As noted previously, for the clearest, best-informed information on the Mexico influenza outbreak, we don’t listen to or read the mainstream media, we get it from a worldwide network of doctors and researchers. Here’s the latest from ProMed:

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[1] Some questions
Date: Tue 28 Apr 2009
From: Roger Morris

Some questions
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For those of us who are involved in international work on influenza epidemiology and control and responding to the many media enquiries, there is a very large information gap in relation to diagnosis and epidemiology of the Mexican influenza. What is known of the genetic structure of this virus? It has been called a swine flu, but no evidence has been put forward to allow this statement to be evaluated. I have received information that it is a reassortant, which has genetic components from 4 different sources, but nothing official has been released on this. Where does it fit phylogenetically? Is there any genetic variation of significance among the isolates investigated? Would this help to explain the difference in severity of disease between Mexico and other countries?

It is also stated that it should be diagnosed by RT-PCR, without clarifying which PCR. I have received information that the standard PCR for H1 does not reliably detect this virus. Is this true? What is an appropriate series of diagnostic steps for samples from suspect cases? Could we have an authoritative statement on these issues from one of the laboratories, which has been working with the virus?
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Professor Roger Morris
Emeritus Professor of Animal Health
Massey University EpiCentre, PN623
New Zealand

[The genome sequences of several US isolates are now available at GenBank: see . - Moderator CP]

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[2] New Zealand
Date: Tue 28 Apr 2009
Source: Ministry of Health, New Zealand, Media Release [edited]

Results of H1N1 (swine flu) testing
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Director of Public Health, Dr Mark Jacobs announced tonight [28 Apr 2009] that results from some of the Rangitoto College party who tested positive to influenza A on Sunday [25 Apr 2009], have also tested positive for swine flu H1N1.

Results from 3 of the samples were received earlier this evening [28 Apr 2009] from the World Health Organization regional laboratory in Melbourne and all tested positive for the same strain of swine flu. Testing continues on a 4th sample.

On the basis of these results, we are assuming that all of the people in the group who had tested positive for influenza A have swine flu. As a result we are continuing with the current treatment, which has been based on this assumption.

We were advised that the lab in Melbourne selected 4 of the best samples of the very delicate genetic material to analyse. They found 3 positive results and one is still to be confirmed.

Staff from Auckland Regional Public Health are getting in touch with those affected and informing them of the results. This is expected to be completed by 10:00 pm tonight [28 Apr 2009]. All 10 are understood to be recovering at home.

There is no need to change the treatment and follow-up of the Rangitoto College group. The Tamiflu treatment will continue and they will remain in home isolation and should complete 72 hours of Tamiflu before they can return to normal activities.

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Communicated by
Dr Patricia Priest
Senior Lecturer, Epidemiology
University of Otago
New Zealand

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[3] Israel
Date: Tue 28 Apr 2009
Source: Haaretz News Service [edited]

Israel confirms 1st case of swine flu, raises alert level to 4
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Israel confirmed its 1st case of swine flu on Tuesday [28 Apr 2009], Israel Radio reported, as the Health Ministry raised its level of alert to 4 out of 6. A 26-year-old man who recently returned from Mexico was diagnosed with the virus, after 2 days of quarantine in a Netanya hospital pending results of his health tests. After the
diagnosis, he was listed in good condition at the hospital.

World health officials, racing to extinguish a new flu strain that is jumping borders, raised a global alert to an unprecedented level as the outbreak claimed more lives in Mexico. The US prepared for the worst even as president Barack Obama tried to reassure Americans. With the swine flu having already spread to at least 4 other
countries, authorities around the globe are like firefighters battling a blaze without knowing how far it extends. At this time, containment is not a feasible option, said Keiji Fukuda, assistant director-general of the World Health Organization, which raised its alert level on Monday [27 Apr 2009].

Another Israeli man has also been quarantined until further notice in hospitals in a Kfar Sava, after he too returned from Mexico with fu-like symptoms. The Health Ministry said Monday [27 Apr 2009] that it had embraced the recommendation of the European Commission to postpone nonessential travel to Mexico and recommends that travelers be alert to reports regarding other countries. Health Ministry officials said Monday they were not issuing any special instructions to the public for now, including individuals returning from Mexico. The ministry did recommend that such travelers seek medical assistance if they develop flu-like symptoms within 7 days after their return. These individuals would be quarantined at local hospitals until their condition is determined.

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[4] Comment on seasonality
Date: Mon 27 Apr 2009
From: EA Gould

Swine influenza and the UK
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I haven’t been able to read every single ProMED-mail report covering the new “swine” influenza outbreak but it is possible that the reports have missed an important point concerning the UK and the rest of Northern Europe.

I apologise if you or someone have already pointed it out, but for the time being at least, we should have a breathing space in the sense that influenza virus epidemics don’t normally occur in Northern Europe during the late spring and summer period.

So it would have to be totally outside precedent if this virus caused significant infections at this time of the year in the UK.

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Professor EA Gould
CEH Oxford
United Kingdom

[Analysis of previous pandemics show that transmission in the Northern hemisphere stops in the beginning of May. The best analysis I have found is this paper: Viboud et al. JID 2005;192:233-48.

Even if the present A/H1N1 has pandemic potential it is therefore highly likely that the outbreak will fade out within the next 2 to 3 weeks, but it will reappear in the autumn.

As pointed out in an earlier posting, the second wave can be more pathogenic than the first wave, and inclusion of the present virus in the vaccine for the autumn therefore should have the highest priority (I am sure it does). - Mod.EP]