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Transmission of Swine H1N1 In Scotland Signals Phase 6
Recombinomics Commentary 13:13
May 14, 2009

A 16-YEAR-OLD girl is being classed as the latest "probable" case of swine flu in Greenock.

However, Deputy First Minister Nicola Sturgeon, who is also Scottish Health Secretary, said there was "no obvious connection" between the teenager and any other confirmed or probable cases in the town.

She said if no link emerges between the girl and any other cases, it could be the first evidence of "community transmission" in Scotland.

The news follows the closing of a nursery school and a primary for a week.

As reported in yesterday's Evening Times, Ladybird Nursery shut its doors to pupils less than 24 hours after Ravenscraig Primary became the first school in Scotland to close because of the swine flu outbreak.

A total of 80 youngsters at the nursery are being given the anti-viral drug Tamiflu as a precaution after a three-year-old was diagnosed as a "probable" case.

Ms Sturgeon said the three-year-old, and a five-year-old boy who attends Ravenscraig, are both linked to a 19-year-old man from Greenock who tested positive for swine flu.

The above comments describe a large cluster of confirmed and probable H1N1 swine flu cases in the Greencock region of Scotland (see updated map).  In addition to the large cluster, there is an unlinked case, signaling community transmission in Scotland,  Community transmission of swine H1N1 outside if North America paves the way for a phase 6 declaration.

Swine H1N1 is spread widely throughout North America (see updated map).  In the United States, the incidence of swine flu outpaced the combined cases of H1N1 and H3N2 seasonal flu.  The explosion in cases led to a significant backlog at the CDC, which was confirming swine flu cases.  Recently, the confirmatory kits were distributed to state labs, but the shortage of kits has led to limited testing, which is primarily focused on severe cases.

However, although swine  H1N1 was widespread in Mexico, the United States, and Canada, the WHO maintained the pandemic level at phase 5 because community transmission was not confirmed outside of North America.

This confirmation was largely dependent on testing.  The virus has been sequenced worldwide, and the various isolates are closely related (well over 99% identity).  Thus, the efficient human to human transmission in North America would be present worldwide, but many cases are mild are go unreported or tested.

The confirmed community transmission in Scotland, fulfills the WHO requirement of community transmission in two or more regions to rause the pandemic level from 5 to 6..

Therefore, a phase 6 designation should be announced in the near term.

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