CHICAGO – Did government health officials "cry swine" when they sounded the alarm on what looked like a threatening new flu?
The so-far mild swine flu outbreak has many people saying all the talk about a devastating global epidemic was just fear-mongering hype. But that's not how public health officials see it, calling complacency the thing that keeps them up at night.
The World Health Organization added a scary-sounding warning Thursday, predicting up to 2 billion people could catch the new flu if the outbreak turns into a global epidemic.
Many blame such alarms and the breathless media coverage for creating an overreaction that disrupted many people's lives.
Schools shut down, idling even healthy kids and forcing parents to stay home from work; colleges scaled back or even canceled graduation ceremonies; a big Cinco de Mayo celebration in Chicago was canned; face masks and hand sanitizers sold out — all because of an outbreak that seems no worse than a mild flu season.
"I don't know anyone who has it. I haven't met anyone who knows anyone who contracted it," said Carl Shepherd, a suburban Chicago video producer and father of two. "It's really frightening more people than it should have. It's like crying wolf."
Two weeks after news broke about the new flu strain, there have been 46 deaths — 44 in Mexico and two in the United States. More than 2,300 are sick in 26 countries, including about 900 U.S. cases. Those are much lower numbers than were feared at the start based on early reports of an aggressive and deadly flu in Mexico.
Miranda Smith, whose graduation ceremony at Cisco Junior College in central Texas was canceled to avoid spreading the flu, blames the media.
"It's been totally overblown," she said Thursday.
"Everyone seems to know it's not going to kill you and it's not as deadly as they think," she said. "Everybody needs to just calm down and chill out."
Craig Heyl of Decatur, Ga., said the government overreacted.
"Swine flu is just another strain of flu. People get the flu. I guess you have to call it a pandemic when it's a widespread virus, but I don't think the severity of it is all that concerning," said Heyl, 43.
Public health authorities acknowledge their worst fears about the new virus have not materialized. But no one's officially saying it's time to relax. And experts worry that people will become too complacent and tune out the warnings if the virus returns in a more dangerous form in the fall.
"People are taking a sigh of relief too soon," said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention.
In an interview Wednesday with The Associated Press, Besser said the outbreak in the United States appears to be less severe than was first feared. But the virus is still spreading and its future potential as a killer is not clearly understood.
"The measures we've been talking about — the importance of handwashing, the importance of covering coughs, the real responsibility for staying home when you're sick and keeping your children home when you're sick — I'm afraid that people are going to say, 'Ah, we've dodged a bullet. We don't need to do that,'" Besser said.
"The thing that's keeping me up right now is that feeling of dodging the bullet," he added.
Peter Sandman, a risk communication specialist, says on his Web site that reminding people the risk is still real and warning them in the future if a pandemic looks imminent "will be extremely difficult."
"Swine flu looks to be an extremely mild pandemic if it goes pandemic at all, despite WHO warnings that it may 'come back with a vengeance' in the fall. People are going to be very, very skeptical," Sandman wrote.
That concern is shared by infectious disease specialists. But elsewhere, especially online, talk of hype is rampant.
"If I hear 1+ person freaking out because of the "Swine Flu" they won't have 2 worry about dying from it. I will kill them w/ my handbag!" read a comment Wednesday on Twitter.
"Adults are acting like a bunch of crybabies in a B-rated science fiction germ-outbreak movie, wringing their hands, whining about what to do next," Dallas Morning News reader Mark Thompson wrote in a letter to the editor posted online Wednesday.
Kari Carsey Valente of Lake Oswego, Ore., had similar thoughts in a letter on the Oregonian newspaper's Web site.
"Is the daily front page body count really necessary? In reading the entire content of the collected articles one learns that the H1N1 strain is not likely to be more lethal than its predecessors. Give it a rest — and lots of liquid!," Valente wrote.
Colt Ables, 22, an economics major at the University of Texas in Arlington, said he thinks the Obama administration overreacted and unfairly tried to make it seem as if Republicans have been soft on preparedness.
"This shouldn't be about politics or about hyping up a virus to send the American people into a panic. Do yourself a favor, wash your hands and turn off the TV," he wrote in a campus newspaper column.
Whether the media overhyped or accurately reported the dangers is a toss-up, according to a USA Today/Gallup poll published Thursday on Americans' views of the media's flu coverage.
The May 5 poll also found that concern about the flu peaked a week ago. But even then, only 25 percent of Americans said they worried about getting the virus.
Dr. Robert Daum, a University of Chicago infectious disease expert, says authorities acted properly when news first broke about the new flu strain.
"It's like overcalling a snowstorm in Chicago. You want the plows out even if it's only going to snow a flake," Daum said. If not, and a blizzard hits, "there will be an outcry like you've never seen before."
Still, Daum says authorities have been a bit awkward in "downshifting" now that it appears the U.S. situation isn't dire.
"I think it was right to place everyone on high alert, and now right" to say it's time to calm down, Daum said.
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Medical Writer Lindsey Tanner reported from Chicago and Medical Writer Mike Stobbe reported from Atlanta.
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Kamis, 07 Mei 2009
Flu overhyped? Some say officials 'cried swine'
WHO: Up to 2 billion people might get swine flu
GENEVA – Up to 2 billion people could be infected by swine flu if the current outbreak turns into a pandemic lasting two years, the World Health Organization said Thursday. WHO flu chief Keiji Fukuda said the historical record of flu pandemics indicates one-third of the world's population gets infected in such outbreaks. Independent experts agreed that the estimate was possible but pointed out that many would not show any symptoms.
In Mexico, the hardest hit country so far, high schools and universities opened for the first time in two weeks as the government's top health official insisted the epidemic is on the decline. All students were checked for swine flu symptoms and some were sent home.
"If we do move into a pandemic, then our expectation is that we will see a large number of people infected worldwide," Fukuda said. "If you look at past pandemics, it would be a reasonable estimate to say perhaps a third of the world's population would get infected with this virus."
With the current total population of more than 6 billion, that would mean an infection total of 2 billion, he said, but added that the world has changed since pandemics of earlier generations, and experts are unable to predict if the impact will be greater or smaller.
"We don't really know." said Fukuda. "This is a benchmark from the past. Please do not interpret this as a prediction for the future."
Chris Smith, at flu virologist at Cambridge University in England, said the 2 billion estimate was possible.
"That doesn't sound too outlandish to me for the simple reason that this is a very infectious virus," Smith told The Associated Press. "You're talking about a virus that no one in the population has seen before and therefore everyone is immunologically vulnerable. Therefore it's highly likely that once it starts to spread, people will catch it. And since the majority of the world's population are in contact with one another, you're going to get quite a lot of spread."
John Oxford, professor of virology at St. Bart's and Royal London Hospital, agreed.
"I don't think the 2 billion figure should scare people because it's not as though 2 billion people are going to die. The prediction from WHO is that 2 billion people might catch it. Half of those people won't show any symptoms. Or if they show any symptoms, they will be so mild they will hardly know they've had it."
Fukuda said it also is impossible to say if the current strain of swine flu will become severe or mild, but that even with a mild flu, "from the global perspective there are still very large numbers of people who could develop pneumonia, require respirators, who could die."
A mild outbreak in wealthier countries can be "quite severe in its impact in the developing world," Fukuda said.
People react differently to the flu depending on their general state of health and other factors, he said. Some younger people in the Southern Hemisphere may be more vulnerable because of poor diet, war, HIV infections and other factors.
"We expect this kind of event to unfold over weeks and months," Fukuda said. "Really if you look over a two-year period that is really the period in which you see an increase in the number of illnesses and deaths during a pandemic influenza."
So far the swine flu virus has spread to 26 countries. Brazil and Argentina on Thursday became the second and third countries in South America to announce confirmed cases.
Mexican dance halls, movie theaters and bars were allowed to fully reopen Thursday after a five-day shutdown designed to curb the virus' spread. Businesses must screen for any sick customers, and restaurant employees must wear surgical masks.
Fans can attend professional soccer matches this weekend after all were played in empty stadiums last weekend.
Mexico confirmed two more deaths, for a total of 44, while 1,160 people have been sickened, up 90 from Wednesday. Despite death tolls and confirmed caseloads that rise daily, Health Secretary Jose Angel Cordova insisted the epidemic is waning in Mexico.
WHO raised its global total of laboratory-confirmed cases to 2,099, from 1,893 late Wednesday, and said swine flu also has caused two deaths in the United States.
This swine flu seems to have a long incubation period — five to seven days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. That means the virus can keep being spread by people who won't know to stay home.
Laughing and joking, high school students gathered at the entrance of the National School of Graphic Arts in Mexico City, waiting to fill out forms that asked about their health.
Of 280 students entering the school in the first 20 minutes, two showed symptoms of swine flu, including coughing and nasal congestion, said assistant principal Ana Maria Calvo Vega. Their parents were notified and they won't be readmitted without a statement from a doctor saying they don't have the virus, she said.
Students at a Mexico City vocational high school were welcomed with a hand sanitizer and a surgical mask. Joyful to see each other again, students embraced and kissed — some through masks.
But some worried that the virus could surge back once young people gather in groups again.
"My 17-year-old daughter is afraid. She knows she must go back but doesn't want to," said Silvia Mendez as she walked with her 4-year-old son, Enrique, in San Miguel Topilejo, a town perched in forested mountains near the capital.
Working parents have struggled to provide child care during the shutdown. It forced many to stay home from work, bring their youngsters to their jobs, or leave them at home.
Each school, Mexican officials said, had to be cleaned and inspected this week. Complicating the task: Many schools are primitive buildings with dirt floors and lack proper bathrooms. It was unclear how students attending those schools could adhere to the government's strict sanitary conditions.
The government promised detergent, chlorine, trash bags, anti-bacterial soap or antiseptic gel and face masks to state governments for delivery to public schools. But some local districts apparently didn't get the word.
U.S. health officials are no longer recommending that schools close because of suspected swine flu cases since the virus has turned out to be milder than initially feared. But many U.S. schools have done so anyway, including the school of a Texas teacher who died.
In Asia, top health officials said the region must remain vigilant over the threat of swine flu, stepping up cooperation to produce vaccines and bolstering meager anti-viral stockpiles.
The virus has so far largely spared Asia. Only South Korea and Hong Kong have confirmed cases. On Thursday, China and Hong Kong released dozens of people quarantined over suspected contact with one of the region's few swine flu carriers.
Experience has been the spur to WHO to make sure the world is as prepared as possible for a pandemic, which would be indicated by a rise to phase 6 from the current phase 5 in the agency's alert scale. That would mean general spread of the disease in another region beyond North America, where the outbreak so far has been heaviest.
"I'm not quite sure we know if we're going to phase six or not or when we would do so," Fukuda said. "It's really impossible for anybody to predict right now."
Officials said the agency was likely to shorten its annual meeting of its 193 member states later this month from 10 days to five because of the outbreak, which it was scheduled to discuss.
"That is under consideration," Fukuda said. "Sure it is possible."
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Contributions from AP Medical Writer Maria Cheng in London and Associated Press writers Andrew O. Selsky in Mexico City and Michael Casey in Bangkok.
news source www.news.yahoo.com
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US swine flu victims had chronic health problems
ATLANTA – America's two swine flu deaths — a toddler and a pregnant woman — each suffered from several other illnesses when they were infected with the virus, according to a study released Thursday.
The report by the Centers for Disease Control and Prevention presented a clearer picture of the complicated medical situations faced by those who have gotten swine flu and had the most serious cases so far.
The Mexican toddler had a chronic muscle weakness called myasthenia gravis, a heart defect, a swallowing problem and lack of oxygen. Little Miguel Tejada Vazquez fell ill and died during a family visit to Texas.
The pregnant woman, Judy Trunnell, 33, was hospitalized for two weeks until she died Tuesday. The teacher was in a coma, and her baby girl was delivered by cesarean section. According to the report, she had asthma, rheumatoid arthritis, a skin condition called psoriasis and was 35 weeks pregnant.
People with chronic illnesses are at greatest risk for severe illness from the flu, along with the elderly and young children. So far, most of those with the swine flu in the U.S. and Mexico have been young adults.
"We're still learning about what patients are most at risk" from the new virus, said Dr. Fatima Dawood, a CDC epidemiologist.
The CDC report released by the New England Journal of Medicine also provided more detailed information on 22 people hospitalized with swine flu. Nine had chronic medical conditions, including the two who died and a 25-year-old man with Down syndrome and a congenital heart disease. Five of the patients had asthma alone.
Separately, the CDC also described the symptoms experienced by Americans with swine flu. About 90 percent reported fever, 84 percent reported cough and 61 percent reported a sore throat — all similar to what's seen with seasonal flu.
But about one in four cases have also involved either vomiting or diarrhea, which is not typical for the normal flu bug.
It's possible the virus is spreading not only through coughed and sneezed droplets — as with seasonal flu — but also through feces-contaminated hands, said Dawood.
"This is a new virus and we're still learning how transmission occurs," she said.
There are now nearly 900 confirmed cases in the United States, said the CDC's acting chief, Dr. Richard Besser. That count included 42 hospitalizations as of Thursday.
About 10 percent of the Americans who got swine flu had traveled to Mexico and likely picked up the infection there. That's a change from over the weekend when the CDC said about a third of the U.S. cases at that point were people who had been to Mexico, where the outbreak began.
The ongoing spread within the U.S. borders explains why a shrinking proportion of cases are people who traveled to Mexico, Besser said.
The ages of those in the U.S. who got swine flu now range from 1 month to 87. More than half are under 18.
In the new report, CDC scientists discussed what's known about the swine flu virus. It has a unique combination of genes from flu viruses seen in birds, humans and pigs from not only North America but also Europe and Asia.
"There are no really close relatives, nothing we can say was an immediate precursor," said Michael Shaw, a CDC microbiologist.
It's still not clear how the combination occurred. Pigs from the Americas are imported into Europe and Asia for breeding purposes, but not the other way around, CDC officials said. Yet the virus first surfaced in California and Mexico.
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On the Net:
CDC swine flu web site: http://www.cdc.gov/h1n1flu/
news source www.news.yahoo.com
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FDA: Kids at risk from testosterone gel
WASHINGTON – A little testosterone might be good for adults, but it can cause serious harm to children, federal health officials warned Thursday. The Food and Drug Administration said adults using prescription testosterone gel must be extra careful not to get any of it on children to avoid causing serious side effects.
These include enlargement of the genital organs, aggressive behavior, early aging of the bones, premature growth of pubic hair, and increased sexual drive.
Boys and girls are both at risk.
The agency ordered its strongest warning on the products — a so-called black box.
The problems arise if adults don't wash their hands well.
Also, since testosterone gel is usually applied to the upper arms or shoulders, adults must cover up to keep kids from accidentally touching a spot that has the medicine on it.
Testosterone gel is used by men whose bodies no longer make the sex hormone, or who have very low levels of it. Doctors sometimes prescribe it to women to increase sexual drive, although the FDA has not approved that use.
U.S. pharmacies dispensed about 1.8 million prescriptions in 2007 for testosterone gel, with the leading brand, AndroGel, accounting for about three-fourths of the sales.
"These drugs are approved for an important medical need, but can have serious unintended side effects if not used properly," Dr. Janet Woodcock, director of the FDA's drug division, said in a statement. "We must ensure that the adults using them are well-informed about the precautions needed to protect children."
Although current drug warnings recommend that people using the gels wash and cover up, some patients are apparently not heeding the advice.
The FDA said it received reports of eight cases since the beginning of December in which children were accidentally exposed to testosterone gels. The kids ranged in age from nine months to five years. Only a small fraction of cases in which there is a problem with a drug are reported to the FDA, so there could be many more.
Health officials said in most cases the signs and symptoms went away once testosterone gel was identified as the cause of the problem and adults took the proper precautions.
But in some children, enlarged sex organs did not return to their appropriate size, and bone age remained somewhat higher than the child's chronological age. One child underwent surgery because the link to testosterone gel was not recognized right away.
Health officials are recommending that adults who use testosterone gel wash their hands with warm soap and water after each use and cover their skin after the gel has dried. Pregnant women, and those who may become pregnant, should avoid any exposure, since it could lead to birth defects.
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On the Net:
FDA press release: http://tinyurl.com/dnkyeo
news source www.news.yahoo.com
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WHO: up to 2 billion people might get swine flu
GENEVA – The World Health Organization says up to 2 billion people could be infected by swine flu, if the current outbreak turns into a pandemic.
WHO flu chief Keiji Fukuda says the number wasn't a prediction, but that past experience with flu pandemics indicated one-third of the world's population gets infected.
Fukuda says that with a world population of 6 billion people, it's "reasonable" to expect that kind of infection tally.
He said WHO is unable to know what the future holds, and it is impossible now to say whether the pandemic would be mild or severe.
WHO has said it believes a global swine flu outbreak is imminent, and last week it raised its alert to five, one step short of a pandemic.
news source www.news.yahoo.com
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Rabu, 06 Mei 2009
Plenty of flu caution as Mexico returns to work
MEXICO CITY – In gleaming office towers and gritty markets, Mexicans returned to work Wednesday after a five-day swine flu shutdown, and dozens returned to a heroes' welcome from "humiliating" quarantines in China. But Mexico's death toll rose, feeding fears of more infections now that crowds are gathering again.
The World Health Organization urged countries not to quarantine visitors or impose trade restrictions without scientific reasons. But China defiantly justified its quarantines as protection for its densely populated cities. And even impoverished Haiti turned away a Mexican ship carrying desperately needed food aid because of flu fears.
In Mexico City, friends and co-workers greeted each other with back slaps, firm handshakes — and dollops of hand sanitizer. Some high-rises stationed doctors in their lobbies who questioned returning employees and required visitors to fill out forms stating they had no flu symptoms. Maitre d's in surgical masks stood at attention amid rows of sidewalk tables that were pulled out and washed down for the first time in days.
"We're returning to normal," said Eugenio Velis, 57, a graphic artist sipping coffee with friends in the trendy Condesa neighborhood.
But Ernesto Viloria, 40, worried about his children using public transit and returning to school.
"Nothing can be the same," insisted Viloria, who works in finance. "The virus continues, even though it's declining, and we have to pay attention."
Mexico's government said the shutdown reduced the spread of the virus at its epicenter. Deaths have slowed as the country mobilized an aggressive public health response to the epidemic that has sickened thousands in 24 countries.
Sweden and Poland were the latest countries to confirm swine flu cases, both in women who had recently visited the U.S.
In Mexico, the confirmed death toll reached 42 Wednesday — mostly as backlogged cases got tested, but also two new deaths on Tuesday. It also confirmed more than 1,100 nonfatal cases. Eighty percent of Mexico's swine flu infections have been in and around the capital, and a majority of the dead were between 20 and 39 years old.
There was some concern that Mexico was relaxing too quickly, especially with high schools and universities reopening Thursday, and primary schools reopening next week. While "filter teams" prepared to screen out sick students and teachers, epidemiologists warn that the virus has spread throughout Mexico, and could bounce back.
"We have seen a tendency (of the outbreak) to diminish but not disappear," Health Secretary Jose Angel Cordova acknowledged.
Indeed, this swine flu seems to have a long incubation period — 5-7 days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. And that means the virus can keep being spread by people who won't know to stay home.
While restaurants opened, Mexico City's government indefinitely closed bars, discos, gymnasiums, movie theaters and dance halls. Sports halls and arenas were allowed to reopen only at half capacity. Archaeological sites began reopening Wednesday, with museums to follow.
From gritty taco stands to the Cartier store on Mexico City's version of Rodeo Drive, people were glad to be back at work.
Jesus Cortez, 43, manned El Taquito Veloz, "The Speedy Little Taco," in the rough Tepito neighborhood, offering roasted pork on a spit as its specialty — tacos al pastor. Nearby, workers sliced chunks of meat from a boiled steer's skull, flanked by cilantro branches.
"People are just starting to come back out, but they're still afraid," Cortez said. "We're going to have to open on Sundays now, and we're going to have to work really hard. If not, we're not going to make enough money."
Cartier manager Paula Guerra, 34, waited out the furlough in Valle de Bravo, a lakeside retreat for Mexico City's well-to-do, and returned Wednesday blowing air kisses to her employees through her surgical mask. But she, too, was hoping to make up for lost sales — in Mother's Day merchandise.
Rafael Ramirez, 65, rushed to the just-reopened Metropolitan Cathedral to pray to a Christ statue known as the Lord of Health, which the church brought out from storage for the first time in 300 years.
"I gave thanks that the city is returning to normal, and prayed so countries stop looking down their noses at us," Ramirez said.
Mexico has protested Chinese quarantines and China's cancellation of direct flights between the countries as discriminatory.
First lady Margarita Zavala was up before dawn to greet 136 Mexicans who were flown home from China on a government charter. None had flu symptoms, Mexican diplomats said.
While Zavala pointedly removed her face mask and smiled broadly as she welcomed the Mexicans home, the scene in Shanghai was far different: 119 returning Chinese gamely waved their country's flags as health workers in full body suits escorted them into a weeklong quarantine.
Several Mexican passengers said they were treated well in China. Others begged to differ.
"It was discrimination and humiliation in my case," said Myrna Berlanga, who said she was taken off a flight from the United States and put in a mobile laboratory for five hours without food, water or a bathroom. "They took me out because of my passport."
Haitian officials said they would not accept a Mexican navy ship carrying 77 tons of rice, fertilizer and emergency food kits, said Mexico's ambassador, Zadalinda Gonzalez y Reynero. She said Haiti asked for the ship to come "on another occasion."
Haitian officials had no immediate comment.
In San Diego, Calif., the U.S. Navy canceled the deployment of the USS Dubuque, an amphibious transport ship, after a crew member was confirmed to have swine flu. About 50 others were suspected cases, and all crew members were being treated with anti-viral drugs.
The ship was to leave June 1 on a humanitarian mission to the South Pacific, Navy spokesman Lt. Sean Robertson said.
And the Philippines urged boxing idol Manny Pacquiao to postpone a triumphant return home after beating Ricky Hatton in Las Vegas, saying a motorcade in Manila could risk spreading the virus through adoring crowds. There are no confirmed cases in the Philippines.
In Washington, officials with the U.S. Centers for Disease Control and Prevention said they identified genetic characteristics of the virus and were in position to produce a vaccine if one is needed.
Dr. Dennis Carroll, a special adviser on pandemics with the U.S. Agency for International Development, said investments to stave off an avian flu epidemic aided the quick swine flu response.
Canada, meanwhile, said researchers at the National Microbiology Laboratory in Winnipeg, Manitoba, genetically sequenced three samples of the virus from Mexico and Canada, a breakthrough they hope will answer questions about how it spreads and mutates.
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Associated Press writers Margie Mason, Mark Stevenson, Lisa J. Adams and Juan Carlos Llorca in Mexico City and Jonathan M. Katz in Port-au-Prince contributed to this report.
Selasa, 05 Mei 2009
Nation's first face transplant patient shows face
CLEVELAND – Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a dead woman. Connie Culp stepped forward Tuesday to show off the results of the nation's first face transplant, and her new look was a far cry from the puckered, noseless sight that made children run away in horror.
Culp's expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish, and her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles.
But Culp had nothing but praise for those who made her new face possible.
"I guess I'm the one you came to see today," the 46-year-old Ohio woman said at a news conference at the Cleveland Clinic, where the groundbreaking operation was performed. But "I think it's more important that you focus on the donor family that made it so I could have this person's face."
Up until Tuesday, Culp's identity and how she came to be disfigured were a secret.
Culp's husband, Thomas, shot her in 2004, then turned the gun on himself. He went to prison for seven years. His wife was left clinging to life. The blast shattered her nose, cheeks, the roof of her mouth and an eye. Hundreds of fragments of shotgun pellet and bone splinters were embedded in her face. She needed a tube into her windpipe to breathe. Only her upper eyelids, forehead, lower lip and chin were left.
A plastic surgeon at the Cleveland Clinic, Dr. Risal Djohan, got a look at her injuries two months later. "He told me he didn't think, he wasn't sure, if he could fix me, but he'd try," Culp recalled.
She endured 30 operations to try to fix her face. Doctors took parts of her ribs to make cheekbones and fashioned an upper jaw from one of her leg bones. She had countless skin grafts from her thighs. Still, she was left unable to eat solid food, breathe on her own, or smell.
Then, on Dec. 10, in a 22-hour operation, Dr. Maria Siemionow led a team of doctors who replaced 80 percent of Culp's face with bone, muscles, nerves, skin and blood vessels from another woman who had just died. It was the fourth face transplant in the world, though the others were not as extensive.
"Here I am, five years later. He did what he said — I got me my nose," Culp said of Djohan, laughing.
In January, she was able to eat pizza, chicken and hamburgers for the first time in years. She loves to have cookies with a cup of coffee, Siemionow said.
No information has been released about the donor or how she died, but her family members were moved when they saw before-and-after pictures of Culp, Siemionow said.
Culp said she wants to help foster acceptance of those who have suffered burns and other disfiguring injuries.
"When somebody has a disfigurement and don't look as pretty as you do, don't judge them, because you never know what happened to them," she said. "Don't judge people who don't look the same as you do. Because you never know. One day it might be all taken away."
It's a role she has already practiced, said clinic psychiatrist Dr. Kathy Coffman.
Once while shopping, "she heard a little kid say, `You said there were no real monsters mommy, and there's one right there,'" Coffman said. Culp stopped and said, "I'm not a monster. I'm a person who was shot," and pulled out her driver's license to show the child what she used to look like, the psychiatrist said.
Culp, who is from the small town of Unionport, near the Pennsylvania line, told her doctors she just wants to blend back into society. She has a son and a daughter who live near her, and two preschooler grandsons. Before she was shot, she and her husband ran a painting and contracting business, and she did everything from hanging drywall to a little plumbing, Coffman said.
Culp left the hospital Feb. 5 and has returned for periodic follow-up care. She has suffered only one mild rejection episode that was controlled with a single dose of steroid medicines, her doctors said. She must take immune-suppressing drugs for the rest of her life, but her dosage has been greatly reduced and she needs only a few pills a day.
Also at the Cleveland Clinic is Charla Nash of Stamford, Conn., who was attacked by a friend's chimpanzee in February. She lost her hands, nose, lips and eyelids, and will be blind, doctors said. Clinic officials said it is premature to discuss the possibility of a face transplant for her.
In April, doctors at Harvard-affiliated Brigham and Women's Hospital in Boston performed the nation's second face transplant, on a man disfigured in a freak accident. It was the world's seventh such operation. The first, in 2005, was performed in France on Isabelle Dinoire, a woman who had been mauled by her dog.
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On the Net:
Cleveland Clinic: http://www.clevelandclinic.org/face
news source www.news.yahoo.com
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Ga. man stable after 1st US double hand transplant
PITTSBURGH – Teams of surgeons performed the nation's first double hand transplant on a man whose hands and feet were ravaged by a bacterial infection a decade ago and who hoped to once again be able to hold his daughter.
Jeff Kepner, 57, of Augusta, Ga., underwent surgery lasting just under nine hours Monday at the University of Pittsburgh Medical Center, where surgeons worked on each hand simultaneously, a hospital spokeswoman said.
He was in critical but stable condition Tuesday at the hospital's transplant intensive care unit, spokeswoman Amy Dugas Rose said.
Rose did not have information about the donor. The hospital was expected to release more details later this week.
Kepner, a native of Lancaster, Pa., told the Sunday News of Lancaster before his surgery he was looking forward to holding his 13-year-old daughter, who was 3 when he lost his hands and feet.
His surgery was done using a technique developed at UPMC called the Pittsburgh Protocol, which aims to reduce the amount of toxic medication that must be taken to suppress the immune system so the body doesn't reject the new hands. The toxic medication can lead to an increase in the risk for diabetes, infections and other complications.
Under the protocol, Kepner was given antibodies the day of the transplants and will be given bone marrow from the hand donor over the next several days. Instead of a variety of anti-rejection medications, he should have to take just one.
Eight double hand transplants have been performed abroad. Last month, French physicians performed the world's first simultaneous partial face and double hand transplant.
Five U.S. hand transplants have been done at Jewish Hospital Heart and Lung Center of Louisville, Ky.
In March, UPMC performed its first hand transplant, on a Marine who lost his right hand when a quarter-stick of dynamite blew up in it during a training exercise in Quantico, Va.
The first U.S. hand transplant was performed in January 1999, on a New Jersey man who lost his hand in 1985 in an M-80 firecracker blast.
The first hand transplant was done in Ecuador in 1964, but the patient's body rejected the hand after two weeks.
Texan dies of swine flu; Mexico ready for business
MEXICO CITY – Mexico emerged from its swine flu isolation Tuesday as thousands of newspaper vendors, salesmen hawking trinkets and even panhandlers dropped their protective masks and joined the familiar din of traffic horns and blaring music on the streets of the capital.
There were still signs, however, of the virus that set off world health alarms. A Texas woman who lived near a popular border crossing was confirmed as the 28th person — only the second outside Mexico and the first U.S. resident — to die from the virus.
Across Mexico, people were eagerly anticipating this week's reopening of businesses, restaurants, schools and parks, after a claustrophobic five-day furlough.
"We have a lot of confidence nothing is going to happen," said Irineo Moreno Gonzales, 54, a security guard who Tuesday limited takeout customers to four at a time at a usually crowded downtown Starbucks. "Mexicans have the same spirit we've always had. We're ready to move forward."
The Texas woman, the second to die of swine flu in the U.S., lived not far from the Mexico border and had chronic medical conditions, as did the Mexico City toddler who died of swine flu last week during a visit to Houston, Texas, health officials said.
The 33-year-old woman was pregnant and delivered a healthy baby while hospitalized, said Leonel Lopez, Cameron County epidemiologist. She was a teacher in the Mercedes Independent School District, which announced it would close its schools until May 11.
Mexico's government imposed the shutdown to curb the flu's spread, especially in this metropolis of 20 million where the outbreak sickened the most people. Capital residents overwhelmingly complied, and officials cautiously hailed the drastic experiment as a success.
But by Tuesday, pedestrians — many wearing protective masks, many not — were back to dodging the familiar green-and-white VW taxis cruising for fares and noisy heavy trucks bearing bottled water.
Some officials worried about a sudden rush toward normalcy, though no Mexican swine flu deaths have been confirmed since April 29.
"The scientists are saying that we really need to evaluate more," said Dr. Ethel Palacios, the deputy director of the swine flu monitoring effort here. "In terms of how the virus is going to behave, we are keeping every possibility in mind. ... We can't make a prediction of what's going to happen."
Palacios acknowledged the enormous responsibilities that come with balancing the public's health and economic welfare.
"One of most the important things is that you need to know that these measures do have an impact not only on health but also on other aspect of life and society," Palacios said.
With 840 people sickened in Mexico at last count, public celebrations of Cinco de Mayo were banned, and politicians' homage to the soldiers who fought off the French 147 years ago were subdued.
For the first time in decades, Mexico canceled the popular re-enactment of its May 5, 1862, victory over invading French troops in the central state of Puebla. Another traditionally boisterous Cinco de Mayo party in Mexico City's central plaza, the Zocalo, will wait for another year, as will military ceremonies across the nation.
Cinco de Mayo celebrations generally attract bigger crowds in the U.S., where many Mexican-Americans gather to embrace their heritage. These crowds prompted concerns Tuesday about spreading the virus.
Denver's annual festival, which typically draws 400,000, will be held as planned this weekend, with hand sanitation stations installed 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.
Swine flu has now sickened more than 1,600 people in 21 countries, including nearly 500 in the United States. The World Health Organization said it was shipping 2.4 million treatments of antiflu drugs to 72 countries "most in need," and France sent 100,000 doses of antiflu drugs worth $1.7 million to Mexico.
Mexican Finance Secretary Agustin Carstens unveiled plans Tuesday to stimulate key industries and fight foreign bans on Mexican pork products. He said persuading tourists to come back will be a top priority.
Carstens said the outbreak cost Mexico's economy at least $2.2 billion, and he announced a $1.3 billion stimulus package, mostly for tourism and small businesses, the sectors hardest hit by the epidemic. Mexico will temporarily reduce taxes for airlines and cruise ships and cut health insurance payments for small businesses.
U.N. Secretary-General Ban Ki-moon said he will ask governments to reverse trade and travel restrictions lacking a clear scientific basis.
About 20 Chinese businessmen and students, each wearing surgical masks, left Tijuana on Tuesday on a Chinese government flight after being stranded when China canceled all direct flights to Mexico.
Mexico, meanwhile, was collecting more than 70 Mexican nationals quarantined in China with its own charter flight.
Four U.S. citizens were quarantined in China, the U.S. Embassy in Beijing said Tuesday, and about 200 passengers who flew from the United Kingdom were under quarantine in a Brunei hospital after three of them arrived with fevers.
Mexico City recovered a bit of its ebullient self Tuesday, one day before the official reopening of stores, restaurants and factories. Only essential services like gas stations and supermarkets have been allowed to operate since April 27, and the weekend's professional soccer games will again be staged in empty stadiums.
High schools and universities were being scrubbed down to reopen Thursday. Younger children return to school on Monday.
Many people shunned their surgical masks Tuesday; a boy selling music CDs on a subway train planted a wet kiss on the unprotected cheek of a girl hawking tiny flashlights. A fruit salad vendor dished up slabs of freshly cut mango and coconut without mask and gloves.
The government is requiring businesses to keep a distance of 2 meters (yards) between customers to prevent the disease from spreading. The rule seemed unlikely to survive in the overcrowded capital.
"It's a little senseless, that people ride into town all jammed together on the subway, and the minute they enter a restaurant, they have to be 2 meters apart," said Nahum Navarette, manager of Yug, a vegetarian restaurant that was still serving only takeout on Tuesday, its dining room deserted.
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Associated Press Writer Katherine Corcoran contributed to this report.
Experts: Mild swine flu could quickly turn deadly
WASHINGTON – A flu virus is a powerhouse of evolution, mutating at the maximum speed nature allows. A mild virus can morph into a killer and vice versa.
One change already made this year's swine flu more of a problem, helping it spread more easily among people. The big question is: What mutations are next? That's why scientists are watching it so closely.
"There are no rules to flu viruses; they are just so mutable," said Dr. Paul Glezen, a flu epidemiologist at the Baylor College of Medicine in Houston. "The fact that it changes all the time really confounds our efforts to control it."
Think of flu's evolution like a family tree: In the current flu's distant ancestry are last century's three pandemics. But its more immediate relatives are swine flu strains that were no big deal to humans.
The good news right now is that this flu has lost some of the most dangerous genetic traits of past pandemics. The bad news is that it's gained something its parents didn't have: the ability to spread from human to human.
Flu reproduces about every eight hours, said Dr. Raul Rabadan, professor of computational biology at Columbia University. That means this morning's flu is a parent by the afternoon, a grandparent by the evening, and a great-grandparent by the next day.
Instead of complex double-helix DNA — nature's basic biological instruction book — flu has a simpler, single strand of genetic code. Normal DNA has a spellcheck-like system that reduces mistakes in replicating the code; the flu virus does not. So mutations come more often. If the mutations are good for the virus, they multiply, and voila, you have a new and sometimes nastier flu.
Scientists are trying to piece together swine flu's ever-changing genome, its genetic ancestors and the random mutations that in this instance turned a simple pig disease into something that scares billions.
They also don't know how the virus is going to mutate next.
In the world's most devastating global flu epidemic in 1918, the first wave of cases in the spring were mild. Then, the virus evolved and came back in the fall as a strain that proved truly deadly, flu experts say. So scientists today are watching to see if that could happen again.
Also troubling is the possibility that this virus could develop resistance to anti-flu drugs, and flu trackers are watching for such changes, Centers for Disease Control and Prevention flu chief Dr. Nancy Cox said.
It's impossible to know where this swine flu strain began exactly, Cox said. But flu trackers do have clues to its closest ancestral genes.
"Its two parents were swine viruses that we know and love," said virologist Dr. Richard Webby, a researcher at St. Jude Children's Research Hospital in Memphis, Tenn.
The mother of the swine flu was a surprising genetic event that went unnoticed except by a few scientists a little over a decade ago. Three influenza strains — some pig, some bird, some human — combined in pigs to form two new strains of swine flu. This new flu was unusual. Virus hunters called it a "triple reassortment."
That 1998-99 flu in pigs first hit a farm in North Carolina, then spread to Iowa, Texas, Oklahoma and eventually to at least 23 states. No more than 4 percent of the swine died. But the disease was in more than one-quarter of tested pigs. A handful of people who were in close contact with the hogs got slightly sick when they caught this flu from pigs, but they didn't die and didn't spread it to others.
In 2005, a 17-year-old Wisconsin boy caught that triple reassortment flu virus from "respiratory secretions" of a pig he had been helping his brother-in-law butcher, according to the CDC. He recovered and didn't pass it on to others.
There have been about 10,000 generations of that virus since. Six of the eight genetic segments of the current swine flu can be traced to that triple combination, Rabadan said.
The rest of the swine flu parentage is more of a mystery. The other two of the eight genetic segments can be traced to pig viruses in Europe and Asia that were seen from time to time in the 1990s, Rabadan said. Scientists don't quite know if those other two segments combined with the triple reassortment at the same time or separately.
How the triple reassortment genes and the European and Asian genes met and mixed is not known, Webby said.
The three global flu epidemics of the past, including the 1918 event, all passed on traits to ancestors of this flu, Rabadan said. But there have been many changes in the thousands of generations since.
A specific gene for virulence that was seen in the 1918, 1957 and 1968 pandemics was notably absent in this swine flu, said Dr. Peter Palese, a prominent flu researcher for Mount Sinai Medical Center in New York. He said when he removed that gene from other viruses of the past, they weren't as dangerous.
Rabadan suggests the way to think of this flu is like a homemade car with parts from different vehicles. The parts have all been in several different vehicles before. Sometimes the combination of parts is a dud and the car doesn't move. And sometimes you get a race car. A pandemic is a race car.
All eight of the new flu's genetic segments have been in different viruses before. But this is the first time this specific combination has been seen. The big question is: Why is this particular swine virus spreading so fast among people when past swine viruses haven't?
One possibility is that it's just this particular combination of the eight parts that makes it spread among people, Webby said. But a more logical explanation is that a small mutation within the individual genetic segments changed things.
These tiny changes are possible because there are about 13,000 individual letters, or bases, in the flu genetic code, Rabadan said. That's tiny compared to more than 3 billion in humans.
One prime suspect is the surface protein hemagglutinin, the "H" in the virus' H1N1 name. It is "probably the most important gene determining virulence and immunological characteristics," according to Palese.
In flu viruses, scientists have so far identified 16 hemagglutinins. Only three — H1, H2 and H3 — commonly infect humans. The other surface protein, neuraminidase, has nine variations. Palese said scientists are seeing more different types of flu strains because of better surveillance and increases in bird, pig and human populations.
"These genetic processes of mutation and genetic reassortment occur all the time," he said, "and every once in a time, it's a lottery winner."
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US no longer advising schools close for swine flu
ATLANTA – U.S. health officials are no longer recommending that schools close if students come down with swine flu, the government said Tuesday.
Last week, schools were advised to shut down for about two weeks if there were suspected cases of swine flu. Hundreds of schools around the country have followed the government's guidance and closed schools, giving students an unexpected vacation and leaving parents scrambling for child care.
"We no longer feel that school closure is warranted," said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention.
Health and Human Services Secretary Kathleen Sebelius said the swine flu virus had turned out to be milder than feared and the government decided to change its advice. So far, the virus has not proved to be more infectious or deadly than the seasonal flu.
The CDC said parents should still make sure to keep sick children with flulike symptoms at home for seven days.
As the threat seemed to diminish, health officials also considered the problems the closings were creating for parents, Besser said. Officials were hearing about children getting dropped off at libraries, or parents who couldn't take sick leave to care for their children.
"The downsides of school closure start to outweigh the benefits," Besser said.
The change in guidance was made in consultation with the White House and other officials, Besser and others said.
An estimated 726 public and nonpublic schools were closed Tuesday for flu-related reasons, in 24 states and the District of Columbia, according to the Education Department. In total, these schools enroll approximately 468,000 students on a typical day. (There are more than 100,000 schools in the U.S., with about 55 million students.)
The number of confirmed swine flu cases in the United States is now over 400, with hundreds more probable cases. The CDC knows of 35 swine flu-related hospitalizations and one death, a Mexican toddler who died in Texas.
Nearly two of every three cases are under the age of 18, CDC officials said.
Local school officials still have the ultimate say in whether to close or not, CDC officials noted.
In the new guidance, the CDC recommends that when children or school staff are sick, they stay home. Those who do go to school should practice good hygiene — like coughing into their sleeve or shoulder instead of their hands or the air, and washing their hands well and often.
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On the Net:
CDC swine flu web site: http://www.cdc.gov/h1n1flu/
Mexico gets some bustle back after flu shutdown
MEXICO CITY – Traffic is picking up again, cafes are reopening and cleanup crews are getting universities ready to resume classes. Mexico City has some of its customary bustle back, and the president promises life is returning to normal after a five-day shutdown to contain the spread of swine flu.
Mexico still called off Cinco de Mayo celebrations Tuesday, including the biggest one of all — a re-enactment of the May 5, 1862, victory over French troops in the central state of Puebla. And health experts warned that Mexico and the rest of the world needed to remain on guard against the virus.
Saying the outbreak is waning in Mexico, the epicenter of an illness that has sickened hundreds around the world, President Felipe Calderon announced it was nearly time to reopen businesses. Universities and high schools will open their doors Thursday, and younger schoolchildren are to report back to school May 11.
"The school schedule will resume with the guarantee that our educational institutions are in adequate hygienic condition," Calderon said. He urged parents to join educators in a "collective" cleansing and inspection of schools nationwide.
"This is about going back to normalcy, but with everyone taking better care," Calderon said.
Already more vehicles prowled the streets of the capital Monday than over the weekend, and fewer people wore surgical masks. Some cafes even reopened ahead of time.
Health Secretary Jose Cordova said infections were trending downward after Mexico's 27 deaths, including a Mexican toddler who died in Texas. He said those infected appeared to pass the virus on to an average of 1.4 other people, near the normal flu rate of around 1.3.
Cordova said soccer stadiums and concert halls could reopen — but only if fans were kept 2 meters, about 6 1/2 feet, apart.
However, world health officials stressed that the global spread of swine flu was still in its early stages and a pandemic could be declared in the days to come. Experts inside Mexico's swine flu crisis center warned that the virus remained active throughout Mexico and could bounce back once millions return to work and school.
"It's clear that it's just about everywhere in Mexico," Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention, told The Associated Press.
Widdowson said it is too early to say the outbreak is over in Mexico, but the signs of progress are clear.
"What we have not seen in Mexico City is a huge, runaway epidemic, and I think that's totally clear. The hospital capacity has not been exceeded. So there hasn't been anything like the kind of picture that people might expect from a severe flu," he said. "I think that gives us optimism."
Scientists said the virus is spreading in the U.S. and that chances of severe cases could rise there as well, even as a New York City school reopened after the swine flu hit following a spring break trip by some students to Mexico.
"We are by no means out of the woods," said Dr. Richard Besser, acting director of the CDC.
As of Monday, Mexico had 802 confirmed cases, and U.S. cases grew to at least 380 in 36 states. Globally, the virus had infected more than 1,445 people in 20 countries, the World Health Organization said, including South Korea which reported its second confirmed case Tuesday. Experts said the known cases were almost certainly only a fraction of the real total.
The latest figures from Mexico suggest the virus may be less lethal and infectious than originally feared. Only 38 percent of suspected cases have turned out to be swine flu, and no new deaths have been reported since April 29. But Cordova acknowledged that about 100 early deaths in which swine flu was suspected may never be confirmed because mucous or tissue samples were not collected.
WHO was studying whether to raise the pandemic alert to 6, its highest level, which would mean a global outbreak had begun. WHO uses the term pandemic to refer only to geographic spread and not to the severity of an illness. The two most recent pandemics — in 1957 and 1968 — were relatively mild.
"We do not know how long we will have until we move to Phase 6," WHO Director-General Margaret Chan said. "We are not there yet. The criteria will be met when we see in another region outside North America, showing very clear evidence of community-level transmission."
The Southern Hemisphere is particularly at risk. While Africa still hasn't reported any swine flu infections and New Zealand is the only country south of the equator with confirmed cases, winter is only weeks away. Experts worry that typical winter flus could combine with swine flu, creating a new strain that is more contagious or dangerous.
"You have this risk of an additional virus that could essentially cause two outbreaks at once," Dr. Jon Andrus said at the Pan American Health Organization's headquarters in Washington.
Still, the U.N. health agency urged governments to avoid unproven actions to contain the disease, including group quarantines of travelers from Mexico and bans on pork imports.
"Let me make a strong plea to countries to refrain from introducing measures that are economically and socially disruptive, yet have no scientific justification and bring no clear public health benefit," Chan said in a video message to the U.N. General Assembly in New York.
China, Argentina and Cuba are among the nations banning regular flights to and from Mexico, marooning passengers at both ends. Mexico and China both sent chartered flights to each other's countries to collect their citizens, with a chartered Mexican plane landing in Shanghai early Tuesday. Argentina also chartered a flight to bring Argentines home.
In a televised message to the country late Monday, Calderon had harsh words for countries that he said are treating Mexicans unfairly. "Stop taking actions that only hurt Mexico and don't contribute to avoid the transmission of the disease."
Economy Secretary Gerardo Ruiz said Mexico would raise the issue at the World Trade Organization if other countries didn't drop restrictive measures.
Chinese authorities quarantined Mexicans and other passengers who came in close contact with them, even those who didn't show symptoms.
Among them was Olivier Dolige of France, one of 274 guests and employees kept inside a Hong Kong hotel where a Mexican tourist came down with swine flu. Dolige celebrated his 43rd birthday under quarantine Tuesday, telling The Associated Press in a phone interview he invited other guests to share in champagne being sent by the French consulate.
"The day has started very well," said Dolige, who was visiting Hong Kong for a trade fair. He said he had come to terms with the quarantine. "I feel good. I feel very good."
The American Embassy in Beijing said Tuesday that four U.S. citizens were quarantined in China due to swine flu fears. Embassy spokeswoman Susan Stevenson said two of the Americans were in Beijing and the other pair were in the southern province of Guangdong.
Stevenson declined to go into specifics of the individual cases, citing privacy reasons, but said only two of them remained in quarantine.
In Tokyo, 37 passengers and two flight attendants on a flight from Los Angeles were detained in a hotel after Japanese officials suspected one traveler of having swine flu. They were released about 10 hours later when the passenger, a Japanese woman coming back from Las Vegas, tested negative for swine flu, American Airlines spokesman Tim Smith said.
About 200 passengers who flew from the United Kingdom to Brunei were under quarantine in a Brunei hospital over swine flu fears Tuesday after three of them showed fever symptoms, an official said.
Swine flu leaves Southern Hemisphere out in cold
SAO PAULO – The Southern Hemisphere has been mostly spared in the swine flu epidemic. That could change when winter starts in coming weeks with no vaccine in place, leaving half the planet out in the cold.
So far, the most affected nations have been in North America and Europe, which are heading into summer. But flu is spread more easily in the winter, and it's already fall down south. Experts fear public health systems could be overwhelmed — especially if swine flu and regular flu collide in major urban populations.
"You have this risk of an additional virus that could essentially cause two outbreaks at once," Dr. Jon Andrus said at the Pan American Health Organization's headquarters in Washington.
There's also a chance that the two flus could collide and mutate into a new strain that is more contagious and dangerous.
"We have a concern there might be some sort of reassortment and that's something we'll be paying special attention to," World Health Organization spokesman Dick Thompson said.
Flu spreads more readily during the winter because people congregate indoors as the weather gets colder, increasing the opportunity for the virus to hop from person to person, said Raina MacIntyre, public health director at the University of New South Wales in Australia. Colder temperatures also may make it easier for the virus to infect people.
"The highest peaks of influenza activity occur in winter," MacIntyre said. "For us in the Southern Hemisphere, it's particularly concerning."
And while New Zealand is the only southern nation with confirmed swine flu cases, "it's almost inevitable that it will come to Australia," she said.
Humans have only limited natural immunity to this new blend of bird, pig and human viruses, but the strain has killed relatively few people in its current form compared to traditional flu, which kills about 36,000 people each year in the U.S. and more than 250,000 worldwide.
The timing is particularly challenging for vaccine makers. A vaccine for swine flu is still months from being produced, and will likely be available just as flu season is ending in southern countries.
"The vaccine won't come in time for South America," said Dr. Gonazalo Vecine of Sao Paulo's prominent Hospital Sirio-Libanes.
In addition, many companies may switch to making swine flu vaccine instead of seasonal flu vaccine, jeopardizing the southern countries' regular flu vaccine stocks. That could mean fewer seasonal flu vaccines available for next year's Southern Hemisphere winter.
"This is a concern we are working on," Andrus said. "We want to prevent it from being a potential barrier to getting it to the people who need it most."
Even in normal years, vaccine makers don't have the capacity to make enough courses for more than a fraction of the world's population.
Some experts think health officials in Southern Hemisphere countries should be more concerned with seasonal flu than with swine flu.
John Mackenzie, a flu expert at Curtin University in Australia, said countries should focus on regular flu vaccines for high risk populations, including the elderly and those with chronic illnesses, since this swine flu appears relatively mild so far.
"Governments have to step up their actions to protect their populations, especially in the absence of a (swine flu) vaccine," Thompson said. "Latin American countries may have a somewhat stronger surveillance system than in Africa. Africa's going to need some additional support and surveillance."
In Africa, which has yet to confirm a swine flu case, an outbreak during traditional flu season will make diagnosing and treating the two viruses a challenge, said Barry Schoub, director of South Africa's National Institute for Communicable Diseases.
Even in the absence of cases, officials are preparing. O.R. Tambo International Airport in Johannesburg, the gateway to the region handling millions of travelers each year, has plans to get a thermal image detection system running to check passengers for fever. A supply of masks has been provided to that airport and others, as well.
Hospitals have been given guidelines on how to handle suspected cases. South Africa, the richest country in the region, is poised to assist its neighbors should they need help with testing or treatment.
South Africa has stockpiled about 100,000 courses of the antiviral drug Tamiflu, which appears to help people afflicted with swine flu, and has access to more if needed, Schoub said.
Other countries said they're well-prepared, too. Australia has a stockpile of 8.7 million courses of Tamiflu and Relenza to treat its population of 22 million, MacIntyre said. Brazil says it is well-prepared but has Tamiflu for just 9 million people in a nation of more than 190 million.
Argentina, population 40 million, has 500,000 treatments with another 110,000 on order. Chile, with 16 million, has 300,000 treatments and has asked for 500,000 more.
And in Bolivia, one of the hemisphere's poorest nations, top epidemiology official Eddy Martinez wouldn't say how much Tamiflu it has in hand. If Bolivia needs more, it will go to the WHO, which is sending millions of courses of the drug to 72 developing nations.
The greatest risk to South American nations are its most vulnerable populations, who live in slums ringing big cities and have little access to health care.
"You can't talk about at-risk countries, but rather populations at risk, and that's the families of eight people who live together in a single room," said Dr. Mauricio Espinel, an epidemiologist at Ecuador's University of San Francisco.
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Associated Press writers Kristen Gelineau in Sydney, Maria Cheng in London, Donna Bryson in Johannesburg and Gonzalo Solano in Quito, Ecuador, contributed to this report.
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Helping doctors ask about drug, alcohol problems
WASHINGTON – If more doctors started asking, would more drug and alcohol abusers 'fess up so they could get help?
It's a huge irony of health care: Go to the emergency room and you'll be asked about a tetanus shot, even though "most of us have never seen a case of tetanus," says Dr. Gail D'Onofrio, emergency medicine chief at Yale-New Haven Hospital.
Yet although up to half of ER visits involve illegal drugs or alcohol, typically "we don't ask it. It makes no sense whatsoever," says D'Onofrio, who teaches new doctors to break that chain of silence.
A new program from the National Institute on Drug Abuse aims to help health workers past the stigma and ensure that more patients are asked for simple clues to addiction at every visit — not just in the ER, but anytime they see a doctor.
It's a step-by-step computerized guide that takes patients' answers to various behavior questions, analyzes their risk for a serious substance use problem and tells doctors what next steps to take.
A patient admits to experimenting with heroin? A few more questions about how often, when and if he felt cravings can guide how big his risk is for ongoing drug use and what intervention is needed — plus remind the doctor to administer an HIV and hepatitis test.
Someone else insists she's a social drinker? If she's ever had four or more drinks in a day, she may have a bigger problem.
The goal: To get substance abuse treatment for more of the 23 million Americans estimated to need it. Only about 2 million today get that help, NIDA says.
Better would be finding people early, when substance abuse is just taking hold and a doctor intervening might keep it from getting worse. A government study last year found that some simple doctor steps — brief in-office counseling or referral to a specialty center — could help slash drug use by patients coaxed to come clean.
They have plenty of opportunity. Studies suggest people with brewing drug or alcohol problems actually see the doctor more often than their sober counterparts. They have a lot of injuries, and a tougher time with problems ranging from high blood pressure to liver disease.
"There are all sorts of people who are using alcohol, drugs, who are continuing to work and do their jobs and slowly spiraling down, who are not the hard-core users," says Dr. Brian Jack, a family medicine specialist at Boston University Medical School. "Those are people who are in the clinics every single day for all sorts of different things."
Hence the push for better substance abuse screening. The American College of Obstetricians and Gynecologists in December urged its members to ask every patient about alcohol or drug use. Top-level trauma centers must screen trauma patients as part of their accreditation. The government adopted new insurance payment codes last year so doctors could bill for screening time.
The new federal program, called NIDAMED, aims to break another barrier: How doctors not trained in addiction medicine can tell the difference between experimenting and abuse, and what they should do for a patient with a problem. Already, New York City officials have told the government they're planning to incorporate NIDAMED into the health department's electronic medical records, enabling more than 1,000 providers in underserved parts of the city to use it.
Don't patients just lie? Sure, some do. "Help your doctor read between the lines," says patient information accompanying NIDAMED.
There are consequences. Lie about what's in your system and you might be prescribed a legal drug that could trigger a deadly interaction. Lie if you're pregnant and you can hurt your baby. The key, say doctors who routinely screen, is earning patients' trust and explaining they're not being judgmental: Substance use is a medical problem.
"We're not the police," says D'Onofrio. Medical information is confidential.
"Get to know them as a person and treat them as a person, and care, frankly," adds Jack.
Dana Moulton of Boston recalls long ago being hospitalized with hepatitis and concealing that he was trying to kick a nearly 20-year heroin addiction. But one doctor sat by his bedside, talking about a mutual love of books and eventually coaxing Moulton to reveal his struggles in methadone treatment. Moulton credits that doctor's help with his success in going drug-free a decade ago.
"It was the first time someone did not stigmatize me, showed me genuine concern about my health issues despite the fact that I was a substance abuser," recalled Moulton, now 58 and with Massachusetts' substance-abuse office. "He dealt with me as a human being."
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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Leading US health expert urging cautious approach
WASHINGTON – U.S. officials said Monday that it's too early to say the swine-flu threat is receding, even though there are some signs the outbreak may not be as serious as originally feared.
Homeland Security Secretary Janet Napolitano said the outbreak could die down with warmer weather only to roar back during fall flu season. And she said the public shouldn't be alarmed if the World Health Organization declares that the new virus has officially begun a pandemic, meaning it has spread pretty much globally.
That word describes "geography, not severity" and thus wouldn't change U.S. steps to stem infections that have been confirmed in about 300 people in more than half the states, she said.
Another top U.S. health official said "there are encouraging signs" of a leveling off in the severity of the threat, but added that it's still too early to declare the problem under control.
"I'm not ready to say that yet," Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said when asked about indications by Mexican health authorities that the disease has peaked there.
"What we're seeing is an illness that looks very much like seasonal flu. But we're not seeing the type of severe disease that we were worrying about," Besser told network television interviewers. He noted that roughly 36,000 people die each year in this country from the winter flu, so it's still a serious matter.
About 300 cases of swine-flu virus have been confirmed in 36 states so far, according to a count by The Associated Press.
"We are by no means out of the woods," Besser said. "In previous pandemics, there have been waves and you don't know what this virus is going to do."
U.S. confirmed cases from CDC or states: New York, 90; Texas, 43; California, 29; Delaware, 20; Arizona, 18; South Carolina, 15; Illinois, nine; Colorado, Louisiana, Massachusetts and New Jersey, seven; Florida, five; Alabama and Maryland, four; Indiana, Ohio, Oregon, Virginia and Wisconsin, three; Connecticut, Kansas and Michigan, two; and one each in Nebraska, Iowa, Kentucky, Minnesota, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Pennsylvania, Rhode Island, Tennessee, Idaho and Utah.
There has been one death in the United States, a toddler who succumbed to the disease after he was brought to this country from Mexico.
Besser said health authorities also are concerned about indications that the flu had so far struck the young more heavily than older people, and that there still may be deaths from it.
He also said he didn't think it was necessarily time to ease off on school closings and other steps that have been taken to contain the spread of the infection.
"We're seeing infections in almost every state," Besser said, "and as that occurs, those who have underlying problems (such as the elderly and people with compromised immune systems) may be affected more. ... It may be that this disease is starting first in children, and then moving to the elderly, so there's still much that we do not know."
Besser said that as a parent and a pediatrician, he thinks it's best for kids to be in school, whenever possible, and that adjustments in school shutdowns might be possible "as we learn and see that this virus is not more serious than ordinary flu."
Asked whether the food supply has been compromised, he said, "It may be that pigs have more to fear from people than people have to fear from pigs."
"With each day some of the uncertainty goes away, we learn more, and we're seeing encouraging signs," Besser said. "The encouraging signs have to do with severity." He summed up the situation by saying he was "precautiously optimistic" about trends now surfacing.
But he hastened to add that people still need to take everyday precautions, like vigorous and frequent hand washing, covering their noses and mouths when they sneeze and staying home when they're sick.
Besser said that what now ensues in the Southern Hemisphere, which is just entering flu season, will be "critically important for us to understand as we think about the decisions around vaccination."
The CDC chief was interviewed on CBS's "The Early Show" and NBC's "Today" show.
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