Swine Flu in New York May 1, 2009

Pertussis (also known as “whooping cough”) is a vaccine-preventable, highly contagious respiratory illness that is caused by bacteria. Pertussis circulates worldwide; however, disease rates are higher in areas where vaccination coverage is low. The disease is most severe in unvaccinated infants.

Current Situation

Since early 2009, several areas in Australia have reported an increase in cases of pertussis. As of April 13, 2009, more than 7,000 cases have been reported across the country.

• New South Wales, which includes the city of Sydney, has seen the highest number of cases, with over 5,000 cases. On March 10, 2009, a 4-week-old infant from the North Coast (New South Wales) was reported to have died from pertussis.
• Queensland, which includes the cities of Brisbane and Cairns, has also seen significant activity, with over 1,200 reported cases.
• The state of Victoria, which includes Melbourne, has reported over 500 cases.

This outbreak highlights how important it is for all international travelers to be up-to-date on routine vaccinations such as pertussis vaccine, regardless of the travel destination. Routine vaccinations, sometimes called “childhood vaccinations,” protect against many diseases that occur both in the United States and in other parts of the world.

Recommendations for Travelers and Americans Living Abroad

• Be up-to-date on all routine vaccines, including pertussis. (See the child and adolescent vaccination schedule and routine adult vaccination schedule.)
• If you are traveling with a child, make sure he or she is up-to-date on all vaccines that are recommended for travel.
• Keep a copy of your vaccination records with you as you travel.
• If you live abroad, make sure that you are up-to-date on pertussis vaccination. If you have not been vaccinated against pertussis, consider getting a pertussis vaccine from a reliable local health-care facility.
  • U.S. Embassies or Consulates maintain lists of local medical facilities. See the Doctors/Hospitals Abroad webpage for more information.
  • The International Society of Travel Medicine (ISTM) has member clinics in many different countries with doctors who can speak English and are familiar with treating expatriates. You can search the ISTM clinic directory for more information.

Information about Pertussis

Pertussis is a highly contagious respiratory infection. It is spread by contact with an infected person, through coughing and sneezing. Early symptoms of pertussis are usually mild and may look like the common cold, with congestion, sneezing, and perhaps mild cough or fever. A severe cough usually develops within 1 to 2 weeks of exposure. Children with the disease cough violently and rapidly and this cough is associated with
with a loud "whooping" sound. Older children and adults usually have less severe symptoms, such as a persistent cough without the “whoop.”

Information about Pertussis Vaccine

Two combination vaccines give protection against pertussis: DTaP (acellular pertussis vaccine in combination with diphtheria and tetanus toxoids) and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine).

MEASLES - USA: (PENNSYLVANIA) ex INDIA, ALERT
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[1]
Date: Sat 11 Apr 2009
Source: Pittsburgh Post-Gazette [edited]
<http://www.post-gazette.com/pg/09101/962227-53.stm>


The Allegheny County Health Department and state Department of Health
have provided a comprehensive list of places and times that exposure
to measles might have occurred last month [Mar 2009] throughout
southwestern Pennsylvania. The source of the measles was a child from
India who arrived 7 Mar 2009 in the United States. Since then, 5
other people have contracted measles, which is highly contagious,
with possibly more awaiting confirmation. Health officials continue
to track down unvaccinated or susceptible people who might have been
exposed to people with measles and face a risk of infection.

Exposures may have occurred at the following places and times:

- The Emergency Department of Children's Hospital of Pittsburgh of
UPMC:

- anytime on 10 Mar 2009;
- between 8 p.m. 21 Mar 2009 and 11 a.m. 22 Mar 2009;
- between 6 p.m. 25 Mar 2009 and 5 a.m. 26 Mar 2009;
_-between 6 p.m. 27 Mar 2009 and 3 a.m. 28 Mar 2009; and
- between 2:30 p.m. 28 Mar 2009 and 4 a.m. 29 Mar 2009.

- People also could have been exposed to measles anytime on 23 Mar
2009 at Children's Hospital's 3rd floor Ear Nose and Throat and
Specialty Clinics.

- Alle-Kiski Medical Center's Emergency Department, main lobby and
ground floor public areas in Natrona Heights, between 10 a.m. and
3:30 p.m. 28 Mar 2009.

- During an EMS-1 Conference at Seven Springs Mountain Resort in
Somerset and Fayette counties, exposure in the Snowflake Room and the
main dining room might have occurred between 9:30 a.m. and 3:30 p.m.
26 Mar 2009.

- On the following Allegheny County Port Authority buses:

- Route 28X (Airport Flyer) between 10 a.m. and noon 24 Mar 2009 and
between 2:30 p.m. and 4:30 p.m. 28 Mar 2009;
- 33X (West Busway all stops) between 10 a.m. and 1 p.m. 27 Mar 2009; and
- 71A between 11 a.m. and 1 p.m. 24 Mar 2009 &between 11 a.m. and 2  
p.m. 27 Mar 2009.

People who aren't immune to measles, including those not fully
vaccinated, should contact a primary health-care provider immediately
to let them know you may have been exposed, especially if you have
had a fever and rash anytime since 15 Mar 2009. Those who had
possible exposure to someone with measles and have become ill with
measles symptoms from one to 2 weeks after possible exposure also
should contact a health-care provider.

For more information about measles and the mumps-measles-rubella  
vaccination, visit
<http://www.health.state.pa.us> or
<http://www.achd.net>.

[Byline: David Templeton]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

******
[2]
Date: Fri 10 Apr 2009
Source: The Tribune-Democrat [edited]
<http://www.tribune-democrat.com/local/local_story_100234341.html?keyword=topstory>


Emergency personnel from across the region who attended a conference
at Seven Springs Mountain Resort may have come in contact with an
individual infected with measles. In an alert issued Friday [10 Apr
2009], the state Health Department said at least 6 measles cases in
western Pennsylvania have been traced to a traveler from India who
attended the Somerset County conference on 26 Mar 2009. Officials
suspect there are other measles cases that have yet to be confirmed.

The person from India, who has not been identified, was in the Seven
Springs Snowflake Room and the main dining room between 9:30 a.m. and
3:30 p.m. on that date. While no numbers could be confirmed,
emergency services officials from Cambria and Somerset counties said
they are confident some of those in attendance were local emergency
responders. "Almost definitely, people from Cambria County were
there," said Brian Feist, executive director of Cambria County
Department of Emergency Services. "It's an annual event. That's a big
thing with our ambulance services." The training was sponsored by
Emergency Medical Services (EMS) Institute of Allegheny County, a
multicounty out-of-hospital medical services oversight agency and a
division of the state Health Department. Some Somerset County EMS
personnel would have attended the conference, said Rick Lohr,
executive director of Somerset County Department of Emergency
Services.

Along with one day at the EMS conference, the traveler also visited
the emergency rooms of UPMC Children's Hospital and the Alle-Kiski
Medical Center. The person also traveled on several public transit
buses in Pittsburgh in late March 2009.

The Centers for Disease Control and Prevention's website says the  
disease can cause more serious problems such as ear infections,  
pneumonia, encephalitis (inflammation of the brain), and the CDC says  
that although measles was declared eliminated in the USA in 2000, it  
still is common in many other countries. Worldwide, 20 million cases  
of measles occur each year. The virus can be imported by foreign  
visitors or returning travelers who are not fully protected against  
the disease. Close to 90 percent of the measles cases reported this  
year [2009] in the United States either were acquired abroad or linked  
to imported cases.

Measles symptoms include fever, rash, cough, runny nose or red watery
eyes, said Stacy Kriedeman, state Health Department spokeswoman. "We
want people to make sure they take notice so that if they have any of
these symptoms, they contact their primary care doctor," she said.

[Byline: Kate Melliott]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The USA has eliminated indigenous measles by a comprehensive
vaccination policy. It remains vulnerable to importation of infection
from endemic areas with subsequent limited spread through the
minority of individuals who have declined or escaped routine
protective vaccination. So far, all importation-related outbreaks
have been self-limited, but vigilance has to be maintained. The
current importation has given rise to 5 additional cases, and there
is risk of further spread, hence the current alert in Pennsylvania.

Seven Springs and Pittsburgh in the state of Pennsylvania can be
located in the HealthMap/ProMED-mail interactive map at:
<http://healthmap.org/promed/en?name=Seven%20Springs,%20Pennsylvania,%20United%20States&g=5211478&v=40.023,-79.297,5>.
   - Mod.CP

Measles can be really nasty; 2 of ProMED's senior moderators had  
life-threatening cases of measles when sub-teen-aged in the  
pre-vaccination era. - Mod. JW]

[see also:
2008
----
Measles - USA (07): update Jan - Jul 2008 20080822.2618
Measles - USA (06): (NY) ex Europe, alert 20080817.2555
Measles - USA (05): (MN) 20080808.2445
Measles - USA (04): (multistate) 20080711.2118
Measles - USA: (IL) ex Switzerland, corr. 20080603.1774
Measles - USA: (IL) ex Switzerland, corr. 20080603.1773
Measles - USA: (IL) ex Switzerland 20080602.1763
Measles - USA: (WA) 20080522.1688
Measles - Spain, USA 20080517.1654
Measles - Worldwide: Peru ex India, USA 20080505.1539
Measles - USA (03): (AZ) 20080501.1498
Measles - USA: (WI) 20080413.1342
Measles - USA (02): (AZ) 20080401.1207
Measles - USA (VA) ex India: alert 20080315.1033
Measles - USA (AZ) ex Switzerland, Alert 20080308.0956
Measles - USA (CA) ex Switzerland (03) 20080217.0633
Measles - USA (CA) ex Switzerland (02): HI 20080215.0603]
.................................................cp/msp/jw
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The pandemic alert level remains at Phase 5 in the CNMI as the Department of Public Health continues to its routine testing to identify flu illnesses.

As of yesterday afternoon, the DPH has found no traces of the H1N1 influenza virus, even as the number of areas in the United States affected by the virus keeps going up.

DPH said it is increasing its surveillance operations because this is a “rapidly evolving” situation and that current guidance and other content may contain variations in how this new H1N1 flu virus is referred to.

Since the CNMI Pandemic Alert Committee and the DPH Emergency Operations Center were activated, there have been two cases of flu reported but Public Health analyst Roxanne Diaz explained that these were just the results of routine flu testing.

The tests have already been sent to the U.S. mainland for further evaluation.

Formerly known as the swine flu, this new illness is now referred to as H1N1 flu.

DPH said its six sentinel sites-CHC clinics, Marianas Medical Center, Medical Associates of the Pacific, Tinian Health Center, and Rota Health Center-have not reported any suspicious 2009 H1N1 flu cases.

“All flu tests in the CNMI are sent for further laboratory testing and confirmation in San Antonio, Texas,” the DPH said.

In the past six weeks, hundreds worldwide have been infected by the new H1N1 flu.

The following countries have reported laboratory confirmed cases with no deaths: Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (8), Ireland (1), Israel (3),

Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15). Mexico has reported 506 confirmed human cases of infection, including 19 deaths.

As of May 3, the Centers for Disease Control and Prevention reported 226 confirmed human cases of H1N1 in the United States.

Human infections with this new virus have been confirmed in 30 states at this time, with one death.

The list of states with the numbers of people who are confirmed cases is updated daily at 11am at www.cdc.gov/swineflu.

DPH said the Commonwealth Health Center has received adequate supplies of medication to treat individuals who have severe flu.

It said that because this is a new virus, most people will not have immunity to it, so the illness may be more severe and widespread as a result.

DPH explained that there is no vaccine available for the H1N1 flu virus at this time.

“The H1N1 flu virus is not transmitted by food. You cannot get this H1N1 flu from eating pork and pork products,” DPH further explained.

[edit] South America

Outbreak evolution in South America:
     Confirmed cases     Unconfirmed or suspected cases

[edit] Argentina

According to an Epidemic Alert order issued by the Ministry of Health, Airlines have been required to report passengers with influenza symptoms arriving from Mexico and United States. Passengers from these countries must fill out a form to be located should they experience any symptoms.^[321] In addition, the government has also stepped up safety checks, and thermal scanners are being used on airports to detect passengers with fever and other influenza symptoms. As of April 28, the Government has suspended all flights originated from Mexico until May 4 as a precautionary measure.^[322]

On May 7, Health Authorities confirmed the first case, a tourist that had recently returned from Mexico. 55 other suspected cases continue to be studied under isolation.^[323]

On May 12, Health Authorities confirmed the second case, a tourist from Puerto Madryn who had recently returned from Mexico. ^[324]

[edit] Brazil

Outbreak evolution in Brazil:
     Confirmed cases     Unconfirmed or suspected cases

Two people who had arrived in Brazil from Mexico with symptoms of an undefined illness were hospitalized in São Paulo on April 25. It was initially suspected that they were suffering from the swine flu virus.^[325] The Brazilian Ministry of Health later issued a press release stating that while the exact cause of the two patients illnesses remained unknown, they "did not meet the definition of suspected cases of swine influenza because they did not have signs and symptoms consistent with the disease: fever over 39 °C, accompanied by coughing and/or a headache, muscle and joint pain."^[326]

The press release also stated that airports would monitor travelers arriving from affected areas, under the direction of the National Sanitary Surveillance Agency (ANVISA). Air crews are also being trained on signs and symptoms of swine influenza so that passengers displaying symptoms may receive guidance from ANVISA upon arrival.

On April 27, a person who had arrived in Salvador, Bahia, from the United States was hospitalized.^[327]

On May 7, the first four cases of swine flu were confirmed, two of them in São Paulo state, one of them in Rio de Janeiro state and one in Minas Gerais. Three of the infected patients were recently in Mexico and the other was recently in the USA. ^[328]

On May 8, another case of swine flu was confirmed, this time in Santa Catarina state. The infected patient was a girl of seven years old, she was recently in USA. The country has another 30 suspected cases. That same day, the sixth case of swine flu was confirmed in Brazil. This case was from Rio de Janeiro state. This was the first confirmed case of transmission inside the country. However, the infected person only had contact with an infected patient and is now under observation and being cured.^[329] On May 9, besides the confirmed cases, the health ministry confirmed the existence of 30 suspected cases in the country: São Paulo (12), Paraná (4), Minas Gerais (4), Federal District (2), Goiás (2), Santa Catarina (1), Mato Grosso do Sul (1), Pernambuco (1), Ceará (1), Rondônia (1) and Rio de Janeiro (1). The two new cases are each at Rio Grande do Sul and Rio de Janeiro. ^[330]

On May 10, the health ministry informed that the suspected cases in Brazil fell to 18. They are located in São Paulo (6), Rio de Janeiro (2), Minas Gerais (1), Paraná (1), Federal District (3), Santa Catarina (1), Pernambuco (2), Ceará (1) e Rondônia (1). ^[331] Today in Brazil, the flight with the friends of the first infected man in Rio arrived, probably with this flight more suspected in Rio de Janeiro will confirmed. ^[332]

On May 10, in the night, the minister of health confirmed two more cases of swine flu, another case in Rio de Janeiro, this patient catch the flu of the others two patients of the Rio. And the first in Rio Grande do Sul, this patient was in several European countries (Germany, Czech Republic, Hungary, Austria, Italy and Spain), before returning to Brazil. As outlined the Ministry of Health, the patient of Rio Grande do Sul is well and showed the first symptoms, light, on May 3 in Italy. ^[333] Now the country has 8 confirmed cases and 22 suspected cases. The suspected cases are in São Paulo (10), Rio de Janeiro (2), Paraná (1), Distrito Federal (3), Alagoas (1), Pernambuco (3), Ceará (1) e Rondônia (1). ^[334]

On May 11, the Minister of Health confirmed the existence of 34 suspected cases in Brasil. They are in São Paulo (14), Distrito Federal (4), Rio de Janeiro (4), Alagoas(2), Minas Gerais (2), Paraná (2), Pernambuco (2), Ceará (1) and Rondônia (1). Today confirmed too that the woman with the swine flu in Rio is with pneumonia, but her state is stable. ^[335]

On May 13, the Minister of Health confirmed the existence of 37 suspected cases in Brasil. They are in São Paulo (14), Distrito Federal (4), Rio de Janeiro (3), Alagoas(2), Minas Gerais (7),Pernambuco (3), Ceará (1), Pará (1), Rio Grande do Sul (1) and Rondônia (1). ^[336]

[edit] Chile

On April 27, the Assistant Secretary of Health Jeanette Vega, confirmed that there are eight suspected cases of swine influenza in the country, which are being examined at the Hospital del Tórax in Santiago. Five other cases have been dismissed by the authorities.^[337]

On April 28 the Health Ministry announced 26 cases under investigation: 16 in Santiago; 2 in Atacama; 2 in Valparaíso; 4 in O´Higgins Region; 1 in Biobío and 1 in Araucanía. 16 other cases have been dismissed.^[338]

On May 1, the Health Ministry announced that it continued to investigate 4 suspected cases: 2 in Santiago, 1 in Valparaíso and 1 in Araucanía. To date, 80 suspected cases have been examined by the Health Ministry; 76 of those have been dismissed.^[339] Another suspected case was identified on May 2, bringing the number of cases under investigation to 5. ^[340]

On May 10, the Health Ministry announced that 116 cases have been dismissed, and there are no cases pending test results. ^[341]

[edit] Colombia

Outbreak evolution in Colombia:
     Confirmed cases     Unconfirmed or suspected cases

The Minister of Social Protection, Diego Palacio Betancourt, announced on April 26, 2009, that 12 suspect cases had been detected, 9 in Bogotá and 3 on the Caribbean coast. Samples of the virus have been sent to the USA for comparisons and analysis. Results of the testing were expected within few days. On April 27, the Government declared a "national disaster" state^[342] in order to face the emergency, which allowed health authorities to have a special budget to do so.^[343] As of April 28, most of the suspect cases were excluded, with only four remaining: three Mexican teachers in Bogotá, and one person in Cartagena.^[344] Another 38 suspect cases were under observation.^[345] On April 29, the suspect cases raised to 49, with 10 of them "highly" suspect.^[346] The government purchased 400,000 oseltamivir doses, which will be distributed through the Social Protection ministry to the affected if there are confirmed cases.^[347]

On May 3, 2009, Minister Palacio confirmed the first case of A(H1N1) in Colombia,^[344] in a 42-year-old person from Zipaquirá, who recently travelled to Mexico.^[348] According to Palacio, only one out of 18 tests sent to Atlanta was positive. The patient was isolated and put under medical treatment. On the same day, Palacio stated there were 108 suspect cases in the country.^[348]

[edit] Ecuador

Health officials are carrying out checks on people with flu symptoms entering the country from sea or air.^[50] On April 29, Ecuador closed its borders to Mexican citizens and foreigners of other nationalities arriving from Mexico for a period of 30 days.^[349] On May 15, Health officials confirmed the first case of AH1N1 flu in Ecuador ^[350].

[edit] Peru

The Governor of Callao, Alex Kouri, ordered that all passengers from any infected country, mainly Mexico, Canada and USA, must be checked before their arrival on Peruvian territory. Also, the Peruvian government must be warned of any case or symptom of fever. This step is in order to prevent any infections, since the main port and airport of Peru are located in Callao. Also, the government has prepared a special area at the Hospital "Daniel Alcides Carrión" to treat cases of this disease.^[351]

The first suspicious case has been detected in the morning of April 27, 2009. It was a Peruvian woman who returned from Mexico.^[352]

In Peru 5 people were considered suspects with the virus, but as of April 28 have been confirmed to be healthy and not carrying the H1N1 virus. The government has stated that the country is clean, but efforts are being made to examine slaughterhouses and they are screening incoming passengers from problem areas.^[353]

On April 29, Peru's Health Minister Oscar Ugarte confirmed one case of swine flu. On April 30, he said the case is not entirely confirmed. Having recently visited Mexico, the patient was flying in a Copa Airlines airplane from Panama to Buenos Aires on April 28, but the flight was diverted to Lima due to her illness. The crew only notified of the suspicion of swine flu only after the passenger had checked in the airport. Three more suspected cases were being investigated. Ugarte also announced the suspension of all commercial flights from Mexico to Peru.^[351] On May 14, Ugarte confirmed a case of swine flu from a woman who returned from New York.

[edit] Venezuela

Controls have been raised at airports to prevent contagion from spreading. Travellers from the United States and Mexico with flu symptoms are being isolated until they are given the all clear. Pig farms in the country are being "closely inspected" and stockpiles of medicines built up.^[50]