the swine flu outbreak. The move suspends the baseball season and eliminates the regional track championships.

INDIANA: 1 confirmed case in Indiana - a student at Notre Dame.

MASSACHUSETTS: 2 confirmed cases - 8- and 10-year-old brothers.

MICHIGAN:  CDC confirms 2 cases in Michigan. (Discrepancy alert: Michigan says the CDC confirmed swine flu in two samples from the same patient, not two separate patients.)

MAINE: Not included in the CDC tally, but Maine says it has confirmed 3 cases Wednesday.  The patients are all aldults and are recovering at their homes.


  1. Connecticut
  2. Florida
  3. Illinois
  4. Maryland
  5. Minnesota
  6. Nebraska
  7. New Jersey
  8. North Carolina
  9. Oklahoma
  10. South Carolina


NOTE: These are numbers from each country's health officials.  Not all are included yet in the latest WHO tally.
SWITZERLAND - First case reportedly confirmed Thursday morning local time (AFP)
GEMANY - 3 cases confirmed Wednesday morning.
AUSTRIA  - First case confirmed Wednesday morning
NEW ZEALAND - 14 cases confirmed Wednesday, the first in Asian region
CANADA  - 8 confirmed cases, all recently traveled to Mexico. All recovered.
ISRAEL  - 2 confirmed cases, both men who recently visited Mexico
SPAIN  - 10 confirmed cases, including one person who had NOT recently been to Mexico and appears to have been infected locally
UK - 5 confirmed cases

Suspected cases are being investigated in at least 14 countries, including:

  1. South Korea
  2. Australia - at least 90 suspected cases
  3. Brazil
  4. Chile
  5. France
  6. South Africa


The World Health Organization held an emergency meeting Wednesday and announced it is raising the alert level for the second time this week - from "Phase 4" to "Phase 5."  On Monday, it went from '3' to '4,' the first time it had been raised above '3' since the system was adopted in 2005. 
Phase 1 - There are no viruses circulating in animals that have been reported to cause infections in humans.
Phase 2 - An animal flu virus has caused infections in humans in the past and is considered to be a potential pandemic threat.
Phase 3 - An animal or mixed animal-human virus has caused occasional cases or small clusters of disease, but the virus does not spread easily.
Phase 4 - The new virus can cause sustained outbreaks and is adapting itself to human spread. Phase 4 indicates a significant increase in risk of a pandemic
but does not necessarily mean that a pandemic is a forgone conclusion.
Phase 5 - The virus has spread into at least two countries and is causing even bigger outbreaks. Declaration of Phase 5 is a strong signal that a pandemic is
Phase 6 - More outbreaks in at least two regions of the world; the pandemic is under way.

WHO does not recommend closing borders or restricting travel. However, people who are sick should not travel.

The number of children who will be out of school across the country on Thursday because of the swine flu:  approx. 160,000.

TEXAS: Fort Worth closing all schools until May 8 - 80,000 students attend.   
On Wednesday there were 53,000 out statewide

ARIZONA: Moon Mountain Elementary School in Phoenix - 800 students

CALIFORNIA: - Branham High in San Jose - approx. 1500 students
- Mountain View Elementary School in Visalia - 675
- Highlands Elementary School in Pittsburg, Ca - 600
- St. Mel School in Fair Oaks - 275

CONNECTICUT: - 3600 students in Wethersfield district
- 1400 in East Haddam district
- 600 at Rotella Magnet School in Waterbury - starting Thu
- 3800 in all Vernon Public Schools - starting Thu

ILLINOIS: - Kilmer Elementary School in Chicago - 850 students
- Sam Rotolo Middle School in Batavia - 1,500 students - starting Thu
- Marmion Academy in Aurora - 513 students - starting Thu

LOUISIANA: Cathedral-Carmel School in Lafayette - 780 - starting Thu

MINNESOTA: - Rocori Middle School - 400 students
- St. Boniface - 323 students   [Both in Cold Spring - they share lunch space]

NEW YORK - St. Francis Prep - 2700
- PS 177 in Queens - 380 students
- Good Shepherd in Brooklyn -  430 - starting Thu
- St. Brigid - 230 - starting Thu
- Fabius Pompey schools in Onondaga County, near Syracuse - 1,000 students - starting Thu

OHIO: Ely Elementary School, southwest of Cleveland - 350 students

RHODE ISLAND: North Kingstown High School - 1500 - starting Thu

SOUTH CAROLINA: Newberry Academy - 250  students

MAINE: Kennebunk Elementary School and the Crayon Academy day care center in York County.


Dr. Julie Gerberding (former head of CDC, now an ABC News consultant) on what we can learn from the deadliest flu pandemic his history:
Possibly we could see a dip in cases and then resurgence in the fall.  That is one interpretation of the 1918 data, but not everyone agrees.  There is a lot of scientific debate over the degree to which cities' actions in 1918 helped to reduce the severity of the flu in their communities.  But overall, when you look at the 1918 data, it seems that cities that took early action - and did not abandon their precautions prematurely - fared better.  School closings appeared the most effective at limiting the severity of the disease.

So school closings will definitely be effective? Not proven beyond a shadow of a doubt, but we have very good reason to believe they should help slow the spread of disease based on 1918 data and more modern studies.  One school in the South had closed for another reason during the start of flu season, and that community ended up having a slow start to their flu season. BUT… there are a lot of differences between 1918 and now.  Kids in 1918 were pretty much confined to their homes when not school.  Kids in 2009 are much more out-and-about, so we don't know for sure how much impact school closings would have today.

Any evidence that surgical masks help protect against getting the flu?  There is no evidence that masks help protect the general community.  They might even make people more vulnerable if the mask leads to more face touching - adjust mask, etc. The N95 respirator masks filter out small particles, and these are useful in a healthcare setting.  But they must be fitted by an expert to be effective at all.  However, it's important for people to feel empowered, and if wearing a surgical mask helps them go about their daily lives, then that's something.  Wearing a mask as a reminder not to touch your face might help too, but again, not proven.

What are the major theories about why the situation in Mexico seems so much worse than elsewhere?  Everything is speculative at this point, but the number one theory is that reporting Mexico is picking up mostly the severe cases and the light cases simply aren't being counted.  Other theories: that there is no difference and we will start to see very serious cases and deaths here as the total number of cases rises; that genetic differences in Mexican patients may play a role; that there are other co-factors we haven't appreciated yet, such as more background disease in Mexican patients, higher levels of smoking, etc.  Nothing is certain.

On whether a border closing would help at this point: Statistical likelihood that a border closing would have an impact is near zero.  The reason is that the virus has already been exported to multiple locations around the globe, and it is not feasible to screen everyone at the border for fever, let alone virus.  Border closings at this stage would make little difference but would devastate the global economy.


From Gary Langer:  In the first national polling data we've seen on swine flu, a Gallup poll conducted last night, 22 percent of Americans said they were worried about contracting the disease. Seventy-eight percent were not worried.

Very small numbers, ranging from 1 percent to 3 percent, report behavioral changes - e.g. canceling or postponing a trip, keeping a child home from school, staying home from work, avoiding mass transit, not going shopping or to a restaurant. Sixty-six percent approve of how the Obama administration is responding.

Results: http://www.gallup.com/poll/118078/Worries-Swine-Flu-Not-Yet-Affecting-Behavior.aspx?CSTS=alert


John McCain asked witnesses at two different Congressional hearings this afternoon about the wisdom of closing the border.

Dr. Richard Besser of the CDC told him this afternoon (notes not quotes) 16:03:15 "at this point we have this virus spreading across our country from person to person, without much trouble... a border strategy would not be effective."

But that did not stop McCain from issuing a paper statement this afternoon suggesting a border closing should be considered.

"I continue to believe that all available options to end this crisis must remain under consideration, including closing the border if it would prevent further transmission of this deadly virus," said McCain in the statement.

DHS Secretary Janet Napolitano said: "What we have been told by the experts is that any kind of universal closing of a port would have no impact or very, very little impact at all on the spread of this virus.  This virus is already in the United States, so any kind of containment theory that you're going to keep it out of the United States is - is really moot at this time." (152100)

Napolitano said customs and border control officers had stopped 49 suspected cases for screening - so far 41 have been cleared and 8 are still being tested.



Tamiflu & Relenza antiviral drugs:  Federal health officials say 25% of the US stockpile of antivirals are being shipped to states (Lisa Chinn)

Vaccine development: The world has no vaccine to prevent against swine flu infection but U.S. health officials aim to have a key ingredient for one ready in early May. 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.   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. The NYT reports today that federal officials have not yet made a decision on whether the swine flu is enough of a threat to warrant vaccine production, but a full 600 million doses, enough to provide the required two shots for each American, could be finished by January.



On Wednesday, China's Commerce Ministry said Wednesday the government is providing $5 million in humanitarian assistance to Mexico, for masks, gloves, disinfectants, infrared thermal scanners and other equipment. The ministry separately advised Chinese citizens to postpone business trips to Mexico and to take precautions when traveling to other affected places. China's Health Ministry says no cases of swine flu have been reported.

Local business groups say the closure of restaurants and other businesses will cost Mexico City about $110 million a day.   Mexico's main stock-exchange index slipped 164.48 points to 21662.53.

The term "swine flu" is a disaster for pork purveyors. China, Russia and Ukraine have banned pork imports from Mexico and parts of the United States, and the outbreak has stalled the usual spring rise in U.S. hog prices.

Hog prices nationwide had dropped to an average of about $59 per 100 pounds of carcass weight Tuesday morning, down from about $62 last Thursday, according to the U.S. Department of Agriculture. Prices typically climb past $70 in late April and May. 

U.S. officials said Tuesday they may abandon the term "swine flu," for fear it's confusing people into thinking they could catch it from pork. Suggested replacement names include "H1N1," "hybrid flu," and "novel flu".  The World Health Organization indicated it had no plans to try to remove the term "swine" from the flu's name.

Egypt pig slaughter: Egypt began slaughtering the roughly 300,000 pigs in the country Wednesday as a precaution against swine flu even though no cases have been reported here, infuriating farmers who blocked streets and stoned vehicles of Health Ministry workers who came to carry out the government's order.



THERMAL IMAGING  Asked why some countries are using thermal imaging at airports, Dr. Anne Schuchat with the CDC said the science showed they were not highly effective, "There are a number of thermal imagers that some governments have opted to use.  And during the SARS outbreak, these were used quite a bit in a number of airports...the scientific evidence at this point is pretty mixed and not that impressive."

EU Foreign relations commissioner Benita Ferrero-Waldner said on Wednesday the bloc was considering halting all travel to Mexico and disinfecting all airports due to the global flu outbreak.  AFP quoting a French diplomat in Brussels reports the question of halting European flights to Mexico is being discussed today at an informal meeting near Prague of EU transport ministers. If they come to an agreement, the decision will be officially validated at a meeting of the 27 EU health ministers due to be held in Luxembourg tomorrow afternoon. (Christophe Schpoliansky)

DHS & CDC "TRAVELER'S HEALTH ALERT NOTICE:" Notices warning about the symptoms of swine flu and how to avoided it are being provided to airports and airlines in the U.S., to be posted at check-in counters and gates. It's also being handed out to all passengers arriving from Mexico at all ports of entry. It's being provided in English and Spanish currently.  (Matt Hosford)

TRAVEL ALERT: Monday evening the State Department issued a Travel Alert, recommending that Americans avoid non-essential travel to Mexico.  Note that in State Dept jargon a Travel Alert is slightly less alarming than a Travel Warning.  Additional info at the State Department website: www.travel.state.gov  (Kirit Radia)
Tuesday Canada joined the list of countries advising against non-essential travel to Mexico.  The EU health commissioner also urged Europeans to postpone non-essential travel to parts of the US and Mexico.

US airlines have not cancelled any flights to or from Mexico, but some carriers are waiving fees for people who cancel their trips. US Customs officials are watching for signs of illness among people arriving at airports, seaports and border crossings; questioning sick travelers about their symptoms and referring them for additional screening if necessary.  Customs officials are wearing protective masks and gloves.

There are 4,049 passenger flights per week between US and Mexico, according to April schedules (the sum of both directions - an average of 2,025 each way). In 2008, 1.7 million Mexican residents traveled by air visiting to the United States and 12 million by surface transportation. 5.9 million U.S. residents traveled by air to Mexico and 14.5 million used surface transportation, according to the Department of Commerce.  (Matt Hosford).

Tuesday afternoon, Cuba announced it is suspending flights to Mexico for 48 hours.

On Wednesday - Australia prepared to roll out thermal scanners in eight major airports to take the temperature of passengers arriving from North America, and was printing cards to be distributed to passengers on incoming flights asking them to declare if they have flu-like symptoms.

Carnival Corp. has suspended cruise stops at Mexican ports over concerns about swine flu. The company says it canceled Mexico stops for three ships scheduled to visit the country Tuesday. It hasn't yet announced a decision on future stops there. (AP)

BORDER NUMBERS: 84 million vehicles crossed the border from Mexico in 2008; 94 percent were personal vehicles. (source: Bureau of Transportation Statistics)

MEXICO TOURISM:  Mexico had 21.4 million international visitors in 2006 (most recent figures), contributing more than $12 billion to the Mexican economy. (source: UN World Tourism Organization)



The White House is asking Congress for $1.5 billion to fight a swine flu outbreak.  President Obama sent a letter to lawmakers on Tuesday, asking them for a supplemental spending plan to build drug stockpiles and monitor future cases.  Obama says the money will also help international efforts to control the outbreak.


From State Dept acting spox Robert Wood:  "We have established a monitoring group here in the Department that will help gather information, try to sort out fact from fiction, support the interagency process that's being led by the Department of Homeland Security." (Kirit Radia)

Wednesday at 10am - DHS Sec'y Napolitano is the big witness when the Senate Homeland Security & Governmental Affairs committee takes-on the swine flu situation.

Thursday at 10am - The House Energy and Commerce Subcommittee on Health has scheduled a hearing to "examine the recent outbreak of swine flu and the next steps for a federal response at the Department of Health and Human Services."

Wednesday May 6 - House Foreign Affairs Subcommittee on Africa and Global Health has announced a hearing: "Global Health Emergencies Hit Home: The Swine Flu Outbreak."  Witnesses TBA.



SWINE FLU DETECTIVE: A startup company in Seattle is taking credit for being ahead of the CDC in spotting the influenza outbreak in Mexico. Veratect Inc., a 2-year-old company with fewer than 50 employees, combines computer algorithms with human analysts to monitor online and off-line sources for hints of disease outbreaks and civil unrest worldwide. It tracks thousands of "events" each month - an odd case of respiratory illness, or a run on over-the-counter medicines, for example - then ranks them for severity and posts them on a subscription-only Web portal for clients who want early warnings. The idea fueling Veratect and similar companies is that blogs, online chat rooms, Twitter feeds and news media and government Web sites are full of data that public health agencies could use to respond faster to problems like outbreaks of swine flu. Veratect attracted attention in recent days by publicly posting a timeline of the outbreak and publishing short reports on Twitter, where more than 4,000 people signed up to receive updates.

WHY ARE PEOPLE DYING IN MEXICO? Meanwhile - as Jeffrey Kofman and John McKenzie reported on World News on Tuesday- health officials are trying to figure out a basic question that could help mitigate the swine flu epidemic here and in other parts of the globe: Why are so many people dying of the infection in Mexico in contrast to elsewhere?  Scientists say the virus found in Mexico and in the U.S. appears to be the same, and therefore different mortality rates likely aren't due to the virus itself. The Wall Street Journal today writes that the answer appears to involve a combination of factors, including Mexico's often poor health-care service, cultural aspects, and the mystery bug's early appearance in this country. Much of the difference in mortality rates could have to do with timing. As the disease hit Mexico very early, doctors didn't suspect anything unusual when patients came in complaining of high fever and body aches. Plus - many Mexicans, especially the poor who rely on public hospitals, try to wait out sickness or medicate themselves rather than go to a doctor. Medicines including antibiotics are available without a prescription. The Washington Post writes that Patients in Mexico experiencing the most severe illness may have been infected with something else, as well, perhaps a bacterium.

GROUND ZERO: The LA Times writes that a possible source of swine flu could have been from a migrant worker from La Gloria who traveled to the US and returned home and infected his wife - who then infected several other people in the town.  


An average flu season kills about 36,000 people in the US. 
The world generally experiences at least two flu pandemics each century.  Historically, the 20th century saw 3 pandemics of influenza:

  1. 1918 - at least 675,000 U.S. deaths and up to 50 million deaths worldwide
  2. 1957 - at least 70,000 U.S. deaths and 1-2 million deaths worldwide
  3. 1968 - about 34,000 U.S. deaths and 700,000 deaths worldwide

(ABC News Medical Unit)



John McKenzie - NY (medical overview)
Ryan Owens - TX schools
Lisa Stark - at the CDC in Atlanta
Terry McCarthy - Mexico City
Jeffrey Kofman –Veracruz, Mexico (in search of 'ground zero')
Matt Gutman - at the CDC in Atlanta
Steven Portnoy - at the WHO in DC
Dr. Tim Johnson - Boston



Find answers to many questions at: www.abcnews.go.com/Health/SwineFlu/

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