Six people, including two minors, across the country Saturday tested positive for the influenza A (H1N1) virus, taking the total number of affected people in India to 56 though 21 of them have been discharged on recovery.
Among the new cases, three were reported from Delhi, and one each from Hyderabad, Bangalore and Fatehgarh in Punjab, the health ministry said in a statement.
'Three more people have tested positive for the swine flu Saturday, including an indigenous case where the patient contracted the flu without going abroad,' Delhi Health Secretary J.P. Singh told IANS.
Three cases in the national capital include: a 27-year-old male passenger who had travelled from Canada to New Delhi transiting Brussels June 17 and self-reported at the identified health facility, a four-and-half-year-old boy who travelled from Toronto transiting Brussels reaching Delhi June 17, and a 30-year-old man and a family contact of a positive case reported June 17.
The new case in Hyderabad is a 32-year-old man who had travelled from New York, transiting Mumbai. On reaching Hyderabad June 13, he self-reported at the identified health facility with swine flu-like symptoms June 18.
The single case in Fatehgarh Sahib is a 15-year-old boy, part of a group of 20 children and four teachers who had gone to Orlando, the US, on a NASA trip and had reached the Punjab town June 16.
Punjab health authorities were examining all children who had returned from the US study tour. Subsequent to this screening, the boy reported with symptoms of fever, running nose and sore throat June 18. All the contacts of these children have been traced and given chemoprophylaxis.
The single case reported in Bangalore is a 25-year-old man coming from Philaldephia via New York and London. A day after reaching Bangalore June 17, he reported at the health facility with the swine flu symptoms.
Indian health authorities have so far tested samples of 412 people, of whom 56 have been tested positive for the Influenza A(H1N1) virus.
Six of them are indigenous cases who got the infection from the positive cases traveled from abroad.
Among these people, 134 were identified through health screening at international airports, 20 through contact tracing and the rest had self-reported.
Twenty-one of the confirmed cases have been discharged while the rest of them are all stable and remain admitted to the identified health facility.
The World Health Organisation (WHO) has reported 44,287 laboratory confirmed cases of influenza A(H1N1) infection from 94 countries as on June 19. The pandemic has claimed 180 lives.
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Another person tested positive for the swine flu virus today, taking the number of such cases in the country to 16, even as the Government asserted that there was no need to panic as the disease was still containable in India despite WHO's "level six" pandemic alert. The latest case was from Hyderabad where a six-year old girl, who came back from the United States along with her parents on June 10, tested positive for the virus.
With this, the total number of cases in Hyderabad has reached eight. In order to ensure better screening of passengers, the Government has decided to install thermal scanners at airports to detect people who were entering the country with fever.
"The scanners would be installed at the Delhi airport first and later at other airports," Vineet Chaudhary, Joint Secretary in the Health Ministry said. The Government has also asked Indian missions abroad to tell people having symptoms of swine flu to defer travelling to India.
Union Health Minister Ghulam Nabi Azad said the number of persons infected in the country is "too less and too small" compared to its size and population. "I don't think there is any need for panic.
So far our country is concerned.
In view of the size and population of the country, the number of persons infected is too less and too small," he said.
Asia got its first case of swine flu in Hong Kong, an official announced Friday.
The patient is a visitor from Mexico, the worst-hit country in the swine-flu outbreak, who travelled to Hong Kong from Shanghai Thursday and was staying at a hotel in the city's Wan Chai district, Chief Executive of Hong Kong Donald Tsang said.
The patient has been taken to the city's Ruttonjee Hospital and was in stable condition Friday evening, he said at a press briefing Friday night.
The hotel where the patient was staying, the Metropark, has been quarantined with all guests barred from leaving, reporters were told.
Guests staying at the hotel told the government-run radio station RTHK that no one was being allowed to leave or enter the hotel.
Tsang announced the case after a meeting of top government officials was convened Friday afternoon in response to news of the confirmed case.
The Hong Kong leader appealed to the public not to panic and said everything would be done to prevent the virus from spreading in the city of seven million.
Hong Kong has raised its swine-flu alert level from 'serious' to 'emergency' in response to the confirmation of the case. Details of the heightened measures were due to be announced later.
Schools were to remain open and public gatherings and exhibitions were to continue as normal but under more stringent hygiene measures, Tsang said in advance of the details being released.
News of the case came after Tsang warned earlier this week that Hong Kong was at a greater risk of a swine-flu outbreak because it is one of the world's most densely populated cities.
Before Hong Kong's announcement of its case, the World Health Organization said Friday that 331 human cases of swine flu have been reported in 11 countries. Ten cases have been fatal - nine in Mexico and one in the United States.
Ironically, the first case of severe acute respiratory syndrome, or SARS, in Hong Kong in 2003 was traced back to a patient from China staying in another hotel in the city.
A total of 299 people died and about 1,800 were infected with the SARS virus in the city of seven million, and the virus spread from Hong Kong around the world.
WHO Assistant Director General Dr Keiji Fukuda said it signalled a "significant step towards pandemic influenza", but added "we are not there yet".
Mexico earlier said it believed 149 people had now died from the swine flu outbreak - only 20 cases are confirmed.
Other, milder, cases are confirmed in the US, Canada, Spain and Britain.
The WHO's decision to raise the alert level to four came after an emergency meeting of experts, brought forward by a day because of concerns over the outbreak.
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Level four means the virus is showing a sustained ability to pass from human to human, and is able to cause community-level outbreaks.
"What this can really be interpreted as is a significant step towards pandemic influenza. But also, it is a phase that says we are not there yet," Mr Fukuda said.
"In other words, at this time we think we have taken a step in that direction, but a pandemic is not considered inevitable."
He said the virus had become too widespread to make containment a feasible option, and said countries must focus on trying to put measures in place to protect the population.
He also stressed that the experts did not recommend closing borders or restricting travel. "With the virus being widespread... closing borders or restricting travel really has very little effects in stopping the movement of this virus," he said.
The first batches of a swine flu vaccine could be ready between four to six months, but it will take several more months to produce large quantities of it, Mr Fukuda said.
Health experts say the virus comes from the same strain that causes seasonal outbreaks in humans. But they say this newly-detected version contains genetic material from versions of flu which usually affect pigs and birds.
Mexico deaths
Earlier, Mexico's Health Minister Jose Angel Cordova said the suspected death toll from swine flu had now risen from just over 100 to 149. Of that number, 20 have been confirmed as swine flu.
All of those who had died were aged between 20 and 50, he said. Infections among young healthy adults was a characteristic of past pandemics.
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"We're in the decisive moment of the crisis, the number [of deaths] will continue rising," Mr Codova told a news conference.
He said the first suspected case of swine flu occurred in the southern state of Oaxaca.
He said nearly 2,000 people had been hospitalised since the first case of swine flu was reported on 13 April, but half had now been allowed home.
Schools nationwide are to remain closed until 6 May as the country attempts to grapple with the outbreak.
As Mr Cordova spoke, Mexico City - where the outbreak is centred - was rocked by a 5.6-magnitude earthquake. It shook tall buildings and led to evacuations, but there have been no reports of damage or injuries.
| SWINE FLU Swine flu is a respiratory disease thought to spread through coughing and sneezing Symptoms mimic those of normal flu Good hygiene like using a tissue and washing hands thoroughly can help reduce transmission |
In almost all swine flu cases outside Mexico, people have been only mildly ill and have made a full recovery.
In the US, a further 20 cases of swine flu were confirmed in New York. Cases have also been reported in Ohio, Kansas, Texas and California, bringing the total across the country to more than 40.
It is thought that only person in the US had been hospitalised as a result of contracting the virus, and all had recovered.
Dr Richard Besser, acting director of the US Centers of Disease Control and Prevention (CDC), has warned that a new US travel advisory is being prepared suggesting "non-essential travel to Mexico be avoided".
Earlier, US Secretary of State Hillary Clinton and EU Health Commissioner Androulla Vassiliou separately urged caution for those considering travelling to Mexico.
In Canada, six cases have been recorded at opposite ends of the country, in British Columbia and in Nova Scotia.
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Swine flu officially arrived in Europe on Monday, when tests confirmed that a young man in spain and two people in Scotland - all of whom had recently returned from Mexico - had the virus. They were said to be recovering well.
Tests are also being carried out on individuals or groups in New Zealand, Australia, Brazil, Israel and South Korea who fell ill following travel to Mexico.
A number of countries in Asia, Latin America and Europe have begun screening airport passengers for symptoms, while Germany's biggest tour operator has suspended trips to Mexico.
Several countries have banned imports of raw pork and pork products from Mexico and parts of the US, although experts say there is no evidence to link exposure to pork with infection.
More than a week after the swine flu outbreak rattled the world, with cases of infected people popping up from Mexico to South Korea, the new virus strain has shown up in a herd of swine.
The catch, Canadian officials say, is that the animals may have caught the flu from a human.
Canadian officials are quarantining pigs that tested positive for the virus -- scientifically known as 2009 H1N1 -- at an Alberta farm in what could be the first identified case of pigs infected during the recent outbreak.
They said the pigs may have been infected by a Canadian farmer who recently returned from a trip to Mexico, the epicenter of the outbreak that has sickened more than 680 people.
The farmer "may have exposed swine on the farm to an influenza virus," said Dr. Brian Evans of the Canadian Food Inspection Agency.
"We have determined that the virus H1N1, found in these pigs, is the virus which is being tracked in the human population," he added.
Evans and other officials said it is not uncommon for flu viruses to jump from humans to animals, and that it does not pose a risk for consuming pork. The number of pigs infected was not disclosed.
The infected farmer had flu-like symptoms and is recovering, Evans said.
Meanwhile, as the number of confirmed swine flu cases reached 787 worldwide, the World Health Organization said Sunday it had started distributing 2.4 million doses of a common anti-viral drug to 72 nations. So far, 17 countries have confirmed cases of swine flu, the WHO said.
The World Health Organization cautioned that the swine flu outbreak could gain momentum in the months ahead, despite claims by the health secretary of Mexico -- the epicenter of the outbreak -- that the virus "is in its declining phase."
The outbreak is only about 10 days old, and even if the illness is declining, it could return, said Gregory Hartl, the WHO spokesman for epidemic and pandemic diseases, at a briefing Sunday.
"I ... would like to remind people that in 1918 the Spanish flu showed a surge in the spring, and then disappeared in the summer months, only to return in the autumn of 1918 with a vengeance," Hartl said. "And we know that that eventually killed 40 million to 50 million people."
Mexican authorities believe the virus's most active period in Mexico was between April 23 and April 28, and Mexican Health Secretary Jose Cordova described the outbreak as being in decline in his country.
As of Sunday, WHO confirmed 898 cases of swine flu -- known to scientists as influenza A (H1N1) -- reported in 18 countries.
Mexico has 506 confirmed cases, including 19 deaths, WHO reported.
Bahrain's state-owned carrier Gulf Air said it has walked away from a deal to lease four Boeing 777 aircraft from Jet Airways, citing economic conditions.
Loss-making Gulf Air said on Thursday it had an option to lease the aircraft after an existing six-month contract expires, but has decided not to go ahead.
"After careful analysis of various commercial and other business considerations, Gulf Air has decided not to pursue the dry-lease option for the foreseeable future," the company said.
Dry leases are contracts where airlines lease planes without staff.
Gulf Air said in February it had agreed to lease four Boeing 777s as part of its efforts to replace its fleet.
The existing six-month contract is a wet lease agreement, which typically includes staff. A Gulf Air spokeswoman said the airline had received the fourth plane under that deal on Thursday.
In March, Gulf Air director of corporate development Siah Joo Tan said the airline was poised to break even next year despite the financial downturn.
The International Air Transport Association (IATA) said on Thursday airlines were prepared to deal with the swine flu outbreak and noted the World Health Organisation was not calling for restriction of regular travel.
The industry body warned earlier this week that swine flu will compound financial problems for airlines, already hard hit by the global economic crisis, which pushed passenger numbers down 11.1 percent in March compared with a year ago.
It said passengers should be reassured that the environment in plane cabins was safe due to air filtration systems similar to those in hospitals, regular disinfecting and crew trained in handling those who might become ill on board.
It noted the WHO had advised there should be no restriction of regular travel or closure of borders, although people who are ill should delay international travel.
"WHO is the global expert," said IATA Director General Giovanni Bisignani in a statement.
"We hope that governments take decisions and coordinate their actions in line with WHO recommendations," he said, adding that the move by some governments to adjust immigration procedures could create confusion for travellers.
IATA, which represents 230 airlines including British Airways, Cathay Pacific, United Airlines and Emirates, has said airlines would lose $4.7 billion this year as a result of the economic downturn that has kept people and cargo from flying.
Pharmaceutical firms in China and India say they can quickly ramp up production of antiviral drugs if swine flu threatens the world's two most populous nations or if other countries need it.
The virus could spread quickly in densely populated cities in China or India where healthcare systems are often inadequate and antibiotic resistance is common, health officials say.
But so far there have so far been no confirmed or even suspected cases of the virus in either China or India, where more than one out of every three humans live.
Since avian flu caught the world off guard in 2003, Swiss drugmaker Roche Holding AG has authorised drug companies in developing countries to manufacture an inexpensive generic form of its Tamiflu drug, called oseltamivir or Fluvir.
Hyderabad-based Hetero Drugs, the only supplier in India licenced by Roche, could ramp up production to reach monthly capacity of about 80 million doses of Fluvir within weeks, Managing Director Srinivas Reddy said.
"We have told them we are keeping 1 million doses ready for them, which we can supply in 4 to 5 days," said Reddy, referring to the Indian government.
India's government has already stockpiled one million doses, which could treat more than 142,000 people.
Hetero supplied 200 million doses of the drug in the last three years to India and other countries, Reddy said, adding nations in Latin America, Middle East and Southeast Asia had inquired recently about it.
While there is no vaccine for the swine flu that has killed up to 159 people in Mexico, the generic drugs have been shown to be effective in treatment.
In China, only two companies are licenced to produce generics and they must supply directly to the government at regulated prices and not through regular commercial channels.
"I believe we have sufficient capacity to meet the government's needs in the case of any emergency," Tu Langou, director of global business at HEC Pharm Co, told Reuters.
GlaxoSmithKline's Relenza has also been shown to be effective against swine flu, but it is more complicated to make and ingest.
India does not currently stockpile Relenza doses.
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Vineet Choudhary, a senior official at India's health ministry, said the government had "millions" of face masks available for distribution, a key weapon against a virus that is spread by droplets.
The government will also shortly step up surveillance at India's international airports and ports, said Choudhary.
China has shown that it can react quickly in national emergencies, mobilising local and national governments, along with the military to deal with last year's devastating earthquake and freak winter storms.
HEC has not yet been asked, however, to begin production of oseltamivir, perhaps because Beijing has anyway been stockpiling the drug over the past two years, said Tu.
"HEC has supplied a great quantity over the past two years to government warehouses," he said. Tu did not reveal any details on capacity or doses shipped to the government.
The World Health Organisation recommended that governments stockpile antiviral drugs after the Avian Flu in 2003.
Roche came under criticism for guarding the rights to Tamiflu too closely after the Avian flu erupted, but eventually licenced rivals in developing nations to help meet soaring global demand and slow its spread.
HEC, Shanghai Pharmaceutical group and the Indian companies were providing the drug at reduced prices to ensure it gets into the hands that need it most.
"We do not make money from this programme," said HEC's Tu.
Amar Lulla, joint managing director of Indian drug maker Cipla Ltd said the company had the capability to supply 1.5 million doses of oseltamivir in four to six weeks.
Cipla's cheaper version of Tamiflu costs about $1 a capsule for export markets, slightly more than Hetero's 10 doses for about $6.0.
"We have received some enquiries from Mexico, Israel, New Zealand and Latin America, but nothing has been finalised in terms of exports," Lulla said.
Cipla has not received any request from the World Health Organisation to supply the drug, but the Indian government had asked whether it could supply the drug and had been told it could.
Ramesh Adige, president of Ranbaxy Laboratories, the third supplier in India, said his company was also prepared to begin supplying a generic version of the drug if needed.
Ranbaxy Pharmaceuticals Inc, a Florida-based subsidiary of Ranbaxy Laboratories, on Saturday said it is conducting a voluntary recall of the whole lot of nitrofurantoin (monohydrate/m-acrocrystals) capsules, USP 100 mg, currently on the market in the US. The drug is an antibiotic used to cure urinary track infection.
"Although certain lots of the product were determined to not be in conformity with the approved laboratory specifications, Ranbaxy decided to recall all the lots, as a matter of abundant caution, given its commitment to the health and safety of patients. Ranbaxy is continuing to look into the cause of such non-conformity," the company said in a media release.
The size of the US sales of the drug being recalled could not be immediately ascertained and a company spokesperson refused to comment. But sources in the company said although the drug was launched in 2005 in the US, it does not have significant sales there.
Ranbaxy had already seen a 14% drop in US sales in the first quarter (Jan-Mar 2009) to Rs 340 crore. Moreover, the pullback comes just months after the company faced USFDA ire on several drugs being manufactured at two of its facilities in India. Following a survey that started in 2006, the USFDA, in 2008 banned 30 drugs manufactured by Ranbaxy at its he Paonta Sahib and Dewas plants for sales in the United States. The USFDA has also put a freeze on sanction of pending and new marketing applications for drugs from these plants.
The withdrawn drug is learnt to have been manufactured from the Paonta Sahib plant.
The recall is being conducted in coordination with the FDA and will be at the retail level. "To the best of Ranbaxy's knowledge, the recalled product is unlikely to produce any serious adverse health effects. However, there is a remote possibility that the non-conforming product may increase the incidence of local non-serious gastrointestinal adverse events such as nausea and vomiting," it said. All patients at present consuming and/or prescribed this formulation should consult their physicians for alternate and appropriate medication/treatment options, it added
Ranbaxy, in which Japanese drugmaker Daiichi Sankyo last year bought a controlling 64% stake, had said last week it expected net losses of about Rs 750 crore and a 9% drip in revenue to Rs 7,000 crore.
Ranbaxy Pharmaceuticals Inc is engaged in the sale and distribution of generic and branded prescription products in the US healthcare system. Ranbaxy Labs has ground operations in 49 countries and manufacturing operations in 11 countries. USP is an official public standards-setting authority for all prescription and over-the-counter medicines and other health care products manufactured or sold in the US.
The World Health Organization (WHO) said Saturday that the risk of a pandemic caused by the A/H1N1 virus was still very high and there was still the possibility to raise the alert level to Phase 6 from the current Phase 5.
'At the present time, I would still propose that a pandemic is imminent because we are seeing the disease spread,' Michael Ryan, the agency's director for global alert and response, told a news briefing in Geneva.
'This is the time for us to prepare, and be ready,' he said.
The WHO's current pandemic alert level remains at Phase 5, which is characterized by human-to-human spread of the virus in two or more countries in only one WHO region.
Currently the sustained spread of the virus is still confined to the region of North America, notably Mexico and the US.
Although human cases have also been confirmed in Europe and Asia, there is still no evidence suggesting that sustained community outbreaks have occurred in the two regions, according to the WHO official.
Ryan warned that the possibility to raise to pandemic alert Phase 6, which means sustained community outbreaks in North America, cannot be ruled out.
'At this point, we have to expect that Phase 6 will be reached, and we have to hope that it is not reached,' he said.
Mexico, the epicntre of the outbreak, has officially reported 397 confirmed human cases of infection, including 16 deaths. The US government has reported 160 laboratory confirmed human cases, including one death.