The Taiwan Centers for Disease Control (Taiwan CDC) indicated that human outbreaks of influenza A (H1N1) in the United States of America, Mexico have been confirmed by various sources, including the World Health Organization (WHO), the US Centers for Disease Control and Prevention (US CDC), the Taipei Economic and Cultural Representative Office in Mexico, and a clinician from Taiwan CDC participating in the Epidemic Intelligence Service (EIS) program at the US CDC.Thus far, the outbreaks have resulted in 62 deaths.

Since March 18, 2009, the number of people presenting influenza-like illness in Mexico has been increasing dramatically outside the typical influenza season.As of April 23, 2009, clusters of human infection with influenza A(H1N1) have been reported in three cities. In Mexico City, the capital of Mexico, almost a thousand of flu-related pneumonia cases with 59 deaths have occurred.In San Luis Potosi, a central state in Mexico, three deaths have occurred. Most cases struck byinfluenza A(H1N1) are young healthy adults, which are different from those struck by seasonal flu who are mostly elderly people and children.In addition, in the Instituto Nacional de Enfermedades Respiratorias(INER), several medical personnel have become infected withinfluenza A(H1N1)while intubating patients and have passed the infection to their family members, which has resulted in one death in a girl.Among the specimens from patients in Mexico sent to Canada's National Microbiology Laboratory for testing, influenza A (H1N1) has been confirmed in 18 isolates.Further, 12 of the 18 confirmed isolates showed the virus had the same genetic structure as that of the virus causing outbreaks in the United States.On the other hand, among the specimens from patients in Mexico sent to the United States for testing, influenza A (H1N1) has been confirmed in 7 isolates.

As of April 24, 2009, the United States has reported 8 laboratory confirmed human cases of influenza A (H1N1): 6 in California and 2 in Texas, and none of the cases had direct contact with pigs.Additionally, clusters of swine flu cases involving a father and a daughter in California and schoolmates in Texas have occurred.The earliest onset occurred on March 28, 2009.Thus far, no deaths have occurred.The influenza A (H1N1) virus isolated in the United States was found to be made up of genetic elements from 4 different viruses: North American swine influenza, North American avian influenza, human influenza, swine influenza virus typically found in Asia and Europe. Moreover, this swine influenza A (H1N1) virus is resistant to amantadine and rimantadine, but is sensitive (susceptible) to tamiflu and relenza.

At the time of writing, six physicians of preventive medicine from Taiwan CDC were participating in a conference held in Atlanta, Georgia, United States who had been forwarding information concerning the current epidemic situation to Taiwan CDC.Furthermore, with the help of the Ministry of Foreign Affairs, Director Kuo of Taiwan CDC had a teleconference with Representative Hsin-tung Chen at the Taipei Cultural and Economic Representative Office in Mexico to stay updated with the swine flu situation in Mexico.

Taiwan CDC urges travelers planning to visit areas affected by the outbreak, including Mexico and the southwestern part of the United States, to regularly check the relevant epidemic information posted on the Taiwan CDC web site, practice hand hygiene and respiratory hygiene/cough etiquette, and avoid contacts with suspected patients. If influenza-like symptoms, including fever, cough, sore throat, body aches, nausea, and diarrhea, develop upon returning to Taiwan, please seek medical attention immediately and inform the doctor of the recent travel history.For more information about swine influenza A (H1N1) such as international outbreaks and prevention measures, please visit the Taiwan CDC web site at http://www.cdc.gov.tw or dial the toll-free communicable disease reporting and consultation hotline, 1922, operated by Taiwan CDC.