Swine Flu Outbreak Spreads to Spain as Mexico Death Toll Rises

By Hans Nichols and Shannon Pettypiece

April 27 (Bloomberg) -- Mexico’s toll of flu-related deaths exceeded 100, Asian countries screened travelers and Spain reported its first case of swine influenza, prompting concern of a pandemic.

Six people in Canada contracted swine flu and more cases are likely, government officials said. New Zealand said as many as 13 students who recently visited Mexico may have swine flu.

Australia, Japan, Singapore and South Korea are among countries screening travelers for fever, while Hong Kong raised its swine-flu response level to “serious” from “alert.” The European Union advised travelers to avoid areas affected by the outbreak. Barack Obama’s administration declared swine flu, normally spread among pigs, a public health emergency after 20 people contracted the disease.

“The surveillance system has been cranked up to a very sensitive level and what we’re getting, and what we expect a lot more of, are rumors of cases and these cases will be investigated,” said Dick Thompson, a spokesman for the World Health Organization in Geneva. “There will be rapid clinical laboratory testing to see whether or not these sick people are indeed sick with swine flu.”

Swine flu is a respiratory disease of pigs caused by type-A influenza that regularly leads to outbreaks among the animals, according to the U.S. Centers for Disease Control and Prevention. Three main human flu strains -- H3N2, H1N1 and type B --circulate and cause 250,000 to 500,000 deaths a year in seasonal epidemics, according to the WHO.

Pandemics occur when a novel influenza A-type virus, to which almost no one has natural immunity, emerges and begins spreading.

Spanish Case

One person in Spain has been confirmed as suffering from swine flu in Europe’s first case of the disease, Health Minister Trinidad Jimenez said. A further 16 people are being tested for the flu, she said. Both the confirmed case and possible infections involve people who had been in Mexico, where swine flu first broke out.

Ten high-school students who returned to New Zealand on April 25 from Mexico tested positive for influenza A, Health Minister Tony Ryall said in Wellington. Three students from another school are ill and being tested for influenza A, he said.

Concern about swine flu contributed to a drop in stocks worldwide today. The MSCI World Index dropped for the first time in five days, slipping 0.6 percent as of 12:05 p.m. in London. Air France KLM-Group led a decline in airline shares. GlaxoSmithKline Plc and Roche Holding AG, which make drugs to treat flu, advanced.

Bars, Theaters, Churches

The number of deaths from Mexico’s flu outbreak has risen to 103, Health Minister Jose Cordova said in an interview with television broadcaster Grupo Televisa SAB yesterday. Not all deaths have been confirmed to be caused by swine flu, he said.

The Mexican government requested that bars, movie theaters and churches be closed in Mexico City. In New York, where eight cases were confirmed at a private school, Mayor Michael Bloomberg is keeping city schools open and urging residents to wash their hands frequently, stay home if ill and avoid the hospital unless very sick.

EU officials “strongly recommend avoiding” travel to Mexico and other areas affected by the virus, EU Health Commissioner Androula Vassilou said in a videotaped statement released in Brussels today. The EU won’t advise against traveling to Spain.

‘More Severe’

While the U.S. cases were mild and no one died, the disease may become “more severe,” said Richard Besser, acting chief of the CDC. The 20 cases were confirmed in California, Kansas, New York, Ohio and Texas states.

Fears of a lethal pandemic lie in the nature of flu germs, which mutate readily and can become virulent by exchanging genes with related influenza viruses. While the H5N1 bird virus that spread across Asia in the last few years, killing millions of fowl and several hundred people, never gained genes to spread easily among humans, the Mexican swine flu already has, said Malik Peiris, a microbiologist from the University of Hong Kong.

“The concern is that this virus has the ability to transmit from humans to humans because a number of the cases who got infection have had no direct exposure to swine,” said Peiris, who has studied the severe acute respiratory syndrome and avian flu viruses.

Swine flu results in symptoms similar to regular human influenza such as fever, lethargy and cough, and may also cause nausea, vomiting and diarrhea, according to the CDC.

Sustained Transmission

Disease trackers are looking for sustained, human-to-human transmission of the viruses in the community to determine whether the WHO needs to elevate its level of pandemic alert.

Singapore tightened checks at Changi airport to screen arriving passengers, the Health Ministry said. Malaysia placed officials at airports to screen travelers, and told hospitals and clinics to check for patients with unusual fevers.

Japan will heighten its monitoring for any signs of swine flu and authorities will examine flights from Mexico, Chief Cabinet Secretary Takeo Kawamura said today.

Taiwan has tightened border checks for visitors from Mexico and the U.S., while Australia will require captains of all planes arriving from the Americas to report on the health of passengers before receiving landing permission.

China warned citizens visiting or already in Mexico to take precautions. It has banned all direct or indirect imports of swine or pork products from Mexico and from Texas, California and Kansas, the country’s General Administration of Quality Supervision, Inspection and Quarantine said.

Pork Ban

Indonesia, Southeast Asia’s largest economy, also banned imports of pork and edible swine products from today.

Russia, which has stopped pork imports from about 10 U.S. states, said it’s seeking more information from the U.S. on measures it’s taking to combat swine flu before lifting the ban.

Swine-flu viruses aren’t transmitted by food, and eating properly handled and cooked pork and pork products is safe, according to the CDC. There’s no evidence the disease is spread by exposure to “pork or pigs,” said Keiji Fukuda, WHO’s assistant director-general for health security and environment.

WHO declared the outbreak a “public health emergency of international concern” on April 25. The organization also concluded that more evidence is needed to determine whether the level of pandemic alert should be increased.

Emergency Committee

An emergency committee will meet again today, the WHO’s Thompson said. The WHO’s six-stage pandemic threat level is currently at 3. Evidence of increased human-to-human spread of a new virus would move it to level 4, according to the agency’s Web site.

Scientists are trying to determine why the virus has been more severe in Mexico. In the U.S. only one person has required hospitalization, Besser said.

There is no vaccine for the virus, he said. Homeland Security Secretary Janet Napolitano said 25 percent of “courses of treatments” of drugs, known as antivirals, were being released from U.S. stockpiles. In all, there are 50 million courses, she said. Among those are Tamiflu, sold by Roche, and Relenza, from GlaxoSmithKline.

The U.S. government is issuing a health emergency declaration to devote more resources to blocking the virus, Napolitano said. For now, the monitoring of travelers will remain “passive” and no restrictions on travel with Mexico have been issued.

White House press secretary Robert Gibbs said it was “far too early to determine” whether there will be an economic impact from the outbreak.

The World Bank promised Mexico $205 million in loans to help fight the disease, said Mexico’s finance minister, Agustin Carstens.

Obama

President Barack Obama was in Mexico City April 16 for meetings with Mexican President Felipe Calderon. Gibbs said the incubation period for an infection is long past and “the president’s health was never in danger.”

John Brennan, a special assistant to the president for homeland security, said the government is putting in place systems to allow “rapid identification” of any new cases and efforts to “mitigate a broader outbreak” in the U.S.

Four people in France suspected of having swine flu have tested negative for the virus, an official at the Health Ministry said today.

In Brazil, the Sao Paulo state hospital Emilio Ribas has isolated a potential case, said Doctor Edenilson Eduardo Calore, head of weekend duty. The patient had been in Mexico, Calore said.

Michael Bloomberg is the founder and majority owner of Bloomberg LP, the parent company of Bloomberg News.

To contact the reporters on this story: Hans Nichols in Washington at Hnichols2@bloomberg.net; Shannon Pettypiece in New York spettypiece@bloomberg.net.