20090519-4

Franck Robichon/European Pressphoto Agency

Train passengers in Tokyo on Monday. Japan was rushing to contain a widening outbreak of swine flu. 

By HIROKO TABUCHI and DONALD G. McNEIL Jr.

The New York Times, May 18, 2009, TOKYO – Japan rushed to contain a widening outbreak of swine flu on Monday, as global health ministers met in Geneva to discuss vaccine preparations and other preventative measures against the new flu strain.

Japanese cases of the H1N1 strain of influenza reached 135 after the government confirmed 74 new infections, including in a 5-year-old boy and a man in his 60s, the Health Ministry said late Monday.

The new cases came as health ministers from around the world met in Geneva for the week-long meeting of the annual World Health Assembly, with pandemic preparedness at the top of the agenda.

Britain, Japan and other nations urged the World Health Organization at the meeting’s opening day to change the way it decides to declare a pandemic – saying the agency must consider how deadly the virus is, not just how fast it is spreading. There has been concern that by raising the global alert level to 5 of a possible 6 on April 29, the United Nations health agency had unduly raised alarm.

The director-general, Margaret Chan, said in her opening address to the assembly Monday that the organization would consider the concerns of member countries. But she warned that the disease’s lethality can vary from country to country, and that while the rapidly spreading virus appeared to be more mild than originally feared – in effect handing the world a “grace period” – no one can say “whether this is just the calm before the storm.”

“An influenza pandemic is an extreme expression of the need for solidarity before a shared threat,” Ms. Chan said. “We are fortunate that the outbreaks are causing mainly mild cases of illness in these early days.”

She added: “I strongly urge the international community to use this grace period wisely. I strongly urge you to look closely at anything and everything we can do, collectively, to protect developing countries from, once again, bearing the brunt of a global contagion.”

The W.H.O. raised its tally of global confirmed cases of the disease Monday to 8,829 in 40 countries. There have been 74 deaths, 68 of them in Mexico, the apparent epicenter of the global outbreak.

In Japan, authorities ordered more than 1,000 schools to close in and around Kobe and Osaka, cities in western Japan where the infections have been centered. None of the cases has been life-threatening, and there have been no deaths, according to the Health Ministry.

The bulk of the infections have been found among high school students in the region who have no record of recent overseas travel, signaling the start of a wider outbreak.

A W.H.O. spokesman, Dick Thompson, said there was still insufficient evidence that the disease was spreading in a sustained way among communities outside of North America, which would be required for the organization to raise its pandemic alert level to 6, the highest level.

All of the confirmed cases in Japan, Mr. Thompson said, derived from infection clusters within schools in Kobe and one in Osaka, and from the family members of people infected in those schools. Sustained community-level transmission, he said, requires cases of the virus to begin to erupt spontaneously, with no apparent link to other sufferers, over a period of time.

“We don’t see sustained community spread at this moment,” Mr. Thompson said, referring to the Japanese cases.

Japan is well known in public health circles for being exceptionally nervous about flu; it has an aging population and a national obsession with cleanliness that makes even Switzerland look messy.

Masks are common on subways because it is considered rude to lack one if you are sneezing. Before the outbreak began last month, Japan used about 60 percent of the world’s stock of the antiviral drug Tamiflu.

In Japan over the weekend, officials in white masks scrambled to set up makeshift tents and telephone hotlines to handle the surge in suspected cases. Osaka city said its public schools would remain closed for seven days, while Kobe imposed similar school shutdowns.

Governor Toshizo Ido of Hyogo prefecture, the region surrounding Kobe, said he would ask the central government to grant financial aid to the affected localities, including support for business owners affected in the outbreak.

In Tokyo, Prime Minister Taro Aso called for calm. “Many infected people received the right treatment at an early stage, and have recovered,” Mr. Aso said at a government task force meeting. “I would like everybody in Japan to act calmly.”

Until Friday, Japanese officials thought they had averted the virus after a string of suspected cases among people entering Japan proved negative. Japan has been sending medical examiners to each flight arriving from North America to take the temperatures of those on board.

On Friday, four Japanese returning from Canada were found with the H1N1 strain, and quarantined together with 50 other passengers. But on Saturday, the authorities confirmed that a 17-year-old student in Kobe with no recent overseas travel was infected.

Since then, new cases have been reported in Kobe and neighboring Osaka. There have been no cases in Tokyo.

Still, the rapid spread of the disease has come as a shock to Japan, which drew up an extensive action plan to contain influenza after bird flu appeared in Asia in 2004. Turkey, India and Chile also reported their first swine flu cases over the weekend.

The patient in Turkey was an American heading to Iraq. India’s case was that of a 23-year-old who arrived in Hyderabad from New York. Chilean officials reported that two of its citizens – two women, 25 and 32 years old – were found to have the flu after returning from a trip to the Dominican Republic.

Late Sunday night, Hong Kong confirmed its third case of swine flu, a 23-year-old man from southern China who had been studying in the United States. He arrived in Hong Kong on Saturday evening on Cathay Pacific Flight 831 from New York.

A spokesman for the Hong Kong health department said the man developed a fever during the flight and was spotted by a thermal scanner at the airport when he left the plane. Authorities put him in an isolation ward at Princess Margaret Hospital and issued a call for other passengers on the flight to report for testing. As of Sunday night, the spokesman said, 22 passengers and a crew member had been quarantined at a camp in rural Hong Kong.

Hong Kong’s first case of flu, on May 1, resulted in the quarantine of hundreds of travelers and hotel guests. The second case occurred last week.

Hiroko Tabuchi reported from Tokyo and Donald G. McNeil Jr. from New York. Mark McDonald contributed reporting from Hong Kong and Sharon Otterman from New York.

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