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Posts Tagged ‘World Health Organization’

September 23, 2009

Helen Branswell

THE CANADIAN PRESS

Unpublished Canadian data are raising concerns about whether it’s a good idea to get a seasonal flu shot this season.

Drawn from a series of studies from British Columbia, Quebec and Ontario, the data appear to suggest that people who got a seasonal flu shot last year are about twice as likely to catch swine flu as people who didn’t.

A scientific paper has been submitted to a journal and the lead authors – Dr. Danuta Skowronski of the British Columbia Centre for Disease Control and Dr. Gaston De Serres of Laval University – won’t speak to the media. Journals bar would-be authors from discussing their results publicly before they go through peer review.

While few people appear to have actually seen or read the study, the puzzling findings have been a poorly kept secret and many in the public health community in Canada have heard about them.

Ontario’s chief medical officer of health Dr. Arlene King said she is concerned about the study but cautions that it is too early to jump to conclusions.

“We are obviously concerned about the information that has occurred and we have certainly seen no higher illness or death rates here in Ontario or anywhere else in the country compared to the rest of the world, so it’s very important for that information to be peer reviewed.”

She said the province has been reviewing the preliminary information from the study for the past few weeks and will continue to do so. She emphasized that Ontario is well-prepared for a second wave of H1N1 influenza.

Concern about the unconfirmed findings is playing into calls from Quebec and possibly other jurisdictions to delay or even cancel this year’s seasonal flu shot campaigns across the country.

The findings are causing consternation abroad as well, with officials at public health agencies and even at the World Health Organization worried the alleged link will deter people from getting vaccinated in a fall when many people are being asked to get both seasonal and pandemic flu shots.

The Public Health Agency of Canada knows of the findings and has been seeking help here and internationally to try to figure out if the effect is real or if the studies are flawed.

“An arms-length review of the various methods is currently underway to assess the validity of the studies relative to that observation,” Dr. David Butler-Jones, Canada’s chief public health officer, said by email.

“We are also examining other data that will help to understand what if any association there is. We look forward to the results of the review and other data to inform our recommendations as we go forward.”

The U.S. Centers for Disease Control also knows of the work. It said it has looked for similar evidence in the United States but sees none.

“It is difficult to speak about a study that has yet to be published, however, as this is an important issue involving the subject of seasonal influenza and the fast moving global pandemic of 2009 H1N1 influenza it is important to note the scientists at the Centers for Disease Control and Prevention have not seen this effect in systems we have reviewed in the United States,” spokesperson Joe Quimby said by email.

A number of influenza and infectious diseases experts know of but are unwilling to speak publicly about the paper. But several were quick to note that British and Australian researchers haven’t seen the phenomenon either. The lack of corroboration in other jurisdictions is “a red flag,” said one expert, who does not believe the findings are true.

Another flu expert who was willing to speak on the record said they do not make sense to him either.

“I cannot think of a good reason why this is biologically likely, especially since we have sufficient evidence now that … there is priming in the population by the way the vaccine is working,” said Dr. Arnold Monto, of the University of Michigan.

He was referring to the fact that studies of swine flu vaccine show a single dose induces a strong and likely protective response in teens and adults. That suggests humankind’s long exposure to seasonal H1N1 viruses has “primed” or awakened our immune systems to recognize the new virus and fight it off.

Dr. Donald Low, chief microbiologist at Toronto’s Mount Sinai Hospital, was reserving judgment on the findings. But he said this kind of effect of previous exposure raising the risk of future illness is seen in some diseases, like dengue fever.

“We don’t see that in flu,” Monto countered.

Low said it is important to get to the bottom of the issue, but in the meantime, delaying the use of seasonal flu vaccine makes sense for logistical reasons. Swine flu activity is on the upswing in the U.S. and in parts of British Columbia, and focusing on speeding delivery of that vaccine makes more sense now, he said.

“If we’re going to try to protect people, this is the virus we should be trying to protect them against,” he said.

Low admitted the controversy could undermine the public’s willingness to be vaccinated against influenza.

“This is obviously difficult for public to be able to digest this,” he said. “There’s a crying need here for a prospective randomized controlled study.”

That type of study – which is not the kind on which the findings are based – is considered the gold standard of medical evidence.

Boost your immunity naturally by alkalizing and energizing your body.

By Gordon Pedersen Ph.D.

Influenza viruses are the respiratory viruses of greatest public health importance, particularly Influenza A (1). Every year 36,000 people die from Influenza making it the 6th leading cause of death in America (1). The CDC estimates that it would cost America $71 – 166 billion if we have an Influenza epidemic today. Approximately 1 in every 1,000 swine flu patients dies from the infection. This is close to the same rate we have been seeing the past few years but antigenic drift and antigenic shift may create a new and fatal form of Influenza that humans have no immunity against (2). Antigenic drift is a variation within the HN sub-type. Antigenic shift is a variation between different HN sub-types, changes in the Heamagluttinin (H) and Neuraminiadase (N) makes large portions of the population immunologically naïve on a regular basis (1). The problem with Type A is that it undergoes both antigenic drift and antigenic shift making it more dangerous and unpredictable (1). The World Health Organization declared the H1N1 Swine Flu a pandemic in June of 2009 (3).

The annual average U.S. winter epidemics affect 5% to 20% of the population.
The CDC (1) reports the following pandemic death histories:

Health Care Practitioners Are At the Highest Risk

Doctors, nurses and other health care providers are at the highest risk of becoming infected with Influenza. Because doctors are exposed to the virus most frequently, it is significant to recognize the survivability of the Influenza virus in open environments.

Mammalian Influenza A survives 1 hour in mucous, while Avian Influenza survives 100 days in water, 200 days @ 63 degrees F, 1 day in feces and indefinitely when frozen. Influenza is easily transmitted from human to human as indicated in the following table.

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Doctors have the obligation to protect themselves and their patients from the potentially pandemic Influenza viruses. This protection could come from many different sources including Vaccination, Hygiene, Anti viral drugs, Antibiotic drugs, Nutritional supplements, Air filters, Water purifiers, Masks, Topical gels and Silver Sol.

Past epidemics provide important insights into what might happen in the potential spread of the current Swine Flu (4-13). The most persistent viruses survive and the most diverse seem to go extinct within a few years (14, 15). This is most likely the result of strong host-mediated selection pressure, resulting in continual evolution at key antigenic sites, a process termed ‘antigenic drift’ (15, 16). This antigenic evolution is observed with major changes in antigenicity occurring periodically in patterns of approximately 3 years between episodes (17).

According to reports from the Army Medical records, (from the 1918 Spanish Flu, H1N1 epidemic) 24% of the people died from the virus and 76% died form a secondary bacterial infection that produced pneumonia in the lungs. There is a high probability that the swine flu will have similar death rates, and if this is the case, then preventing and treating the secondary bacterial infection will be as important if not more important. The conclusion is that the influenza virus will need to be treated by multiple or combination therapies crossing viral and bacterial lines.

Recommendations for Influenza prevention and treatment (1)
Hygiene: The CDC recommends washing the hands after any exposure because most influenza is transferred by hand contact. Masks and gloves can help but the mask must fit tightly with no leaks to be effective. A surgical mask helps protect the persons around the wearer, so if you have a fever, cough or sneeze, wear a surgical mask to protect the patients.

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Anti viral drugs:
These drugs have the ability to destroy viruses but cannot be taken for an extended period of time. They produce side effects that mimic the flu making it difficult to diagnose the severity of the disease. If taken for prevention, Tamiflu produces resistance. 18% of the influenza virus is resistant to Tamiflu already (1). It is suspected that the health care professionals who were taking it for four months as a preventive agent were the persons that developed resistance. This indicates that we cannot use the antiviral drugs for long periods of time. In addition, some drugs cannot be used in children under 13 years of age (Tamiflu). Relenza cannot be used in children under one or in adults over 65. The antivirals must be given within 48 hours of the onset of illness or the virus will run its course. Combine this with the fact that 76% of H1N1 subjects in the Spanish flu 1918, died from a bacterial infection that produced pneumonia and you have an incomplete solution to the influenza problem. Because Tamiflu has developed resistance Relenza may be a better choice as long as you monitor the bronchospasms.

Antibiotic Drugs:
Antibiotic drugs provide no solution against the virus but can be very beneficial for pneumonia that develops later. A broad spectrum antibiotic should be used because there are numerous bacteria that can produce pneumonia. According to a Penn State publication, silver sol can be given with the antibiotics and produce up to a tenfold increase in antibiotic activity (18).

Nutritional Supplements:
There are hundreds of supplements that can be of significant benefit for the immune system and even some that claim to have antiviral activity. The best proven choices for nutritional supplements come in the form of immune stimulants and wellness products. These include: immunity Vit C, B complex, folic acid, vit D (prevention) ginseng, Echinacea, garlic, probiotics, expectorants and silver sol.

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Air Filters:
CDC recommends one in every room. HEPA air filters use silver to inactivate viruses and can effectively kill 99% of all bacteria, and viruses in minutes.

Water Purifiers:
Proper hygiene and a water purifier are recommended by the CDC because the influenza virus can survive 100 hours in water. Get one that has a silver filter that can actually destroy the virus. Carbon, filtration, reverse osmosis does not destroy or remove the virus.

Topical Disinfectants:
Topical disinfectants are recommended by the CDC for use between each patient and can kill germs for 4-6 hours. Patients and health care professionals should use these 4 times a day or as needed. Silver so gel demonstrates effectiveness against some of the worst pathogens including: MRSA, VRE, Strep, and the other bacteria that cause pneumonia.

Silver Sol:
Prescription drugs and vaccines treat and help prevent viral infection and disease but are not capable of totally controlling a dangerous new or novel virus (18). Nutritional supplements such as Vitamins, Minerals, Echinacea, Ginseng, Probiotics and many others have the ability to help boost immune function and improve natural defenses which results in some defense against disease causing viruses and the associated secondary infections

Silver Sol provides proven prevention and treatment against viral and bacterial infections, while there is nothing else with such broad spectrum benefits (19). In addition, Silver Sol can be safely taken every day for prevention where it has been shown to provide protection against the very dangerous Bird flu H5N1. The combination of antibiotics with Silver Sol has been shown to enhance antibiotic function by as much as ten fold due to the fact that Silver Sol kills the residual pathogens that the antibiotics cannot (19). Results of the combination of 19 different prescription antibiotics and silver sol demonstrate safe additive and/or synergistic benefits across 7 different pathogenic strains (Staphyloccocus, MRSA, E coli, Pseudomonas arugenosa, Salmonella and Streptococcus). The results of this combination therapy result in significant pathogenic destruction while helping to reduce bacterial resistance (19). This can be attributed to the fact that Silver Sol does not produce resistance, nor does it destroy the benefitcial intestinal probiotic bacteria (18).

LEARN MORE ABOUT SILVER SOL

Discussion:
H1N1 is a serious threat to our health and way of life. The best way to treat it influenza is to prevent it. Prevention produces a problem is that drugs have serious side effects and cannot be used by the entire population and should not be used for long periods of time. The other problem is that approximately three fourths of the people who have died from H1N1 influenza have succumbed to a secondary bacterial infection in the lungs and no antiviral drug will treat this condition.

In order to control an epidemic, all types of treatment should be employed including prescription drugs, vitamins, mineral, herbs, proper hygiene, air filtration, water filtration and the proper use of diet and nutritional supplements, especially the newly patented, FDA approved Silver Sol technology. Silver Sol destroys bacteria, viruses, and mold so it demonstrates broader spectrum of activity than any antibiotic or antiviral drug. It can be taken daily due the fact that it passes through the body unchanged, and can prevent viral infections, treat them and work synergistically with antibiotics to produce as much as a ten fold increase in activity against the bacteria that cause death in influenza. It is evident that the newly patented EPA certified and FDA approved Silver Sol technology provides tremendous treatment options for prevention and combination therapies. Silver Sol gel can help stop viral spread on the most contagious areas like hands, nose, mouth and skin. It is sufficiently documented and proven to be considered to be a first line of defense against Influenza and a significant companion to antiviral and antibacterial drug regimens topically and orally.

References

1. Centers for Disease Control contributing Authors: Burke Squires (UTSW), Marc Gillespie (CSHL), Peter E’dustacio (CSHL), Adolfo Garc�a-Sastre (MSSM).

2. CDC. Update: swine-origin influenza A (H1N1) virus—United States and other countries. MMWR 2009;58:421.
3. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;361.

4. World Health Organization. Situation updates—influenza A (H1N1). Geneva, Switzerland: World Health Organization; 2009.

5. Rowe T, Abernathy RA, Hu-Primmer J, et al. Detection of antibody to avian influenza A (H5N1) virus in human serum by using a combination of serologic assays. J Clin Microbiol 1999;37:937–43.

6. Laver WG, Webster RG. Selection of antigenic mutants of influenza viruses. Isolation and peptide mapping of their hemagglutination proteins. Virology. 1968;34:193–202.

7. Sleigh MJ, Both GW, Underwood PA, Bender VJ. Antigenic drift in the hemagglutinin of the Hong Kong influenza subtype: correlation of amino acid changes with alterations in viral antigenicity. J Virol. 1981;37:845–853.

8. Fitch WM, Leiter JMF, Li X, Palese P. Positive Darwinian evolution in human influenza A viruses. Proc Natl Acad Sci. 1991;88:4270–4272.

9. Bush RM, Fitch WM, Bender CA, Cox NJ. Positive selection on the H3 hemagglutinin gene of human influenza virus A. Mol Biol Evol. 1999;16:1457–1465.

10. Rvachev LA. Computer modeling experiment on large-scale epidemic. Dokl USSR Acad Sci. 1968;2:294–296.

11. Longini IM, Fine PE, Thacker SB. Predicting the global spread of new infectious agents. Am J Epidemiol. 1986;123:383–391.

12. Bonabeau E, Toubiana L, Flahault A. The geographical spread of influenza. Proc Biol Sci. 1998;265:2421–2425.

13. Grais RF, Ellis JH, Glass GE. Assessing the impact of airline travel on the geographic spread of pandemic influenza. Eur J Epidemiol. 2003;19:1065–1072.

14. Viboud C, Bjørnstad ON, Smith DL, Simonsen L, Miller MA, et al. Synchrony, waves, and spatial hierarchies in the spread of influenza. Science. 2006;312:447–451.

15. Buonagurio DA, Nakada S, Parvin JD, Krystal M, Palese P, Fitch WM. Evolution of human influenza A viruses over 50 years: rapid, uniform rate of change in NS gene. Science. 1986;232:980–982.

16. Fitch WM, Leiter JMF, Li X, Palese P. Positive Darwinian evolution in human influenza A viruses. Proc Natl Acad Sci. 1991;88:4270–4272.

17. Fitch WM, Bush RM, Bender CA, Cox NJ. Long term trends in the evolution of H(3) HA1 human influenza type A. Proc Natl Acad Sci. 1997;94:7712–7128.

18. Smith DJ, Lapedes AS, de Jong JC, Bestebroer TM, Rimmelzwaan GF, Osterhaus AD, Fouchier RA. Mapping the antigenic and genetic evolution of influenza virus. Science. 2004;305:371–376.

19. Ferguson NM, Galvani AP, Bush RM. Ecological and immunological determinants of influenza evolution. Nature. 2003;422:428–433.

20. Thompson WW, Shay DC, Weintraub E, Brammer L, Cox N, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–186.

21. Thompson WW, Shay DC, Weintraub E, Brammer L, Bridges CB, et al. Influenza- Associated hospitalizations in the United States. JAMA. 2004;292:1333–1340.

22. Ina Y, Gojobori N. Statistical analysis of nucleotide sequences of the hemagglutinin gene of human influenza A viruses. Proc Natl Acad Sci. 1994;91:8388–8392.

23. Hay AJ, Gregory V, Douglas AR, Lin YP. The evolution of human influenza viruses. Phil Trans R Soc Lond B. 2001;356:1861–1870.

24. Jenkins GM, Rambaut A, Pybus OG, Holmes EC. Rates of molecular evolution in NA viruses: a quantitative phylogenetic analysis. 2002;54:156–165.

25. Centers for Disease Control and Prevention. Update: influenza activity–United States and worldwide, 2006-2007 and composition of the 2007–2008 influenza vaccine. MMWR. 2007;56:789–794.

26. Roy, R. Ultradilute Material Research Innovations, Ag-aquasols with extradrdinary bactericidal properties: role of the system Ag-O-H2O. 2007 vol 11 no 1.

27. Pedersen, G., Effect of Prophylactic Treatment with ASAP – AGX-32 and nd ASAP Solutions on an Avian Influenza A (H5N1) Virus Infecrion in Mice.

28 Nelson Labs . Hepatitis B and Silver Sol.

29. De Souza. A., Mehta, D, Bactericidal activity of Combinations of Silver-Water Dispersion with 19 Antibiotics Against Seven Microbial Strains. Current Science, Vol 91, No 7, October 2006.

30. Leavitt, R, Pedersen G,. Resistance of Silver Sol and Bacteria: A Discussion, ABL, 2009.

31 Viridis BioPharma, Probiotic Bacteria and Silver Sol, 2007.

32. Laver WG, Webster RG. Selection of antigenic mutants of influenza viruses. Isolation and peptide mapping of their hemagglutination proteins. Virology. 1968;34:193–202.

33. Sleigh MJ, Both GW, Underwood PA, Bender VJ. Antigenic drift in the hemagglutinin of the Hong Kong influenza subtype: correlation of amino acid changes with alterations in viral antigenicity. J Virol. 1981;37:845–853.

34. Fitch WM, Leiter JMF, Li X, Palese P. Positive Darwinian evolution in human influenza A viruses. Proc Natl Acad Sci. 1991;88:4270–4272.

35. Bush RM, Fitch WM, Bender CA, Cox NJ. Positive selection on the H3 hemagglutinin gene of human influenza virus A. Mol Biol Evol. 1999;16:1457–1465.

36. Rvachev LA. Computer modeling experiment on large-scale epidemic. Dokl USSR Acad Sci. 1968;2:294–296.

37. Longini IM, Fine PE, Thacker SB. Predicting the global spread of new infectious agents. Am J Epidemiol. 1986;123:383–391.

38. Bonabeau E, Toubiana L, Flahault A. The geographical spread of influenza. Proc Biol Sci. 1998;265:2421–2425.

39. Grais RF, Ellis JH, Glass GE. Assessing the impact of airline travel on the geographic spread of pandemic influenza. Eur J Epidemiol. 2003;19:1065–1072.

40. Viboud C, Bjørnstad ON, Smith DL, Simonsen L, Miller MA, et al. Synchrony, waves, and spatial hierarchies in the spread of influenza. Science. 2006;312:447–451.

41. Buonagurio DA, Nakada S, Parvin JD, Krystal M, Palese P, Fitch WM. Evolution of human influenza A viruses over 50 years: rapid, uniform rate of change in NS gene. Science. 1986;232:980–982.

42. Fitch WM, Leiter JMF, Li X, Palese P. Positive Darwinian evolution in human influenza A viruses. Proc Natl Acad Sci. 1991;88:4270–4272.

43. Fitch WM, Bush RM, Bender CA, Cox NJ. Long term trends in the evolution of H(3) HA1 human influenza type A. Proc Natl Acad Sci. 1997;94:7712–7128.

44. Smith DJ, Lapedes AS, de Jong JC, Bestebroer TM, Rimmelzwaan GF, Osterhaus AD, Fouchier RA. Mapping the antigenic and genetic evolution of influenza virus. Science. 2004;305:371–376.

45. Ferguson NM, Galvani AP, Bush RM. Ecological and immunological determinants of influenza evolution. Nature. 2003;422:428–433.

6. Koelle K, Cobey S, Grenfell B, Pascual M. Epochal evolution shapes the phylodynamics of interpandemic influenza A (H3N2) in humans. Science. 2006;314:1898–903.

47. Rambaut A, Pybus O, Nelson MI, Viboud C, Taubenberger JK, et al. The genomic and epidemiological dynamics of human influenza A virus. Nature April 16; [Epub ahead of print]

48. Lavenu A, Leruez-Ville M, Chaix ML, Boelle PY, Rogez S, Freymuth F, Hay A, Rouzioux C, Carrat F. Detailed analysis of the genetic evolution of influenza virus during the course of an epidemic. Epidemiol Infect. 2005:1–7.

49. Nelson MI, Simonsen L, Viboud C, Miller MA, Taylor J, et al. Stochastic processes are key determinants of the short-term evolution of influenza A virus. PLoS Pathog. 2006;2:e125. doi:10.1371/journal.ppat.0020125.

50. Viboud C, Alonso WJ, Simonsen L. Influenza in tropical regions. PLoS Med. 2006;3:e89. doi:10.1371/journal.pmed.0030089.

51. Nelson MI, Simonsen L, Viboud C, Miller MA, Holmes EC. Phylogenetic analysis reveals the global migration of seasonal influenza A viruses. PLoS Pathog. 2007;3:e131. doi:10.1371/journal.ppat.0030131.

52. Russell CA, Jones TC, Barr IG, Cox NJ, Garten RJ, et al. The global circulation of seasonal influenza A (H3N2) viruses. Science. 2008;320:340–346.

53. Holmes EC, Ghedin E, Miller N, Taylor J, Bao Y, et al. Whole-genome analysis of human influenza A virus reveals multiple persistent lineages and reassortment among recent H3N2 viruses. PLoS Biol. 2005;3:e300. doi:10.1371/journal.pbio.0030300.

54. Nelson MI, Viboud C, Simonsen L, Bennett RT, Griesemer SB, et al. Multiple reassortment events in the evolutionary history of A/H1N1 influenza A virus since 1918. PLoS Pathog. 2008;4:e1000012. doi:10.1371/journal.ppat.1000012.

55. Nelson MI, Holmes EC. The evolution of epidemic influenza. Nat Rev Genet. 2007;8:196–205.

56. Thompson WW, Shay DC, Weintraub E, Brammer L, Cox N, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–186.

57. Thompson WW, Shay DC, Weintraub E, Brammer L, Bridges CB, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004;292:1333–1340.

58. Ina Y, Gojobori N. Statistical analysis of nucleotide sequences of the hemagglutinin gene of human influenza A viruses. Proc Natl Acad Sci. 1994;91:8388–8392.

59. Hay AJ, Gregory V, Douglas AR, Lin YP. The evolution of human influenza viruses. Phil Trans R Soc Lond B. 2001;356:1861–1870.

60. Jenkins GM, Rambaut A, Pybus OG, Holmes EC. Rates of molecular evolution in NA viruses: a quantitative phylogenetic analysis. 2002;54:156–165.

61. Centers for Disease Control and Prevention. Update: influenza activity–United States and worldwide, 2006-2007 and composition of the 2007–2008 influenza vaccine. MMWR. 2007;56:789–794.

62. Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ, et al. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med. 2005;165:265–272.

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Whether you believe the so called swine flu (which has nothing to do with pigs) is man made or not, it is important to boost your immune system and help it fight off any type of infection. Siler Biotics is one of the most powerful tools we know for doing this and protecting yourself and your family.

GENEVA — The World Health Organization raised its alert on swine flu to the highest level on Thursday, in its first designation of a global pandemic in 41 years.

Calling further spread of the virus “inevitable,” the organization’s director general, Margaret Chan, said, “We are at the earliest days of a global pandemic.” The new H1N1 strain, she said, is “spreading easily from one person to another, and from one country to another” in more than one region of the world.

But the pandemic is “moderate” in severity, she noted, with the overwhelming majority of patients experiencing only mild symptoms and a full recovery, often in the absence of any medical treatment. And scientists are painstakingly tracking its every movement.

“The virus is spreading under a close and careful watch,” Dr. Chan said. “No previous pandemic has been detected so early or watched so closely.”

The heightened alert came after an emergency meeting with flu experts here that was convened after a sharp rise in cases in Australia, which reported 1,263 cases on Thursday, and rising numbers in Britain, Japan, Chile and elsewhere. The declaration will trigger drug makers to speed up production of a swine flu vaccine — expected to take a minimum of 4 to 6 months — and prompt governments to devote more money to containing the virus.

As the disease moves into the developing world, where rates of chronic disease are high and health systems typically poor, Dr. Chan said, “it is prudent to anticipate a bleaker picture.”

The virus itself can also change quickly, she said, and even those nations that have already experienced a rash of cases “should prepare for a second wave.”

“The virus writes the rules, and this one, like all influenza viruses, can change the rules without any rhyme or reason,” Dr. Chan said.

Unlike seasonal flus, which have taken their highest toll on the very young and the very old, Dr. Chan said, most severe cases of the new H1N1 virus have involved people between the ages of 30 and 50, while overall, the majority of all infections have occurred in people under 25.

Some 2 percent of infections, Dr. Chan said, have resulted in severe illness, with rapid progression to pneumonia. Based on preliminary data, asthma, cardiovascular disease, autoimmune disorders and obesity are the underlying conditions that most put people at greater risk. Around a third to a half of the severe cases occurred in previously healthy young people, she said.

Pregnant woman are also at heightened risk, a particular concern for the developing world, Dr. Chan said, which already reports 99 percent of maternal childbirth deaths worldwide.

Typically, pandemics take six to nine months to move throughout the world. This one has been detected early, giving health officials what Dr. Chan called a “head start.” And as the disease continues, it will be important to add to the health resources of poorer countries, Dr. Chan said. Vigilance must be maintained, she said, “for the next year or two — and beyond.”

“Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection,” Dr. Chan said. “We are all in this together and we will all get through this together.”

The W.H.O. released a report on Wednesday saying that 74 countries had reported 27,737 cases of the disease and 141 deaths since April. Those cases had been heavily concentrated in the Americas, but the rise in cases in Australia and elsewhere indicate communitywide spread in other world regions. According to W.H.O. rules, the organization should declare a pandemic once it finds evidence of widespread “community transmission” — meaning beyond travelers, schools and immediate contacts — on two continents.

The last pandemic, the Hong Kong flu of 1968, killed about 700,000 people worldwide. Ordinary flu kills 250,000 to 500,000 people each year, international health officials have said.

Meanwhile, around the world, efforts to limit the spread of the flu continue. In Hong Kong, which is especially skittish about the flu after its experience with a lethal SARS outbreak in 2003, authorities ordered all kindergartens, primary schools and day care centers to close after an outbreak of swine flu was reported at a local secondary school. The order, effective Friday, will last at least two weeks and affect about a half million students.

Fifty cases of the H1N1 flu have been reported in Hong Kong, but health officials said the 12 infected students at St. Paul’s Convent School were the first cluster. The students are being quarantined at a hospital while officials try to determine the source of the infections.

Hong Kong health officials said Wednesday that a 55-year-old man was the first person to contract the disease locally. So far, the city has had no fatalities.

Hong Kong’s Health Department says it will order five million doses of flu vaccine and open eight flu clinics. “The government is well prepared,” Donald Tsang, the city’s chief executive, said at a news conference announcing the school closings on Thursday. “There’s no need to panic.”

China confirmed 10 new flu cases, bringing the total number of infections on the mainland to 111. Health officials say all of the country’s flu cases have involved people returning from abroad. According to the Health Ministry, the new cases include a Canadian-Chinese teenager who just returned from Toronto and two children in Shanghai who had been in the United States. There have been no deaths, and more than half of those infected have been discharged from the hospital, the ministry said.

Chinese officials released Mayor C. Ray Nagin of New Orleans from three days of quarantine in Shanghai on Wednesday. Mr. Nagin and his wife had been placed in isolation after a passenger who sat one row ahead of them on a flight from the United States came down with a fever.

Mr. Nagin, who had been set to attend a series of economic development meetings, described the experience as “surreal” and said he and his wife had their temperatures taken every three to four hours. “When you see people coming toward you with full hazmat gear on, it’s pretty interesting,” he told The Associated Press after his release, referring to hazardous material protection.

In New York City, health officials said Thursday that three more people had died from the H1N1 virus, bringing the city’s total to 15, The A.P. reported. One victim was a child under the age of 5, one was a person between 5 to 24 years old, and another was between 30 to 39 years old.

The deaths came one day after health officials announcedthat in a telephone poll of New Yorkers, 6.9 percent of the 1,006 surveyed reported having flulike illness, like fever and cough or a sore throat, between May 1 and May 20, that may or may not have been swine flu.

Extrapolated to the general population, that would mean that about 550,000 people could have become sick with the virus. The 530 citywide who have been hospitalized make up a tiny proportion — about one-tenth of 1 percent — of those who became ill, an indication of how mild the virus generally has been, officials said.

The total number of swine flu cases reported to the nation’s Centers for Disease Control and Prevention and other national, state, and city health authorities worldwide likely do not account for hundreds of thousands of cases which were not tested by doctors because of their mildness, flu experts have said.

“The findings don’t tell us exactly how many New Yorkers have had H1N1 influenza,” Dr. Thomas A. Farley, the city’s new health commissioner, said in a statement. “But they suggest it has been widespread and mild in most people.”