Swine Flu Outbreak

An outbreak of swine flu in Mexico that has spread to areas in the U.S., Canada, New Zealand, Israel, Spain, Germany, Costa Rica, Scotland and France, is commanding global attention. The World Health Organization (WHO) has raised the Pandemic Alert level for the illness to Phase 5 (human-to-human spread of the virus in at least two countries in one WHO region), indicating that all countries should immediately activate pandemic preparedness plans. 

The situation is changing minute by minute.

Mexico has reported a suspected 159 deaths from swine flu since March 18, many of them in Mexico City, which appears to be the epicenter of the outbreak. The fatalities were otherwise young, healthy individuals—a trend that has caused worry among public health officials.  

Swine flu is a respiratory disease of pigs caused by type A influenza that sometimes crosses over to humans. The current strain of H1N1 is a subset of influenza A combining bird, pig and human viruses, which has mutated for human-to-human transmission. There is currently no vaccine. 

Symptoms include a fever of more than 100 F/37.8 C, body aches, coughing, sore throat, respiratory congestion and, in some cases, vomiting and diarrhea. Treatment is often with anti-virals such as TamiFlu. 

World Reaction  

Mexico
Mexico has closed schools, museums, libraries and theaters, and cancelled hundreds of public events. Archaeological sites such as Mayan ruins and Aztec pyramids are closed.  In Mexico City, many bars and restaurants have been temporarily shut down or are only offering take-out purchases. Companies are urging employees to work from home, while churches are recommending members watch services on television.

The Mexican government has activated emergency measures to deal with the situation, including enacting powers to isolate individuals suspected of having the virus, inspect travelers' luggage and vehicles, and conduct house inspections without fear of legal repercussions. The government also has assumed the authority to prevent public gatherings, shut down public venues and regulate air, sea and overland travel. 

Locals are hoarding bottled water and canned food. Tourists are being asked to wear surgical masks, which are in some cases being handed out by health officials on the streets—although these have become scarce of late. Soldiers and health workers are patrolling transport hubs to try to prevent people displaying flu symptoms from boarding trains, buses, and planes.

United States
The United States Centers for Disease Control (CDC) has declared a health emergency and has advised against nonessential travel to Mexico.  The U.S. has nearly 100 swine flu cases in 11 states, with one confirmed death. Airports are passing out swine flu information from the CDC. To see common questions answered by the CDC, visit: http://www.cdc.gov/swineflu/swineflu_you.htm

Some airlines, including US Air and Continental have relaxed ticketing rules for passengers to Mexico—check with your carrier for details.  Several cruise lines, including Carnival, Holland America, Royal Caribbean, Norwegian and Princess, are bypassing Mexican ports.

Asia Pacific
The government of India has issued a travel advisory, asking Indians to restrict trips to Mexico, U.S., Canada, New Zealand and France. All travelers flying into India from these regions will be individually checked for flu symptoms. Two doctors each will be stationed at airports in Delhi, Mumbai, Kolkata, Chennai, Bangalore and Goa to check passengers. Health officials have also been asked to locate all travelers who arrived from Mexico in the last 10 days. Doctors will visit their local addresses for health screenings.

China, Indonesia and many other Asian nations have advised against travel to Mexico and additional affected regions, and have instituted thermal imaging and other screening measures at airports. Symptomatic travelers will be quarantined.  Japan is suspending visa-free entry for Mexican nationals.

New Zealand confirmed 14 cases of swine flu, all in Auckland, and Australia is testing 112 people for the illness.  Measures to disinfect planes and quarantine people who show symptoms of the disease are underway.

Europe
All EU Member States have recommended against nonessential travel to Mexico, are disseminating information to travelers and the general public, and raising awareness among health care workers. Russia and many others have implemented enhanced airport screening, quarantines for symptomatic travelers and tightened border controls. 

South America & Latin America
Most South America countries have issued warnings to avoid travel to Mexico and other areas of outbreak, and have set up sensors and screening stations at airports for passengers arriving from affected regions. Argentina and Cuba suspended flights coming in from Mexico. 

Middle East
Israel is the only Middle Eastern country with reported cases of swine flu.  Its government has recommended that people should postpone non-essential trips to Mexico and ordered the state of alert raised from level 3 to 4.  If a pandemic breaks out in the area the military will have the power to shut airports and control infected areas. Jordan is intensifying monitoring at airports and border crossings, and will require a health form to filled out by passengers coming from countries with reported swine flu.  Egypt has circulated information to Health Ministry departments, is screening passengers at airport quarantine offices and has ordered the slaughter of the country’s pig population. Lebanon, Saudi Arabia and UAE have not imposed travel restrictions or passenger screening at airports and border crossing points, focusing instead on educating and raising awareness among medical workers.

Information for Travelers

The situation is worst in Mexico—especially Mexico City—so if possible, avoid traveling there. If a trip to Mexico cannot be postponed, expect disruptions and quickly-changing conditions. Anyone planning to travel to Mexico, or to any of the areas affected by swine flu, should follow safety precautions as recommended by the CDC and WHO:

Monitor the local situation in the news and pay attention to announcements from the local government. 

Follow local public health guidelines, including any movement restrictions and prevention recommendations.

Practice healthy habits to help stop the spread of influenza: 

• Avoid large crowds, and keep at least six feet (1.8m) from other people. Avoid kissing, sharing food or shaking hands with others.
• Wash your hands often with soap and water.  This removes germs from your skin and helps prevent diseases from spreading.
• Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
• Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket.
• If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
• Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand gel.
• Follow all local health recommendations, such as wearing a surgical mask to protect others. Opinions on efficacy vary, but a recent study in Australia showed that wearing a surgical face mask lowered the risk of contracting respiratory illness by 74 percent. Make sure you wear the mask correctly so that it is covering your mouth, nose and chin. Guidelines for using surgical face masks can be viewed at: http://www.ehow.com/how_4495597_wear-surgical-mask.html
  

Seek medical care if you feel sick:

• If you develop a fever plus a cough and sore throat or have trouble breathing, seek medical care right away.  Tell the doctor if you have been to an area affected by swine flu, or have had contact with a sick person or farm animals while traveling. 
• Avoid further travel until you are free of symptoms, unless traveling locally for medical care.

After you return from your trip, pay close attention to your health for 7 days: 

• If you become sick with a fever plus a cough, sore throat or have trouble breathing during this period, see a doctor. When you make the appointment, tell the doctor your symptoms, where you traveled, and if you have had close contact with a sick person or farm animals.
• Do not travel when you are sick, unless it is to get medical care. By limiting contact with others as much as possible, you can help prevent the spread of an infectious illness.

Always remember to carry your Assist America membership card when you travel.

Resources for the information presented include, but are not limited to, the following:

Los Angeles Times, CNN, BBC, CDC, WHO, AP Newswire, Reuters, National Medical Library, Times of India, Xinhua

The content of this document is for informational purposes only and is not intended to replace further investigation, common sense, sound judgment and personal observations. If you are planning travel, or are traveling in or near to the locations identified in this newsletter, you are encouraged to contact Assist America for additional information.