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Global health officials mull how to slow swine flu

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[July 22, 2009]  GENEVA (AP) -- Some Muslim countries are advising pregnant women not to attend the hajj pilgrimage. China is quarantining any visitor suspected of having a fever, while priests in New Zealand have been banned from placing Communion wafers on worshippers' tongues.

It's all part of a global effort to slow the spread of swine flu until a vaccine is ready, although experts are divided on whether the measures will work.

Students across Europe may have their summer vacations extended after the World Health Organization said Tuesday that closing schools was one option countries could consider.

Deaths from the H1N1 virus have doubled in the past three weeks, to over 700 from about 330 at the start of July, the agency said.

"We expect to see more cases and deaths in the future," WHO spokeswoman Aphaluck Bhatiasevi told The Associated Press in Geneva.


The agency gave no breakdown, but as of last week, the United States had reported 263 deaths, Canada had 45 and Britain had 29. According to WHO's last update on July 6, there were 119 deaths in Mexico.

Yet even the latest figures may seriously underestimate the true toll because not all swine flu cases are being picked up due to testing limitations.

The race is now on to develop a vaccine that is effective against the pandemic strain before the flu season begins this fall in the Northern Hemisphere. Estimates for when a vaccine will be available range from September to December.

In the meantime, the U.N. health agency is working with its national counterparts around the world to examine what countries can do.

"School closures is one of the mitigation measures that could be considered by countries," Bhatiasevi told reporters.

Experts have argued that school closures may be among the most effective measures, but warn there may be a considerable economic downside, too.

Religious leaders have been drawn into the debate after authorities in Jordan and health officials at a conference in Saudi Arabia recommended that people thought to be most at risk, including pregnant women and those with chronic diseases, skip the hajj pilgrimage this year.

Arab health ministers are holding an emergency meeting Wednesday in Cairo to come up with a unified plan to confront the pandemic.

In New Zealand, the Roman Catholic Church imposed a ban on priests placing Communion wafers on the tongues of worshippers and on the sharing of Communion wine. It also asked parishioners to avoid bodily contact at services, including shaking hands.

In Chile, where 40 people have died from swine flu, authorities canceled a popular religious festival that normally draws tens of thousands of worshippers to the northern town of La Tirana, prompting protests from the faithful.

"The key question is whether citizens will accept the measures governments impose," said Christian Drosten, head of the Institute for Virology at the University of Bonn in Germany.

"You need to get the population on board, otherwise your efforts won't work," he said. "Once people take the disease seriously, you'll begin to see the kind of social distancing that limits infection."

"But it's all a question of culture," Drosten added. "What works in Europe may not work in other countries, and vice versa."

In Switzerland, supermarket chains are considering requiring customers to disinfect their hands and put on a face mask as they enter the store.

"We can put these measures in place as quickly we get food into the stores," said Urs Peter Naef, a spokesman for the Migros chain, Switzerland's biggest.

China's practice of forcibly quarantining visitors has caused bewilderment elsewhere, particularly when hundreds of American, British and other foreign students have been sealed off in hotels for days on just the suspicion of infection.

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Chinese officials in masks or hazmat suits board planes, pointing temperature guns at passengers' foreheads. If a passenger is diagnosed with swine flu, anyone seated within three rows is often tracked down. Those quarantined get to leave if they are healthy seven days from the date they landed.

In Britain, health officials' advice that women put off planning to have children due to the global outbreak was met with ridicule since the swine flu pandemic may last years.

One measure comes up again and again -- school closures -- but it has its own risks.

A paper published Tuesday in the medical journal The Lancet argues that closing schools can help break the chain of transmission, slowing the pace of the disease and lessening the burden on health care systems.

But the paper, written by researchers at London's Imperial College, also noted the considerable economic costs as parents are forced to stay home to look after their children.


France's Education Ministry has already prepared nearly 300 hours of educational programming for radio and television to allow those affected by school closures to follow their lessons, the Le Parisien daily reported.

The experience of school closures in the United States during the early days of the epidemic may prove to be a guide for how best to handle outbreaks in an educational setting.

Initially, authorities recommended schools close for two weeks if there was a suspected case, but when the virus turned out to be milder than feared they switched to advising parents to keep only sick students home. Schools could still close if there were a large number of student and staff out sick -- the same guidance for schools contending with an outbreak of seasonal flu.

"We have some general philosophies and principles that the best place for healthy kids is in school, where they can learn ... and where many of them get breakfast and lunch and can be nourished as well," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said last week.

Apart from school closures, a team of WHO experts is also examining other measures including postponing mass gatherings, such as sports events and concerts, Bhatiasevi said. That could prove very unpopular since football and Major League Baseball as well as world soccer teams all have heavy fall schedules.

Ultimately, the responsibility to decide what to do to keep the pandemic under control rests with individual governments, Bhatiasevi said.

"Different countries could be facing a pandemic at different levels at different times. It is really up to countries to consider what mitigation efforts suit them."

[Associated Press; By FRANK JORDANS]

Associated Press writers Bradley S. Klapper in Geneva, Jenny Barchfield in Paris, Rebecca Santana in Cairo, Jamal Halaby in Amman, Jordan, Eduardo Gallardo in Santiago, Chile, and AP medical writers Maria Cheng and Stephanie Nano contributed to this report.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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