Australia allows in swine flu ship
AFP - Sunday, May 31

SYDNEY (AFP) - - Australia on Saturday invoked an emergency decree to allow a cruise ship with a suspected swine flu outbreak to dock, as the number of A(H1N1) cases worldwide crossed the 15,500 mark.

Queensland health authorities declared a public health emergency after port officials in Brisbane refused to let the Pacific Dawn dock and release passengers. The number of confirmed cases in the state has passed 250.

The ship has been at the centre of a spike in the number of Australian swine flu cases after 2,000 passengers last weekend walked free despite a suspected swine flu outbreak on board.

Scores of guests have since tested positive for the virus, and are believed to be behind its rapid community spread, with cases jumping from 14 to 209 in just one week.

The Pacific Dawn was turned away from the Whitsunday Islands and northern tourist port of Cairns this week, after three crew fell ill with the A(H1N1) influenza with a fresh group of 2,000 passengers on board.

Officials have already tightened the rules applying to cruise ships docking in Sydney, treating them all as potential swine flu sites and allowing for passengers to be kept on board until they have been cleared.

P and O's owner Carnival Australia estimated the onboard swine flu outbreak would cost the company "many millions" in partial refunds.

Once emptied of passengers, the Pacific Dawn will be scrubbed and cleaned ahead of its next cruise.

Russia on Saturday advised its citizens not to travel to the Dominican Republic over swine flu fears after issuing similar advisories on the United States, Canada, Mexico and Spain.

"Officially, the authorities have confirmed two identified cases of A(H1N1) but we fear that in reality, the situation is very different," Gennady Onishchenko, Russia's chief sanitary inspector, told Interfax news agency.

Lebanon on Saturday confirmed three cases -- the country's first -- as Greece reported a fourth case: a young man who has returned from the United States.

On Friday, China confirmed the first case of swine flu involving a person infected inside the country. The death toll reached 99 Friday, with a new fatality each in the United States and Canada and two in Mexico.

But according to figures released by individual governments, the virus has now killed more than 110 people around the world. And in the hours after the WHO updated its figures, three countries announced their first cases.

Health officials in Estonia confirmed that they had detected the virus in a 29-year-old man who had returned from United States two days earlier.

And Hungary announced its first confirmed swine flu case: a Brazilian man living in New York who had come to the country on Wednesday.

Lebanon's Health Minister Mohammad Jawad Khalifeh announced his country's first confirmed swine flu cases on Saturday.

"One Lebanese and two Canadians who arrived in Lebanon a week ago are suffering from swine flu. We put them in quarantine and the blood samples we have taken every day have proven to be positive," he said.

Khalifeh last month advised his fellow citizens to stop kissing -- a traditional Arab greeting -- as a way of avoiding swine flu.

Australian cruiser docks after swine flu outbreak
By ROD McGUIRK,Associated Press Writer
AP - Sunday, May 31

CANBERRA, Australia - An ocean liner docked in an Australian city on Saturday despite objections raised by port officials over a swine flu outbreak on board that cut short a Great Barrier Reef cruise.

Health officials screened 85 passengers who then disembarked from the Pacific Dawn in the Queensland state capital of Brisbane. The nearly 2,000 remaining passengers stayed aboard the ship, which docked for several hours before heading south for its final destination, Sydney.

Many appeared to be in high spirits, waving and giving thumbs up signs as they walked from the terminal wearing face masks.

"We've still had a fantastic time, and I think the crew on the ship and most passengers have all looked at it with glasses half full," a Brisbane woman, who gave her name only as Tania, told Australian Broadcasting Corp.

The passengers were not allowed to disembark at islands and resorts in the coral reefs off the tropical Queensland coast after it emerged passengers from a previous sailing had tested positive for swine flu.

When three crew members aboard the ship also tested positive for the virus Thursday, the 10-day journey north was aborted.

Seven passengers who exhibited flu-like symptoms were tested as well for the disease that has killed 100 people worldwide, but all were cleared before the ship docked in Brisbane, Queensland's chief health officer Jeannette Young said.

"While this is a comforting result, it is not time to drop our guard," she said in a statement.

Queensland state Health Minister Paul Lucas declared a medical emergency early Saturday to force the cruise terminal manager, Brookfield Multiplex Ltd., to allow the ship to dock.

"It was necessary to ensure the cooperation of the port operator as they were reluctant to allow the vessel to berth here," Lucas told reporters.

Brookfield Multiplex spokeswoman Kerrie Muscens declined to detail the company's concerns about the Pacific Dawn to The Associated Press. But she said the company had cooperated fully with the government and health authorities.

New South Wales state authorities, based in Sydney where the ship's journey began, have come under fire for their handling of the incident.

Officials have been criticized for allowing the Pacific Dawn to sail Monday before test results on passengers and crew from the previous week's cruise were known. The three crew who tested positive had been on the first cruise as well.

Authorities have also been blamed for contributing to the spread of the flu because they failed to advise passengers from last week's cruise to quarantine themselves. Authorities say they have now tightened their health procedures concerning cruise ships.

On Saturday, all the disembarking passengers were told to wear face masks and to isolate themselves in their homes or hotels for a week.

Australia's count of confirmed cases increased by 47 on Saturday to 254.

Swine flu worries have deepened across Asia as China reported on Friday its first suspected case of domestic transmission. The previous 13 cases had been infected while overseas.

Singapore's health ministry late Thursday said three more people there have contracted swine flu, a day after announcing the country's first case.

The Philippines announced two more cases Saturday, bringing the nation's total to 16. Thailand, meanwhile, announced its third case.

Lebanon, meanwhile, announced its first three cases in people who recently arrived from abroad.

The World Health Organization reported Friday that its global tally rose to 15,510 swine flu cases in 53 countries.

Mexico reports 2 more swine flu deaths; toll at 97
AP - Saturday, May 30

MEXICO CITY - Mexico is reporting two more deaths from swine flu, bringing the country's toll to 97.
The Health Department says that 5,029 people have been sickened nationwide. That number includes the 97 deaths.

Almost three quarters of the people who died had other complications, such as diabetes, heart disease or respiratory problems, health officials said Friday.

The virus that has sickened more than 13,000 people in 48 countries and been linked to more than a 100 deaths worldwide has largely subsided in Mexico, where it was first identified in late April.

But Mexican officials have said the confirmed toll has been rising as scientists test a backlog of samples from patients.

2 Greek students catch swine flu in UK
By MARIA CHENG,AP Medical Writer
AP - Saturday, May 30

LONDON - Two Greek students caught swine flu in Scotland last week, proof that the virus is circulating more widely than European authorities admit.

The two men, students in Edinburgh, were diagnosed with swine flu when they returned to Greece last week. Neither reported any known contact with a confirmed swine flu case or any history of travel beyond Scotland in the last 15 days.

"This is definitely an indicator the virus is spreading in the community," said John Oxford, a professor of virology at St. Bart's and Royal London Hospital. "Most of the time, this virus is like an iceberg. You can only see the tip but there is a big iceberg below the surface."

The two students went to several parties last week and fell ill about the same time, meaning they probably did not infect each other. Their cases were described in an article published online Thursday in Eurosurveillance, a publication of the European Centre for Disease Prevention and Control.

The researchers wrote there was a possibility that widespread transmission of swine flu exists in Edinburgh, which led to the two men being infected. The researchers added it was the first time swine flu had spread from one European country to another. Greece has four cases total.

Britain's Health Protection Agency, which is coordinating the United Kingdom's response to swine flu, denied that the virus was circulating in the general public.

"We have no evidence to suggest that the virus is spreading in the community," a spokesman said on condition of anonymity, in line with agency policy.

Britain has 215 confirmed cases of swine flu, the highest tally in Europe. On Friday, Britain reported a dozen new cases, 10 linked to a school outbreak, one tied to a previously confirmed case and another whose source of infection was unknown.

The World Health Organization reported Friday that its global tally rose to 15,510 swine flu cases in 53 countries, including 99 deaths, most of them in Mexico.

In the United States, health officials have reported 8,975 cases and 15 deaths.

At the moment, the virus appears only to be causing big outbreaks in North America. But once swine flu is proven to be spreading easily in another world region, the agency's criteria for calling a pandemic _ a global epidemic _ will be fulfilled.

WHO, however, says it is convening an expert panel to determine new criteria for announcing a global outbreak. The agency caved to pressure from member countries, including Britain, who urged the U.N. heath agency not to declare a pandemic.

Oxford said several of the confirmed British and Scottish swine flu cases have no known connection to confirmed cases or travel history. These sporadic cases _ where there is no clear chain of transmission _ are considered to be evidence a virus is widespread.

WHO spokesman Gregory Hartl said the agency was working with national authorities to see if swine flu is spreading more widely in Europe.

Some experts felt nations weren't looking very hard.

"Based on WHO's current definitions, we are in a pandemic," said Michael Osterholm, a flu expert at the University of Minnesota. "To say it is not entrenched in Europe is like denying that the sun rises."

US official in France diagnosed with swine flu
By ANGELA CHARLTON,Associated Press Writer
AP - Saturday, May 30

PARIS - A U.S. official in Normandy to prepare President Barack Obama's upcoming visit has been diagnosed with swine flu and is being treated in a hospital, French authorities said Friday.

Eleven other members of the U.S. delegation were placed in isolation for 24 hours in their hotel rooms and given medical treatment, said an official at the Calvados region administrative headquarters. The official was not authorized to be identified publicly.

The 54-year-old American woman was hospitalized in the city of Caen, and will remain for about a week, the official said.

The hotel where the delegation was staying, in the seaside town of Port-en-Bessin, is not far from the beaches where Allied forces landed June 6, 1944, in the D-Day invasion. Obama is coming to the area for the 65th anniversary of the invasion next week.

The swine flu incident comes as veterans, visitors and French, British, U.S. and other officials are streaming into the area for the anniversary.

The U.S. Embassy said in a statement "the French authorities are taking the appropriate action" in the Normandy swine flu case.

The World Health Organization reported Friday that its global tally rose to 15,510 swine flu cases in 53 countries, including 99 deaths, most of them in Mexico.

In the United States, officials reported 8,975 confirmed cases Friday and 15 deaths. France has 20 confirmed cases.

In April, a U.S. security aide helping with arrangements during Obama's trip to Mexico became sick with flu-like symptoms and three members of his family later contracted probable swine flu.

The employee, who was not identified, was an aide to Energy Secretary Steven Chu.

Venezuela reports first swine flu case
AP - Friday, May 29

CARACAS, Venezuela - Venezuela's health ministry is reporting the country's first swine flu case: a 22-year-old man who arrived on a flight from Panama earlier this week.

The ministry says the man is receiving the proper treatment and has been temporarily confined to his home. Officials did not identify him.

The flu victim arrived on a Copa Airlines flight from Panama late Monday. Ministry officials say the other 79 passengers on the flight are being contacted to determine their condition.

The ministry also announced on Thursday that six other people who had close contact with the patient are being closely monitored.

CDC says October soonest for swine flu shots
By MIKE STOBBE,AP Medical Writer
AP - Friday, May 29

ATLANTA - A U.S. health official said a swine flu vaccine could be available as early as October, but only if vaccine production and testing run smoothly this summer.

Dr. Anne Schuchat (Shook-it) of the U.S. Centers for Disease Control and Prevention said the agency began shipping virus samples to manufacturers in the past several days. The government will have to review the safety and effectiveness of what's produced, and decide if a vaccination campaign is warranted. October is about the time seasonal flu vaccine campaigns generally get rolling.

CDC officials reported more than 8,500 probable and confirmed cases in the U.S., including 12 deaths and more than 500 hospitalizations.

Updated: 27th May 2009 09:40 hrs
WHO to refine flu pandemic criteria

The World Health Organisation will be consulting scientists to clear up the criteria needed before the new Influenza A H1N1 flu outbreak is declared a pandemic.

WHO Assistant Director General Keiji Fukuda said they will meet with a number of prominent scientists and people who have a good perspective on these issues.

The move follows appeals by several countries last week for more caution before moving up a step from the current phase five alert to declaring a pandemic.

Under the current rulebook, phase six would involve a purely geographical step with sustained community spread in another WHO region to the Americas, where the virus first emerged in April.

But officials said last week they were also taking into account issues such as the severity of the virus, possible changes in the pattern of illness, its impact on poor countries and possible mutation.

The outbreak has now infected nearly 13,000 people in 46 countries.

It has also resulted in 92 deaths.

Singapore confirms first H1N1 case
Singapore confirms first swine flu case: 22-y-o woman

Singapore has confirmed it first swine flu case.
The Ministry of Health announced today that a 22-year-old Singaporean woman returned from New York yesterday and tested positive for the flu virus.
"Singapore has confirmed its first case of influenza A(H1N1)," the ministry said in a statement.The patient passed through undetected a thermal scanner at Changi Airport. However, later she went to a general practitioner complaining of flu symptoms.
The doctor sent her by ambulance to Tan Tock Seng Hospital's communicable disease centre where she is in a stable condition.
The woman was in New York from May 14-24. She returned on a Singapore Airlines flight at 6:30 am yesterday and developed a cough during the trip.
All her "close contacts" will be quarantined and provided with antiviral medication, the MOH said.
MSN and AFP
Here is the text of the Ministry of Health's statement:
Singapore has confirmed its first case of Influenza A (H1N1-2009). The patient is currently being treated at the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) and is in stable condition.
2 The patient is a 22-year-old Singaporean female who was in New York from May 14-24. She arrived back in Singapore from New York on SQ25 (Seated at Row 55) on 26 May at 06.30hrs. She began to develop a cough while onboard. She passed the thermal scanner uneventfully as she did not have fever then. Later in the morning, she consulted a GP who decided to send her to TTSH via a 993 ambulance, given her travel history. She was immediately admitted for testing. Laboratory confirmation of her infection was made by midnight of 26 May.
3 The patient has been vigilant in monitoring her own condition and had sought immediate medical attention once she realized that she was unwell. Her attending GP, through his quick response in activating the 993 ambulance for the patient, had also helped to minimize the spread of infection from this case.
4 We have initiated contact tracing of her close contacts. They will be quarantined and provided with antiviral prophylaxis. Passengers who had travelled in the same flight and were seated in rows 52 to 58 are urged to call the hotline at 1800- 333 9999 to enable us to check on their health condition.Enhanced vigilance
5 The Ministry has reminded all medical practitioners and healthcare institutions to continue to be vigilant to suspect cases. We will continue with temperature screening for passengers entering Singapore at all checkpoints (land, sea and air). All passengers passing through or entering Singapore are given Health Alert Notices on board their flights, advising them to monitor their own health if they have been to affected areas and to seek medical attention immediately if they are not well.
Advice from MOH
6 Singaporeans are reminded to maintain high standards of personal hygiene. This means covering your nose and mouth with a tissue when you sneeze or cough, and washing your hand frequently with soap and water, especially after contact with respiratory secretions (e.g., after sneezing and coughing). We also need the cooperation of everyone to be socially responsible. This means staying home and avoiding crowded places (including trains, buses, offices), putting on a surgical mask and seeing a doctor if you have flu symptoms. MOH advises those who travelled to affected areas to closely monitor their health and seek treatment as soon as possible should they develop symptoms.
7 Members of the public are advised to exercise caution over travel to affected areas. In the event that travel is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times. However, iff you are unwell with fever and cough but have no travel history to affected areas, please see a doctor and stay at home.
8 MOH is monitoring the situation closely and will update the public should there be any new developments. For more information on Influenza A (H1N1-2009), please access MOH’s website at http://www.moh.gov.sg, call our hotline at 1800-333 9999, or visit http://www.flu.gov.sg.

MINISTRY OF HEALTH
27 May 2009

DOH: A(H1/N1) patient improving
Philstar.com - Friday, May 22

MANILA, Philippines – The condition of the 10-year-old Filipino girl who was found positive for Influenza A(H1N1) – the country’s first case of the dreaded disease — is improving, an official of the Department of Health (DOH) said today.

“She no longer has fever and cough, only sore throat,” said Dr. Eric Tayag, chief of DOH's National Epidemiology Center, in a press conference this morning.

The girl arrived in the country last May 18, and eventually developed fever, cough and sore throat the next day. She is reportedly currently confined in an “undisclosed health facility.” - By Dino Maragay (Philstar News Service, www.philstar.com)

Japan reports 178 swine flu cases
AFP - Wednesday, May 20

KOBE, Japan (AFP) - - Japan reported 178 swine flu infections Tuesday and closed more than 4,000 schools, colleges and kindergartens for the rest of the week to slow the spread of the virus, officials said.

Experts warned that infections had probably already spread to other regions including the capital Tokyo, which with almost 36 million people is the world's most populous urban area and the heart of the Japanese economy.

"The virus's spread to Tokyo is near certain, and it would be little wonder if the virus had already landed in Tokyo undetected," said Yukihiro Nishiyama, a virologist at Nagoya University in central Japan.

"Of course, there is no need to overreact, but authorities and people in the capital should go ahead with their preparation," Nishiyama told AFP.

Visitors to many public places -- from the parliamentary visitors' gallery to the national sumo tournament in Tokyo -- have been asked to disinfect their hands on entry, wear surgical face masks, or both.

Japan's first domestic cases of the (A)H1N1 virus were confirmed Saturday in the western cities of Kobe and Osaka, where they spread quickly in and between two high schools that had met for a volleyball tournament.

Hundreds have since been tested for the virus, and face masks have become ubiquitous on subways and in shopping centres of the affected prefectures of Osaka and Hyogo in the central region of the main island of Honshu.

The government has urged calm and reminded people that no one in Japan has so far died of the disease and that most infections are mild.

A total of 4,043 kindergartens, schools , colleges and universities were closed for at least this week in the two prefectures at the request of the government, up from some 2,000 Monday, an education ministry official said.

Neighbouring Kyoto prefectures closed eight schools voluntarily.

Japan's number of confirmed cases rose to 178 -- the fourth largest national figure on the world infection table, according local authorities

Japan's first confirmed cases of swine flu were four people who tested positive after they flew in from North America earlier this month. They were immediately quarantined along with about 50 fellow passengers.

The central government has been revising its anti-virus measures, which previously focused on stopping infected persons at the borders and quarantining them before they could leave the airports.

"Day by day, we have to change what action we should take," Health Minister Yoichi Masuzoe told a news conference, adding that the ministry may scale down airport quarantine measures gradually.

Finance Minister Kaoru Yosano said the government was ready to take action to fend off a possible impact of the outbreak on the Japanese economy already battered by the worst recession since World War II.

"Economies obviously declined -- although temporarily -- when a bird flu outbreak occurred," Yosano told reporters. "We have to consider measures to limit the effect."

Swine flu spreads in Japan ahead of WHO meet
AFP - Monday, May 18

KOBE, Japan (AFP) - - Japan's number of confirmed swine flu cases soared to 93 at the weekend, officials said late Sunday, as senior health officials gathered in Geneva for talks on containing the spread of the virus.

Most of the infections were reported among high school and college students in and around the western cities of Kobe and Osaka, where authorities ordered more than 1,000 schools and kindergartens to stay shut on Monday.

"I don't know specifics about the cases but judging from confirmed cases the infection is likely to be spreading to hundreds of people," Japanese virologist Masato Tashiro told public broadcaster NHK.

"There must be a number of people who slipped through border controls (at airports) as their symptoms were quite light, passing the virus to other people before they knew it."

Tashiro was speaking from Geneva, where the World Health Organization (WHO) annual assembly will begin on Monday, with fears about the global outbreak of A(H1N1) influenza expected to dominate discussions.

Nearly 8,500 people in 39 countries have been infected with swine flu, according to the latest figures released by the WHO. Cases confirmed in Turkey, India, Hong Kong, Britain and Chile at the weekend have not been included in the tally.

More than 70 people have died from the virus -- all of them in the Americas and nearly all in Mexico, where the new strain of swine flu was first detected less than a month ago.

Hong Kong officials on Sunday confirmed the third case of swine flu in the city, a 23-year-old man who arrived from the United States a day ago.

Meanwhile 14 new cases were confirmed in Britain, 10 of them in London, pushing the total number of cases of the virus in the country over 100.

And a 32-year-old woman became Chile's first confirmed swine flu case Sunday, hours after returning to the country on a flight from the Dominican Republic via Panama, health officials said.

Acting WHO Assistant Director General Keiji Fukuda has said that studies indicated a "significant number of people" had been infected but their cases were either still to be detected or confirmed by laboratory tests.

A motion has even been put forth to shorten the talks in Switzerland from 10 to five days, so that senior officials are not away from their duties at home for so long.

Ahead of the WHO meeting, world governments failed to reach a final deal on the sharing of virus research material and vaccines in case of a global flu pandemic.

Mexican President Felipe Calderon said his country had given the WHO a sample of the virus on Saturday, along with statistical and clinical data on the evolution of the strain there.

Authorities in Mexico say that they are on the path to controlling the outbreak. The health ministry said in a statement that if the virus "is dealt with on time, usually it is curable."

Japan until Friday thought it had kept the virus at bay, after detecting four people who tested positive when they flew in from North America and immediately quarantining them along with about 50 fellow passengers.

But since the government Saturday confirmed the first domestic case, a 17-year-old male Kobe student who had not been overseas, the number of confirmed infections has risen quickly in Kobe and Osaka.

Late Sunday officials in Hyogo prefecture, which includes Kobe, told AFP 53 cases had been confirmed, while Osaka prefecture reported 36, raising the national toll to 93.

Prime Minister Taro Aso has urged the public to stay calm and take hygiene measures -- such as washing their hands often and gargling. He was due to convene a crisis meeting on the domestic outbreak early Monday.

Shigeru Omi, a former senior official at the World Health Organization, now head of the government's special swine flu task force, warned: "We believe that the infection is beginning to spread in the region."

The WHO said Saturday it was closely monitoring the situation in Japan.

It has not yet recommended travel restrictions to curb the spread of the virus but has advised anyone who is feeling unwell to postpone their trips.

PM Lee says battle with H1N1 far from over although immediate threat has passed
Channel NewsAsia - Sunday, May 17

SINGAPORE: Prime Minister Lee Hsien Loong said the battle with the H1N1 virus is far from over even though Singapore has downgraded its response to the threat and immediate danger has subsided.

Speaking at the Singapore Medical Association’s 50th anniversary dinner, Mr Lee said Singapore must remain vigilant as the virus continues to spread to more countries.

Singapore must watch closely how the pandemic unfolds and continually update and improve its contingency plans.

He said Singapore will also have to address shortcomings, sharpen procedures and restock medical supplies to fight the virus.

Mr Lee said: "Pandemics are a dangerous threat that we must take seriously. Influenza and other viruses will continue to mutate and evolve and if not Influenza A(H1N1), then some other new viruses will eventually emerge and reach our shores. We must be fully prepared when that happens."

At the event on Saturday, Mr Lee was also conferred an Honorary Membership by the Singapore Medical Association.

It’s the highest honour the association can confer on those who are distinguished in public life or who have rendered meritorious service to the medical profession.

Mr Lee acknowledged doctors have a difficult job and outlined five reasons why he thought so.

First, doctors have to perpetually learn and relearn, keeping abreast of the flood of medical knowledge, as patients depend on them to keep up with rapid medical advancements and offer the best advice.

Second, doctors must always do what’s best for the patient and as such, the doctor’s advice must always be honest, well—founded and based on what is the patient’s best interest.

Third, doctors are expected to uphold the highest ethical standards otherwise they will lose patients’ trust.

Fourth, doctors must have a good systems view of the whole healthcare system in that while they do what’s best for individual patients, they also have to think in terms of what works for the whole medical system.

He gave the example of the US, which has many excellent doctors but a healthcare system that has major shortcomings.

PM Lee added: "Despite spending enormous sums each year, the US healthcare system is plagued by bad practices like over—servicing and defensive medicine and poor outcomes in terms of coverage, life expectancy etc.

"In Singapore, our doctors need to understand how our system works — the 3Ms financing network, the restructured hospitals, subsidies and means testing, etc. Not every doctor needs to be an expert in our healthcare system, but doctors need to appreciate enough to operate within it, so as to keep healthcare costs under control and to benefit the greatest number of patients."

Fifth and most importantly, doctors must value the human relationship between doctor and patient. This requires respect and empathy for patients and their families.

Mr Lee notes that technological advancements might have rendered some old practices unnecessary.

He gave the example of how some medical schools have dropped cadaveric dissection using computer simulation instead.

Because there’s no blood, no smell and no mess, there’s also no emotional engagement.

Mr Lee continued: "Old timers worry that we have lost something important along the way. I recently read an article by a US doctor, lamenting the loss of a valuable tool for future doctors to learn about humanity and the emotional strains of doctoring. As she pointed out, ’we learn to heal the living by first dismantling the dead.’"

He said that in Singapore, the practice has also changed with a single body used to teach eight students at one time.

Mr Lee said that as Singapore updates its medical school curriculum to include new knowledge and skills that students must absorb, something has to give.

But its future doctors must still learn about the human and emotional aspects of doctoring and will have to do so in other ways as they progress through medical school and beyond. — CNA/vm

Advice from MOH
Members of the public are advised to exercise caution over travel to affected areas. In the event that travel is unavoidable, the public is advised to take precautionary measures such as avoiding crowded areas and maintaining high standards of personal hygiene at all times. However, if you are unwell with fever and cough but have no travel history to affected areas, please see a doctor and stay at home.

MOH is monitoring the situation closely and will update the public should there be any new developments. For more information on Influenza A (H1N1-2009), please access MOH’s website at www.moh.gov.sg, call our hotline at 1800-333 9999, or visit www.flu.gov.sg.

MINISTRY OF HEALTH
10 May 2009

It’s a matter of time when S’pore will see H1N1 case
Channel NewsAsia - Saturday, May 16

SINGAPORE: The Ministry of Health (MOH) says it is a matter of time when Singapore will see an Influenza A (H1N1) case.

An MOH spokesman, who was responding to media queries on Malaysia confirming its first H1N1 case, said Singaporeans should not be surprised by this development.

The spokesman added that the Malaysian health authority had informed its Singapore counterpart that there were no Singaporeans and also no passengers connecting to Singapore onboard the flight taken by the confirmed Malaysian case.

He said the infected person in Malaysia is reported to be in stable condition and will likely recover fully — as in many other cases elsewhere — because he had sought medical treatment as soon as symptoms appeared.

The spokesman added that prompt treatment will lead to full recovery, unless there are other underlying medical conditions.

He also said the only way to avoid infection is for people to maintain a high standard of personal hygiene and be socially responsible by staying at home if they are unwell and wearing a mask if they are on the way to see a doctor.

— CNA/ir

Mexico restaurants reopen
May 6 2009




Offices and restaurants in Mexico were to re-open on Wednesday after a week-long shutdown of many public activities. --PHOTO: ASSOCIATED PRESS








MEXICO CITY - OFFICES and restaurants in Mexico were to reopen on Wednesday after a week-long shutdown of many public activities that officials say greatly curbed a swine flu epidemic now on the wane.
Although the toll from the outbreak of the new A(H1N1) virus continued to creep up each day, and currently stood at 29 dead and more than 913 infected, authorities say the epidemic peaked last week and was now under control.

The lifting of the shutdown was to be progressive over coming days. On Thursday, high schools and universities were to open, to be followed by primary schools and kindergartens next Monday.

There was no word yet, however, when cinemas, theaters and nightclubs in the capital Mexico City would be permitted to again open their doors.

Despite the efforts to restore normal life to Mexico City and the rest of the country, it was clear the economic damage dealt to Mexico by the disease would be felt for some time to come.

Finance Minister Agustin Carstens told reporters on Tuesday that the nationwide shutdown and the devastation to the tourism industry cost the economy around US$2.3 billion (S$3.4 billion), or 'close to 0.3 per cent' of gross domestic product.

He said the government was to roll out a fiscal stimulus package to mitigate the damage that would include a US$1.3 billion injection into the economy.

A marketing campaign to lure back tourists and US$380 million in credits for companies and subsidies would also be launched.

Hotels in Mexico City are down to 10 per cent occupancy, and foreign visitors have been absent from the city centre and from tourist draws, such as Mexico's famed Aztec pyramids, which were declared off-limits. -- AFP

Alerts

Travel warnings
NATIONS WHICH HAVE SUSPENDED FLIGHTS TO MEXICO: Argentina and Cuba.
Argentina, China and Peru have banned flights from Mexico, prompting Mexico to advise Mexican citizens to avoid travel to China – where dozens of Mexicans have been quarantined despite not showing symptoms, prompting a diplomatic row. The WHO has not recommended travel restrictions or the closing of borders.

Pork warnings
NATIONS WITH PARTIAL OR TOTAL BANS ON PORK IMPORTS:
Bahrain, Belarus, Chad, China, Croatia, Ecuador, Gabon, Indonesia, Kazakhstan, Macedonia, Montenegro, Philippines, Lebanon, Russia, Serbia, South Korea, Thailand, Ukraine, United Arab Emirates. Egypt has ordered a cull of pigs reared on its territory.

Texas confirms first death of US resident with flu
By CHRISTOPHER SHERMAN,Associated Press Writer
AP - Wednesday, May 6

McALLEN, Texas - Texas health officials on Tuesday announced the first death of a U.S. resident with swine flu, and said she was a 33-year-old school teacher who had recently given birth to a healthy baby.

The woman died early Tuesday and had been hospitalized since April 19, said Leonel Lopez, Cameron County epidemiologist.

Health officials stopped short of saying that swine flu caused the woman's death. State health department spokeswoman Carrie Williams said the woman had "chronic underlying health conditions" but wouldn't give any more details.

Lopez said the flu exacerbated the woman's condition. "The swine flu is very benign by itself," Lopez said. But "by the time she came to see us it was already too late."

Tuesday evening, cars filled the driveway and lined the quiet street in front of Judy Trunnell's home in a quiet, new Harlingen subdivision.

A woman who came to the door with tear-streaked eyes declined to give her name or to comment on the death, saying "we're grieving now."

The only other swine flu death in the U.S. was of a Mexico City boy who also had other health problems and had been visiting relatives in Brownsville, near Harlingen. He died last week at a Houston children's hospital.

There have been 29 other confirmed swine flu deaths, all in Mexico. Hundreds of cases of the disease have been confirmed in several countries, but mostly in Mexico and the U.S.

The teacher was from Harlingen, a city of about 63,000 near the U.S.-Mexico border. The school district where she worked announced it would close its schools for the rest of the week, though officials said anyone who might have contracted the disease from her would have shown symptoms by now.

She was first seen by a physician April 14 and was hospitalized five days later. The woman delivered a healthy baby while hospitalized and stayed in the hospital until her death, said Lopez, who declined to give further details about the baby.

Doctors knew she had a flu when she came in, but did not know what kind, Lopez said. The area is undergoing a Type A influenza epidemic right now, of which the swine flu is one variety, he said. She was confirmed to have swine flu shortly before she died, he said.

Dr. Joseph McCormick, regional dean of the University of Texas School of Public Health's Brownsville campus, said the woman was extremely ill when she was hospitalized.

Mercedes Independent School District, where the woman taught, announced it would close its schools starting Wednesday and reopen May 11.

U.S. health officials changed course on their advice to schools Tuesday, saying they are no longer recommending that schools close for the swine flu. Last week, the government had advised schools to shut down for about two weeks if there were suspected cases of swine flu.

___

Associated Press writers Alicia A. Caldwell in El Paso and Jamie Stengle in Dallas contributed to this report.

New flu kills U.S. man, spreads to Australia, Japan
Reuters - Sunday, May 10
By Maggie Fox, Health and Science Editor

WASHINGTON - A Washington state man with H1N1 influenza died last week, health officials said, the third U.S. sufferer to die as the new flu strain confirmed in more than 2,200 Americans appeared in Japan and Australia.

Health officials have warned that the true number of cases may be underestimated. Although most cases appear to be mild, the new swine flu strain has killed just as seasonal flu does.

Another 48 people have died in Mexico and one each in Canada and Costa Rica.

Washington state officials said on Saturday a man in his 30s with underlying heart conditions died last week, state governor Chris Gregoire describing his death as "a sobering reminder that influenza is serious."

The virus has moved into the southern hemisphere, where influenza season is just beginning, and could mix with circulating seasonal flu viruses or the H5N1 avian influenza virus to create new strains, health officials said.

"One of the big challenges with influenza viruses is the way that they change, the way they combine and their prevalence in a number of species," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention told a news briefing on Saturday.

"This is why it is so important for countries to have a strong capacity to deal with influenza and also why it is very important to understand what happens at the interface between people and animals."

Before the Washington man's death was announced, the CDC reported 2,254 confirmed U.S. cases of the virus with 104 people in hospital, up from 1,639 cases previously.

"Today there are almost 3,000 probable and confirmed cases here in the United States," Schuchat said. "The good news is we are not seeing a rise above the epidemic threshold."

Japan reported four cases, and globally officials reported more than 4,200 people in 30 countries had been ill. Australia reported its first case, a woman who been travelling in the United States but officials said she had made full recovery.

VERY GREAT UNDERESTIMATE

"We think this virus is in most of the United States," Schuchat said. "The individual numbers are likely to be a very great underestimate."

More Americans are seeing doctors for influenza-like illnesses at a time of year when such visits usually decline.

Schuchat said tests showed they do not all have the new H1N1 virus. Many have seasonal flu -- the H1N1 seasonal strain, the H3N2 seasonal strain and influenza B -- and other infections.

Seasonal flu kills 250,000 to 500,000 people globally and infects up to a third of the population each year.

Health experts have not openly criticized efforts by other countries to stop the virus from getting in -- most notably China and its territory of Hong Kong, which have quarantined travellers in contact with patients.

A spokeswoman in Hong Kong said on Saturday that a Mexican traveller confirmed as Hong Kong's first and only case of the new flu strain had been discharged from hospital.

The unidentified man, who unwittingly caused the confinement of almost 300 guests and staff at a Hong Kong hotel where he had stayed, had been in hospital for a week.

China put seven people who had been exposed to three Japanese passengers diagnosed with the H1N1 flu in quarantine, the official Xinhua news agency quoted the government as saying.

MORE TESTING

Mexican health ministry spokesman Carlos Olmos said the government was testing thousands of samples to confirm which patients with severe respiratory symptoms were actually infected with the flu.

He said more than 5,000 tests had been done on suspected cases and that 1,578 people were ill but were being treated.

After the virus was identified on April 23, Mexico banned public events and shut schools, bars, restaurants and many businesses to prevent people from gathering. Officials say disinfection of public spaces has helped control its spread.

Schools in the capital will reopen on Monday.

But the state government of Jalisco, home to Mexico's second-largest city Guadalajara, said schools, nightclubs and theatres there will remain shut for another week after three suspected flu deaths.

Schuchat said it is not yet clear whether some measures taken have slowed the outbreak, but she said it was clear that early detection methods had alerted the world quickly.

She noted that the AIDS virus, which has now killed 25 million people globally and infects 33 million, spread for years before it was even identified.

"If we end up having a bad pandemic of influenza from this strain we would have had a real jump-start on things like vaccines," she said.

Flu cancels Mexico's Cinco de Mayo celebrations
By ISTRA PACHECO,Associated Press Writer
AP - Wednesday, May 6

PUEBLA, Mexico - Swine flu fears closed Mexico's biggest Cinco de Mayo celebration in this colonial city on Tuesday, while Mexicans in the U.S. planned to party despite the growing epidemic north of the border.

For the first time in decades, the re-enactment of the Battle of Puebla, Mexico's May 5, 1862 victory over French forces, was called off to avoid contagion-prone crowds. It was replaced by a somber ceremony featuring President Felipe Calderon, other officials and a small number of soldiers. Surrounding streets were empty.

With 26 Mexicans dead and 840 sickened by swine flu, Calderon said Mexico faces a different, more silent enemy than the one it faced 147 years ago. France had invaded to install the Emperor Maximilian, who ruled the country until Mexican forces executed him in 1867.

"Back then, Mexicans truly fought like giants against an invader who aimed to take over our country and tarnish our flag," Calderon declared. "Today, almost a century and a half later, Mexico faces a new threat of a very different kind ... the appearance and spread of an epidemic that puts at risk the lives and health of Mexican families."

Calderon vowed that Mexico would again emerge victorious.

"We have faced foreign invasions, civil wars, natural disasters and economic and political crises," Calderon said. "None of these threats has been able to break the will of Mexicans."

Mexico has been stung by travel and trade barriers imposed by other nations during the flu outbreak, and Calderon suggested that Mexico was being punished for openly combating the epidemic.

"Mexican doctors and nurses are on the front lines in the field of battle against this new blow to humanity," Calderon said. "Here we have been defending all of humanity against this virus."

In addition to the 26 in Mexico, the only other confirmed swine flu deaths so far are two reported in Texas.

Puebla's traditional parade usually features actors dressed in the snappy blue-and-red uniforms of the invading French force facing off with Mexican troops alongside peasant defenders clad in sandals, serapes and straw hats. It boasts baton-twirlers, marching bands and floats.

This year a black-clad military band and an honor guard took part in a short ceremony at a monument to Mexican battle heroes.

Newspaper El Sol de Puebla reported that the celebration has never before been canceled since it began in its current form in 1937.

In the United States, where Cinco de Mayo has become a pseudo-holiday adopted by the general population, the epidemic spawned some concern.

Denver's annual Cinco de Mayo Festival, which typically draws 400,000, will be held as planned this weekend, though there will be more hand sanitation stations at the urging of city health officials. Los Angeles won't skip its weekend celebration on historic Olvera Street. But in Chicago, the Mexican Civic Society of Illinois canceled its annual festivities because of flu concerns.

On Monday, President Barack Obama celebrated Cinco de Mayo a day early at the White House with the Mexican ambassador _ and fumbled the name of the holiday while greeting guests.

"Welcome to Cinco de Cuatro _ Cinco de Mayo at the White House," said Obama, in what appeared to be an attempt to note he was celebrating on May 4 instead of May 5.

"Cinco de cuatro" means "five of four" in Spanish.

Confirmed cases of H1N1 virus approach 900
May 3, 2009 -- Updated 2159 GMT (0559 HKT)

(CNN) -- The World Health Organization cautioned that the swine flu outbreak could gain momentum in the months ahead, despite claims by the health secretary of Mexico -- the epicenter of the outbreak -- that the virus "is in its declining phase."

The outbreak is only about 10 days old, and even if the illness is declining, it could return, said Gregory Hartl, the WHO spokesman for epidemic and pandemic diseases, at a briefing Sunday.

"I ... would like to remind people that in 1918 the Spanish flu showed a surge in the spring, and then disappeared in the summer months, only to return in the autumn of 1918 with a vengeance," Hartl said. "And we know that that eventually killed 40 million to 50 million people."

Mexican authorities believe the virus's most active period in Mexico was between April 23 and April 28, and Mexican Health Secretary Jose Cordova described the outbreak as being in decline in his country.

As of late Sunday, Mexican health officials reported 568 cases and 22 fatalities linked to the flu. WHO says it has confirmed 506 cases and 19 deaths in Mexico.

The world has 898 confirmed cases of the virus, known to scientists H1N1 virus, in a total of 18 countries, WHO said Sunday.

The United States has reported 226 confirmed cases in 30 states. The U.S. cases include one death -- a Mexican toddler visiting relatives in the United States.

According to WHO, Canada has 70 confirmed cases; the United Kingdom has 15; Spain has 13; Germany has 6; New Zealand has 4; Israel has 3; France has 2; and Austria, China, South Korea, Denmark, Netherlands, Switzerland, Costa Rica and Ireland each have one.

In China, officials have quarantined 68 people, including 13 crew members, who were passengers of a Mexico City to Shanghai flight, which carried a passenger who tested positive for the virus, China's state-run Xinhua news agency reported Sunday. None of the other passengers has exhibited any flu-like symptoms, one health official said.

About another 110 people who were on the Aeromexico plane went on to other destinations, and may face quarantines elsewhere, the news agency said. Fifteen have been quarantined at a Beijing hotel.

Shanghai's airport is now barring other Aeromexico planes from landing there, a representative of the airline told CNN. Aeromexico is suspending flights to Shanghai until May 15, the representative said. The airline does not fly to Hong Kong or Beijing.

In the United States, New York has the most confirmed cases, with 63, according to the Centers for Disease Control and Prevention. Texas has 40; California has 26; Arizona 18; South Carolina 15; Delaware 10; Massachusetts and New Jersey each have seven; Colorado has four; Florida, Illinois, Indiana, Ohio, Virginia, Wisconsin each have three; Connecticut, Kansas and Michigan each have two; Alabama, Iowa, Kentucky, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Mexico, Rhode Island, Tennessee and Utah each have one.

California officials suspended visitation and other "nonessential activities" at Centinela State Prison in Imperial County after an inmate was suspected of having swine flu. The case has yet to be confirmed with lab testing.

On Sunday, health officials in North Carolina and Pennsylvania announced the first confirmed cases in those states, and Louisiana's governor said his state had seven confirmed cases. The cases from those three states were not immediately included in the CDC tally.

In Washington, U.S. Secretary of Health Kathleen Sebelius, appearing on CNN's "State of the Union," warned that even if the flu outbreak wanes, "it could come back with greater force in the winter and fall, when we get into flu season."

"So, this is no time for complacency," she said. "We want to stay out ahead of this."

Dr. Anne Schuchat, the CDC's interim deputy director for public health, told reporters Sunday that she was "heartened" by Mexican authorities' reports but still is "very cautious."

"I know that influenza can be surprising, and the time course here in the United States is later. We believe we're just on the upswing here, and in several parts of Mexico, cases began quite a while ago," Schuchat said.

"From what I know about influenza, I do expect more cases, more severe cases and I do expect more deaths," she added. "And I'm particularly concerned about what will happen in the fall."

Acting CDC Director Richard Besser, also speaking on "State of the Union," said U.S. health officials are examining whether people who received flu shots for the swine flu in 1976 may have some level of protection from the current swine flu.

"That's going to play in very, very big as we move forward with our plans around vaccines, because that may help guide some of the issues around who is most at risk at getting this in the future," Besser said.

Offering a general picture of the state of U.S. efforts to combat the virus, Besser said "there are encouraging signs."

"We're not out of the woods yet," he said. "But what we've learned about the virus itself -- it doesn't contain the factors that we know are seen in much more severe flu strains."

While the new virus strain in the recent outbreak has affected humans, Canadian officials said it has shown up at a pig farm in Alberta, Canada.

Officials said the pigs may have been infected by a Canadian farmer who recently returned from a trip to Mexico, the epicenter of the outbreak. The pigs have since been quarantined.

"We have determined that the virus H1N1, found in these pigs, is the virus which is being tracked in the human population," said Dr. Brian Evans of the Canadian Food Inspection Agency.