Historical perspective — Illness with influenza in pigs was first recognized during the influenza pandemic of 1918 to 1919, and a swine influenza virus was first isolated from a human in 1974 [2,5]. Between 1958 and 2005, 37 cases of swine influenza among civilians were reported . Six cases (17 percent) resulted in death. Forty-four percent of infected individuals had known exposure to pigs. Cases were reported in the United States, former Czechoslovakia, the Netherlands, Russia, Switzerland, and Hong Kong.
In 1976, swine influenza virus caused a respiratory illness with one fatality among 13 soldiers in Fort Dix, New Jersey . No exposure to pigs was found. A subsequent epidemiologic study showed that up to 230 soldiers had been infected with the virus [2,7].
2009 outbreak — In the spring of 2009, an outbreak of respiratory illnesses was first noted in three clusters in Mexico, which were eventually identified as being related to swine H1N1 influenza A [8,9]. The majority of cases to date have been in Mexico City, but over 2500 suspected cases and more than 150 deaths have been reported throughout the country [4,8,9]. As of April 30, 2009, over 25 laboratory-confirmed cases of swine H1N1 influenza A infection have been reported in Mexico, including 20 deaths [10,11].
As of April 30, 2009, over 100 confirmed cases of swine H1N1 influenza A infection have been reported from several states in the United States (New York, California, Texas, Kansas, Ohio, Massachusetts, Michigan, Indiana, Nevada, Arizona) . The majority of cases in the US have been mild, although some patients have required hospitalization and at least one patient has died . Cases have also been reported in Canada, Spain, New Zealand, Israel, Germany, Austria, Switzerland, the United Kingdom and other countries [4,10].
On April 29, 2009, the World Health Organization raised its pandemic alert level to phase 5, indicating that there is sustained person-to-person spread in at least two countries . This designation implies that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
Updated information on the number of confirmed cases can be found at the websites of the United States Centers for Disease Control and Prevention (http://www.cdc.gov/swineflu) and the World Health Organization (http://www.who.int/csr/disease/swineflu/en/index.html).
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