Times of India
30 April 2009
Kounteya Sinha
New Delhi, India

Who waits For Confirmation Of Virus In At Least 2 Nations
The World Health Organisation is moving closer to declaring a pandemic alert phase five for swine flu, just one step short of announcing a fullblown pandemic.

Confirming that the swine flu outbreak was clearly showing human–to–human transmision with no indication of it slowing down, Who assistant directorgeneral Keiji Fukuda said in a global teleconference (that TOI was part of), “It is clear that the virus is spreading. We are therefore moving closer to phase five but we are not there yet.”

According to Fukuda, the Who will declare phase five if it gets confirmed that infected people in at least two countries were spreading the disease to other people in a sustained manner. On Tuesday, Who had declared pandemic alert phase four for H1N1 outbreak. Phase five is characterised by humanto–human spread of the virus into at least two countries in one Who region.

While most countries will not be affected at this stage, the declaration of phase five is a strong signal that a pandemic is imminent and that the time to finalise the organisation, communication and implementation of the planned mitigation measures is short.

Referring to sporadic cases like that in Spain where people were found infected with H1N1 infection without having travelled to Mexico, Fukuda said, “We are trying to establish how this is happening. It is however premature to think the present outbreak as a mild one or a severe pandemic. We can’t predict the future. The last pandemic in 1918 also started off mild. In the present scenario, countries have time to prepare for control and containment measures.”

According to scientific information available with Who, the infections being caused by H1N1 has similar symptoms with a seasonal flu. However, cases infected with H1N1 seems to be suffering from diarrhoea more often than normal seasonal influenza infection. This infection can go from mild (not even needing hospitalisation) to fatal illness, scientists said.

Talking about the nature of the virus, Fukuda said, “The virus we are dealing with right now is a new influenza virus that is behaving like a human virus. Clearly, we do not however believe that the infections are occurring in people who are in close association with pigs. The virus originated from pigs but is not transmitted by pigs. This is the basic difference H1N1 has with H5N1 bird flu virus in which those getting infected handled infected birds.”

According to an editorial in the Lancet journal, the next global influenza pandemic would kill 62 million people with 96% of these deaths occurring in low income and middle–income settings. Meanwhile, India on Wednesday sprung into action, putting into place control and containment measures against swine flu.