WHO watching Spain for signs of flu transmission

A passenger wears a face mask Thursday at Gatwick Airport in England on arrival from Mexico.
The number of confirmed swine flu cases worldwide has risen to 154, with six additional cases reported in Spain, the World Health Organization said Thursday.

The WHO is troubled because in one of the 10 cases in Spain the virus was transmitted from person-to-person within the community. The other nine infected people had returned from Mexico, where the crisis is most severe, according to WHO spokesman Dick Thompson. If Spain sees more such cases of community transmission, the world body may have to elevate its pandemic alert to its highest level. Phase 6 is the pandemic phase and is characterized by a community-level outbreak in another country in a different WHO region. Spain falls in a different region from the United States and Mexico — the two countries that have until now shown human-to-human spread. “The significance is that it’s another phase,” Thompson said. “The virus is becoming established in another area, another country.” But, Thompson added, the virus would have to show a sustained pattern of transmission in order for the level to be raised. Watch how Mexican authorities are dealing with the outbreak » “We’re looking for intergenerational spread. So, that means from a traveler to a spouse to the butcher to the kindergarten, something like that — through generations of spread in one community.” For now, the WHO’s breakdown of confirmed cases is: United States, 91, including one death; Mexico, 26, seven deaths; Canada, 13; Spain, 10; United Kingdom, five; Germany, three; New Zealand, three; Israel, two; Austria, one. Peru and Switzerland reported their first cases late Wednesday and early Thursday, respectively — but they were not among the WHO’s official tally. The WHO is also investigating possible swine flu cases: 11 in New Zealand, 2 in France; 1 in South Korea, and 1 in Switzerland.

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The world health body defines “possible” as cases where the patient tested positive for Influenza A — the general category of strains that includes the H1N1 swine virus. But further tests are needed to verify whether they are positive for that specific virus. Meanwhile, the family of a toddler who became the first confirmed U.S. death from swine flu was back in Mexico Thursday, awaiting the arrival of his cremated body. Federal health officials warned the 22-month-old boy’s death would not be the last in the United States as the swine flu cases continue to mount at home and abroad. On Wednesday, the WHO raised its pandemic threat to its second-highest level, warning of widespread human infection from the outbreak that originated in Mexico and has been jumping from person to person with relative ease. Learn about swine flu » It urged countries to ramp up efforts to produce a vaccine. “It really is all of humanity that is under threat during a pandemic,” said Dr. Margaret Chan, the WHO’s director-general. “We do not have all the answers right now, but we will get them.” Nowhere has been as hard hit as Mexico, where thousands stream into hospitals in Mexico City daily complaining of sore throats and aches. Before it spread to four continents, the first cases of the virus were detected in Mexico — including the earliest documented case, a 5-year-old boy in a small mountain village in the state of Veracruz. On Wednesday, medics in Mexico City tended to patients in tents set up outside hospitals while clad head-to-toe in biohazard suits, goggles and two pairs of glasses. The government has ordered a shutdown of about 35,000 public venues, mandated restaurants to serve takeout only and closed all nonessential government offices and private businesses. The shutdown, beginning Friday and lasting until Tuesday, encompasses the long Cinco de Mayo holiday weekend, and may be extended, officials said. “We’re all very alarmed for ourselves and our families,” said Cadina Navarro, who lives in eastern Mexico City. “We’re going through difficult times.” Mexican President Felipe Calderon took to television late Wednesday night, telling an anxious nation the country has enough medicine to cure the sick. “In times of difficulty, we’ve always come together,” he said. “Together we will overcome this disease.” But his words did little to calm jittery nerves. “With stories and statistics changing by the hour, it seems, we just don’t know what to believe,” said Melvin Francisquini, who is working as a volunteer in Mexico City after getting laid off from his job in the United States. Mexican health officials suspect the swine flu may have killed more than 150 and infected roughly 2,500. But even Mexico’s number of confirmed cases differs from the WHO count: 99 infected versus WHO’s 26; eight deaths versus WHO’s seven. In a city of 20 million, it has became impossible to find protective surgical masks, which the government had given to one out of every five residents. “If everyone taking mass transit were wearing blue masks, I would feel safer,” Francisquini said. “But they are not. This is why I continue to change the times I get into and leave work. Otherwise, as long as I’m not taking mass transit, I do feel safe.” Back in Texas, the funeral home director who carried out the cremation of the swine flu victim said the services “left an impression” on him. “They were a very, very nice family,” said the director, Gregory Compean, who has been in business for 25 years. “The mother was very distraught.” The boy, whose name CNN is withholding, arrived in the border town of Brownsville on April 4 with his architect father, his mother and five siblings, said Compean. He fell ill with flu symptoms four days later, was airlifted to a Houston children’s hospital, and died Monday night. He had “several underlying health problems,” and was likely infected in Mexico, state health officials said, without elaborating. Swine flu is a contagious respiratory disease that affects pigs and can jump to humans. Symptoms include fever, runny nose, sore throat, nausea, vomiting and diarrhea. But this virus, technically called 2009 H1N1, is a hybrid of swine, avian and human strains, and no vaccine has been developed for it. In response, countries are scrambling to prevent its spread. In the United States, where the cases are spread over 10 states, President Barack Obama called on schools with confirmed or possible swine flu cases to consider closing temporarily. At least 74 elementary, junior high and high schools have done so, the Department of Education said Wednesday. Watch Obama touch on swine flu during his press conference » Ecuador joined Cuba and Argentina in banning travel to or from Mexico. Egypt is reportedly considering culling all pigs although there have been no reported cases of swine flu in that country. Some, such as China and Russia, have banned pork imports from the United States and Mexico, though the WHO says the disease is not transmitted through eating or preparing pig meat.

Amidst the anxiety, health officials tried to tamp down concerns. “When you think pandemic, people tend to reflect on the pandemics from years past,” said Dr. Sanjay Gupta, CNN’s chief medical correspondent. “Lots have changed. We are better taking care of people in hospitals, we have anti-viral medications. It doesn’t mean everyone’s going to die.”