Similar cases reported in the California counties of San Diego and Imperial, as well as in San Antonio, Texas

Mexico is dealing with what experts believe to be a new strain of influenza which has a combination of genes not previously identified with either human or swine flu. However, this emerging strain-described as A/H1N1 in news reports-seems to be most similar to a flu virus circulating in pigs since 1999. A troubling number of deaths connected to this virus have caught the attention of Mexican health authorities, along with the World Health Organization (WHO), health officials in Canada, and, as of this afternoon, the Centers for Disease Control and Infection (CDC).

Dark Daily is the first laboratory news resource to alert medical laboratories, pathology laboratories and experts in laboratory medicine to this situation, which has only caught the attention of news outlets in recent hours. In particular, clinical laboratories in states bordering Mexico, including Texas, New Mexico, Arizona, and California, will want to be particularly vigilant.

Medical laboratories should respond to these developments in three ways:

One, notify laboratory staff and clinicians within the organization that a new strain of influenza has been identified. Thus, caregivers can be prepared to look for and recognize any cases of this new strain of influenza virus.

Two, every clinical laboratory should review existing procedures for specimen collection, specimen transport, specimen processing, and specimen analysis with the goal of minimizing the risk of exposure and infection by this new disease agent.

Three, clinical laboratory managers and pathologists will want to access clinical literature and public health sources, including WHO, and the Centers for Disease Control and Infection (CDC), to stay current on this situation.

Dark Daily emphasizes that, outside of Mexico, this story is only now becoming public knowledge. Thus, medical laboratories should also expect to see worried patients show up at physicians’ offices and hospitals. This early warning, even late on a Friday afternoon, can help laboratory directors and pathologists prepare to give useful counsel to clinicians who call the laboratory for guidance.

Here are useful facts, gleaned from exclusive sources of Dark Daily, as well as some published news reports:

  • The outbreak in Mexico appears to have first been identified at Hospital Civil Aurelio Valdivieso in Reforma, Oaxaca State, Mexico early in April. The Oaxaca health agency did confirm the deaths of two adults due to “atypical pneumonia”. Sixteen hospital workers are ill from respiratory infections at the hospital.
  • In Mexico City, 17 fatal cases of pneumonia-related deaths were reported between April 17-22, 2009. This was termed an “unprecedented” situation because the normal influenza season has ended. One union official claims that at least 500 healthcare employees in Mexico City are ill with the flu. He also stated that medical facilities in the facility are “overwhelmed” by influenza cases at this time.
  • On April 22, Canada instituted a national alert. The Public Health Agency of Canada (PHAC) put quarantine services on alert for travelers returning from Mexico with influenza‐like illness (ILI). Public media announcements commenced on that date.
  • Earlier today, the New York Times reported that Mexican health officials in Mexico City closed all schools and universities in the city today, April 24. The Times quoted Health Minister Jose Angel Cordova, who said “We’re dealing with a new flu virus that constitutes a respiratory epidemic that so far is controllable.”
  • The New York Times further reported that, for infections identified in the United States, “Five of the people infected were in Imperial and San Diego Counties in California and two were in San Antonio. They were 9 to 54 years old. None had any contact with pigs, and in two sets of cases-involving a father and daughter and two 16-year-old schoolmates-those infected had contact with each other. That convinced the authorities that the virus was being transmitted from person to person. The seven people were apparently infected from late March to mid-April. Only one was hospitalized, and all recovered.”
  • Of note for clinical labs in the United States, WHO states that “of the Mexican cases, 18 have been laboratory confirmed in Canada as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California.
  • Veratect, Inc. of Kirkland, Washington, a company which tracks disease outbreaks globally, was first to detect this unknown strain of influenza virus from a case in Vera Cruz, Mexico. It reported this finding on April 6 to several government health agencies, including the CDC.
  • Veratect has told its clients that “On 22 April, Veratect reported that the National Ministry of Health [in Mexico] recorded a total of 20 fatal cases of influenza throughout Mexico in the past three weeks in the Distrito Federal (13), San Luis Potosí (4), Baja California (2), and Oaxaca (1).”

At the World Health Organization spokesman Thomas Abraham told a USAToday reporter that “We have what appears to be a novel virus and it has spread from human to human.” Abraham also noted that, if it is confirmed that this virus has spread internationally, it would meet WHO’s criteria for raising the pandemic alert level.

Clinical laboratory managers and pathologists will get additional updates from Dark Daily on this rapidly-developing story, as well as complete coverage in the April 27 issue of The Dark Report . Having dodged the proverbial bullet on SARS in 2003, healthcare systems in developed countries seem to be gearing up rapidly to identify and resolve this potential new threat to public health. Pathology laboratories will be among front line providers as they provide lab test results from specimens collected from patients showing up in physicians’ offices and hospitals with symptoms consistent with this new influenza virus.

It is recommended that you forward this e-briefing to colleagues and other medical professionals who should be alerted to this important and fast-breaking story.

Related Information:

Follow new developments via Veratect’s Twitter postings:

Mexico Shuts Some Schools Amid Deadly Flu Outbreak

WHO worries Mexico flu deaths could mark pandemic

Swine flu outbreak kills scores in Mexico amid fears it has spread to US

Influenza-Like Illness in the United States and Mexico

Human Swine Influenza Investigation