H1N1: North Korea finally confirms pandemic swine flu outbreak

Finally, North Korea announced for the first time that it has several cases of swine flu, confirming overseas reports of an outbreak in the secretive and impoverished communist state.

The health ministry has reported a total of nine cases of (A)H1N1 in the capital Pyongyang and the city of Sinuiju on the Chinese border, the official Korean Central News Agency said.

Authorities put a quarantine system in place and centres have been set up nationwide to check for new cases, it said.

The World Health Organisation is working with Pyongyang to help stem the outbreak and assess the scope of infections, WHO spokeswoman Aphaluck Bhatiasevi told South Korea's Yonhap news agency.

"We are working closely with the government to see what is required and if they need any assistance from WHO," she said.

Yonhap quoted Bhatiasevi as saying there are likely to be more cases of the virus than announced, as people who have mild symptoms are not tested.

The South's unification ministry said it would send a message to the North offering swift deliveries of Tamiflu and other medicine.

"Assistance must be provided swiftly as the disease could quickly spread in North Korea where conditions are not so good," President Lee Myung-Bak said.

Most government-to-government aid was suspended after cross-border relations worsened last year, although private South Korean groups still send shipments northwards.

Observers say the virus could pose a particular threat to the impoverished North because of malnutrition amid persistent food shortages and a lack of drugs.

Good Friends, a Seoul-based aid group with cross-border contacts, reported Monday the disease has been spreading rapidly because Tamiflu is rare there. Although, given the reported ineffectiveness of Tamiflu, it will be interesting to monitor how quickly the virus spreads.

It said seven youths died in Pyongyang in November while two others reportedly died in Pyongsong north of the capital.

Schools last Friday started their winter vacation a month early to guard against the spread of the disease, the group said.

Public health conditions are also dire with medical equipment and medicine in short supply and clean drinking water and sanitised items frequently problematic, it said.

Drugs for Leaders only
The conservative Dong-A Ilbo newspaper quoted unidentified sources as saying that North Korea has secured Tamiflu and other drugs through foreign missions in Europe but only for leader Kim Jong-Il and other top officials.

North Korea refused Tamiflu
In May, the WHO supplied a total of 2.4 million courses of Tamiflu to 72 countries, but Seoul officials said the North's likely share of this would be grossly inadequate.

"Considering the North's population is 24 million, and the infection rate going up to 20 to 30 percent in underdeveloped countries, the North would need the drug by the millions," said Kwon Jun-Wook, a swine flu specialist at the South Korean health ministry.

North Korea has a high death rate from pneumonia, which rises when there is a food shortage.

Kwon told Yonhap the (A)H1N1 virus has an even higher infection rate than pneumonia and would be more dangerous to the North Korean people.

Swine flu: The predictable pandemic

THE swine flu virus has been a serious pandemic threat for years but research into its potential has been neglected compared with other kinds of flu.

New cases are being reported far from the original outbreak in Mexico. The clusters of milder infections in the US suggest the virus is spreading readily among people. The US Centers for Disease Control and Prevention (CDC) says this strain is so different from existing human flu viruses that most people have no immunity to it. Despite the claims, there are no existing vaccines.

All this means the virus could go pandemic. Or it might not: it could be self-limiting. If the virus spreads less readily than is feared, it might not be able to maintain itself in the human population and could fizzle out.

Vaccines such as Tamiflu (Oseltamivir) and Relenza (Zanamivir), are not totally effective against viral strains

The WHO is only now taking measures to produce an effective vaccine against the new H1N1 virus. This will between four to six months to develop, test and produce in sufficient numbers.

Deadly H1N1 Swine Flu outbreak: Pandemic looms

A novel flu virus has struck hundreds of people in Mexico, and at least 18 have died. It has also infected eight people in the US, and appears able to spread readily from human to human. The World Health Organization is calling an emergency meeting to decide whether to declare the possible onset of a flu pandemic.

Ironically, after years of concern about H5N1 bird flu, the new flu causing concern is a pig virus, of a family known as H1N1.

Flu viruses are named after the two main proteins on their surfaces, abbreviated H and N. They are also differentiated by what animal they usually infect. The H in the new virus comes from pigs, but some of its other genes come from bird and human flu viruses, a mixture that the US Centers for Disease Control and Prevention calls "very unusual".

On Wednesday, the CDC announced that routine surveillance had uncovered mild flu cases during late March and April, caused by a novel swine flu virus. Those affected, aged 9 to 54, live in and around San Diego, California, and San Antonio, Texas, near the Mexican border. None was severe. Symptoms were normal for flu, with more nausea and diarrhoea than usual.

Mongrelised mix

On Thursday, Canadian public health officials warned Canadians travelling to Mexico of clusters of severe flu-like illness there. Then on Friday the WHO in Geneva said in a statement there have been around 900 suspected cases of swine flu in Mexico City and two other regions of Mexico, with around 60 suspected deaths. Of those, 18 have been confirmed as H1N1 swine flu, says the WHO, and tests so far have shown that 12 of those are "genetically identical" to the California virus.

On Friday, Richard Besser, head of the CDC, confirmed that Mexican samples tested at CDC were also "similar" to the US virus. "From everything we know to date, this virus appears to be the same," he said.

To be declared a pandemic, Besser said, the virus must be new, cause severe disease, and transmit easily enough to be sustained.

It is new. Anne Schuchat, head of science and public health at the CDC, said that the US virus is an unusually mongrelised mix of genetic sequences from North American pigs, Eurasian pigs, birds and humans. The H protein on its surface, having hitherto circulated only in pigs, is one most human immune systems have never seen, the crucial requirement for a pandemic flu.

Too late to contain

The virus's severity will depend on how many people who catch it die. While suspect deaths in Mexico are being tested for H1N1, is not yet known how many mild cases of virus there may have been in the affected region that have gone untested. Both numbers are needed to calculate how deadly a case might be. One ominous sign, however, is that the Mexican cases are said to be mainly young adults, a hallmark of pandemic flu.