GENEVA, April 29, (Agencies): The World Health Organization raised its pandemic alert for swine flu to the second highest level Wednesday, meaning that it believes a global outbreak of the disease is imminent. WHO Director-General Margaret Chan declared the phase 5 alert after consulting with flu experts from around the world. The decision could lead the global body to recommend additional measures to combat the outbreak, including asking vaccine manufacturers to switch production from seasonal flu vaccines to a pandemic vaccine. “All countries should immediately now activate their pandemic preparedness plans,” Chan told reporters in Geneva. “It really is all of humanity that is under threat in a pandemic.” A phase 5 alert means there is sustained transmission among people in at least two countries. Once the virus shows effective transmission in two different regions of the world, a full pandemic outbreak would be declared.

WHO has confirmed human cases of swine flu in Mexico, the United States, Canada, Britain, Israel, New Zealand and Spain. Mexico and the US have reported deaths.
WHO’s flu chief Keiji Fukuda said it was clear that the virus is spreading. “We don’t see any evidence that it is slowing down at this point,” he said.
Chan earlier Wednesday hosted a “scientific review” of the latest outbreak information, at which some 150 experts examined how swine flu spreads, its symptoms and how it can be treated.
Swine flu is suspected of killing more than 150 people in Mexico and sickening over 2,400 there, according to authorities there.
WHO has confirmed 114 cases of swine flu in seven countries, but reports are still coming in. Over half of the confirmed cases — 64 — are in the United States.
In an interview with CNN, Dr. Richard Besser, acting director of the US Centers for Disease Control and Prevention, confirmed the flu death of a 23-month-old child in Texas — the first death outside Mexico.
WHO experts were still trying to determine just how dangerous the virus is, said Dr. Nikki Shindo, a WHO flu expert.

“The one thing we don’t really understand is why the cases in Mexico are so severe,” she said, adding that WHO is looking into whether the Mexican cases involve underlying medical conditions that have caused people there to fare worse than patients elsewhere.
Shindo told The Associated Press before the scientific review that “hundreds of thousands” of people in Mexico could theoretically be infected with swine flu even if they are showing no or only mild symptoms.
“The tricky thing is the virus will evolve very, very quickly, so we have to continuously monitor it,” she said.
In the past, most swine flu patients have shown only mild symptoms, and the disease tends to be far less serious in humans than the bird flu virus that has infected at least 421 people and killed 257 in the last six years.
Shindo said it was important to keep in mind that even normal flu outbreaks kill people. In poor countries such as Madagascar and Congo, outbreaks of seasonal influenza have infected up to half of the population, with mortality rates reaching 1 percent.
Screening
Kuwait on Wednesday began airport screening of passengers arriving from countries with reported cases of swine flu, a health official said.
Travellers arriving from six countries including Mexico, the United States and Britain, will be checked at the airport for any rise in temperature, deputy head of public health department Yussef Mendkar told a news conference.
However he stressed that the country with a population of 3.44 million, including 2.35 million foreigners from some 120 countries, is “totally free of the disease” that has killed a confirmed seven people in Mexico.
But nearly 160 deaths in Mexico have been blamed on the disease and testing of those cases is continuing.
All doctors in Kuwait’s public and private sector have been instructed to immediately refer “suspected cases” to the infectious diseases hospital for further examination, Mendkar said.
Kuwait has around 10 million capsules of the Tamiflu medicine, sufficient to treat up to one million flu patients, he said.
Mendkar said Kuwait has not imposed travel restrictions to any country, but “we strongly advise people not to travel to countries that reported any swine flu cases.”
He also said Kuwait will attend a meeting of Gulf Cooperation Council (GCC) health ministers in Doha on Saturday to discuss coordination of efforts to face any possible outbreak of swine flu.
GCC member the United Arab Emirates on Tuesday placed its busy airports under strict surveillance for the disease.
Bahrain also decided to suspend imports of live pigs and pork products
Meanwhile, the virulent swine flu spread to 10 US states from coast to coast Wednesday and swept deeper into Europe, extending its global reach as the US was hit with the first flu death outside of Mexico — a Mexican toddler who had traveled with his family to Texas. Total American cases surged to nearly 100.
The World Health Organization said the outbreak is moving closer to becoming a full-scale pandemic. But in Mexico City, the mayor said the outbreak there seemed to be stabilizing.
In Washington, Homeland Security Secretary Janet Napolitano was questioned closely by senators about whether the US should close its border with Mexico, where the outbreak apparently began and the casualties have been the greatest, with more than 150 deaths. She repeated the administration’s position that questioning of people at borders and ports of entry was sufficient for now and said closing borders “has not been merited by the facts.”
Dr Richard Besser, the acting chief of the Centers for Disease Control, said in Atlanta that there are confirmed cases now in ten states, with 51 in New York, 14 in California and 16 in Texas, where officials said Wednesday they were postponing all public high school athletic and academic competitions until May 11. Two cases have been confirmed in Kansas, Massachusetts and Michigan, while a single cases have been reported in Arizona, Indiana, Nevada and Ohio.
In a possible outbreak north of the Mexican border, the commandant of the Marine Corps said a Marine lieutenant in southern California might have the illness and 39 Marines were being confined on their California base until tests come back.
Marine 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.
President Barack Obama said he wanted to extend “my thoughts and prayers” to the family of a nearly two-year-old Mexican boy who died in Houston, the first confirmed US fatality among more than five dozen infections. Health officials in Texas said the child had traveled with his family from Mexico, to Brownsville on April 4 and was brought to Houston after becoming ill. He died Monday night.
“This is obviously a serious situation,” and “we are closely and continuously monitoring” it, Obama said of the spreading illness.
Meanwhile, Egypt’s government ordered the slaughter of all pigs in the country as a precaution, though no swine flu cases have been reported there.
Germany became the latest country to report swine flu infections. It reported four cases on Wednesday.
New Zealand’s total rose to 14. Britain had earlier reported five cases, Spain four. There were 13 cases in Canada, two in Israel and one in Austria.
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.”
He was underscoring advice that the CDC 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.
He advised people to take their own precautions — washing hands, staying home if they are sick, and keeping sick kids home.
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.
CDC for days has said people with flulike symptoms should stay home — but now also is stressing that other family members should consider staying home or at least limiting how much they go out until they’re sure they didn’t catch it.
Besser, the acting CDC director, called it “an abundance of caution,” but stressed that it’s voluntary and that the government hasn’t urged actual quarantine, which isn’t really effective with flu.
Millions
The swine flu outbreak, which could be especially dangerous for millions of people already battling other infections, such as HIV or tuberculosis, health experts said.
The virus has caused mainly minor symptoms in countries with confirmed infections outside Mexico, and the outbreak remains tiny in scale compared to other epidemics such as malaria, hepatitis, cholera and meningitis.
However, as it continues to spread epidemiologists worry that swine flu could have a devastating impact on people whose immune systems are weak due to the AIDS virus or other diseases.
World Health Organisation (WHO) spokesman Gregory Hartl said adults who suffered severe pneumonia and died from the virus in Mexico may in fact have fallen into this category.
“It is a question which a lot of our scientists have been looking at,” Hartl told reporters in Geneva on Tuesday, when asked why the deaths so far have been clustered in Mexico.
“Maybe people were infected with other illnesses too that made their illness more severe. Maybe they were immunologically suppressed,” he said.
Vaccine
A top US health official told lawmakers that vaccines against seasonal flu likely to not protect against swine flu and that a vaccine against that deadly disease cannot be ready before September.
“If everything went great, production could lead to availability as early as September,” Anne Schuchat, acting deputy director for science and public health program at the US Centers for Disease Control and Prevention.
But “everything doesn’t always go great,” she warned the Senate Homeland Security and Governmental Affairs Committee.
Schuchat said there were “active efforts” to prepare for making the vaccine, but, when asked whether it would definitely be made, replied: “I don’t believe that decision has been made yet.”
Schuchat warned that scientists did not believe that vaccines against seasonal influenza, which kills 36,000 people each year, would protect against the “novel” virus now making headlines.
“We don’t expect there to be protection,” she said. “Based on the laboratory testing that’s been done so far, we don’t expect there to be cross-protection.”
Asked why experts worried about swine flu given the annual havoc wreaked by regular, seasonal influenza, Schuchat said “we are dealing with a novel virus” and that the general population had not built up resistance to the illness.
“It’s a virus that hasn’t been around before,” she said. “The general population doesn’t have immunity to this virus. With seasonal flu, a good proportion of the population has some immunity.”
Impact
With global anxiety spreading even faster than the new swine flu — and a vaccine still months away — health authorities are struggling to reduce the impact of an outbreak that can’t be contained by simply shutting borders.
The world has no vaccine to prevent infection but US 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 US Food and Drug Administration’s swine flu work, told The Associated Press.
Meanwhile, the US is shipping to states not only enough anti-flu medication for 11 million people, but also masks, hospital supplies and flu test kits. President Barack Obama asked Congress for $1.5 billion in emergency funds to help build more drug stockpiles and monitor future cases, as well as help international efforts to avoid a full-fledged pandemic.

Authorities sought to keep the crisis in context: Flu deaths are common around the world. In the US alone, the CDC says about 36,000 people a year die of flu-related causes. 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 US, 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.