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Originally published April 29, 2009 at 12:00 AM | Page modified April 30, 2009 at 11:18 AM

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Did swine-flu outbreak begin with 5-year-old?

Edgar was one of hundreds of people in La Gloria who came down with flulike symptoms. Local residents accuse public-health officials of dismissing the outbreak at the time. Federal officials said they responded quickly, though only after the virus infected people in another part of the country, at least a week after Edgar developed symptoms.

The New York Times

When to call a doctor

SWINE FLU AND SEASONAL FLU produce similar symptoms, but King County health officials do not recommend people with mild symptoms seek medical care just because they've recently been to Mexico or another area where swine flu has been reported. So what should you do if you have flulike symptoms?

Call your doctor if you have: An unexplained fever for three or more days, a bad sore throat, trouble breathing or you suddenly feel worse.

Skip the doctor if you have these symptoms and they're mild: Runny nose or nasal stuffiness, low-grade fever for fewer than three days, headaches, body aches, upset stomach.

Infectivity: Incubation period for swine flu is estimated to be one to seven days, compared with one to four days for seasonal flu. A person is infectious from the day before symptoms appear and for another four or five days. Children and others with weak immune systems might shed viruses for 10 days or longer. Influenza viruses spread primarily through large respiratory droplets from coughs and sneezes. Large droplets travel less than 3 feet in the air. Viruses also can survive on surfaces.

Antiviral drugs: Authorities think swine flu may be treated or prevented with two prescription antiviral drugs: Tamiflu and Relenza. Tamiflu is a pill; Relenza comes in a powder form that may be difficult for some people to inhale. A full course of Tamiflu runs five days.

Supply: King County expects to have enough Tamiflu to treat about 30 percent of residents, with priority given to the sick and people showing flu symptoms.

Sources: Public Health — Seattle & King County; Centers for Disease Control

and Prevention, Seattle Times reporting.

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LA GLORIA, Mexico — Edgar Hernandez can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his 5 years: His head was hot. He coughed until his belly and throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.

"I feel good now," he said Tuesday, flashing a smile. But the government has identified Edgar as the first person in Mexico to have become infected with a strain of swine flu, a notoriety that makes his parents anxious and that could raise questions about how Mexican officials reacted — or failed to react — to the early stages of what might become a global epidemic.

Maria del Carmen Hernandez, Edgar's mother, said her son began sniffling and feeling feverish in late March. She gave him medicine from the local pharmacy, but the fever didn't go away. She put wet cloths on his forehead. She considered putting him in a tub of water.

Finally, after a week, the fever broke, and Edgar seemed as good as new, she said.

"We didn't isolate him," Hernandez said. "We all slept in the same bed, he'd greet his little brother with a kiss. We all lived together, and no one else got sick."

Edgar was one of hundreds of people in La Gloria who came down with flulike symptoms. Local residents accuse public-health officials of dismissing the outbreak at the time. Federal officials said they responded quickly, though only after the virus infected people in another part of the country, at least a week after Edgar developed symptoms.

One of the many unknowns about the fierce flu that struck Edgar is whether it could have set off alarms early on, and whether it could have been contained if it had.

La Gloria may not, in the end, be found to be the source of anything. The village has many immigrants in the United States. Mexican epidemiologists say one theory is that someone who had been in the United States brought the virus back to the community. Even before Edgar fell ill, another person in San Diego may have been affected, said Miguel Angel Lezana, the director of the Centro Nacional de Vigilancia Epidemológia y Control de Enfermedades, Mexico's top federal health authority.

Edgar's mother said she received conflicting accounts of the exact illness her son had.

"Some people are saying my boy is to blame for everyone else in the country getting sick," said Hernandez, 34. "I don't believe that. I don't know what to think."

Village is confused

In La Gloria, two children died from the flu in March and early April, although the authorities said they have yet to determine whether it is the same strain that infected Edgar and spread widely to other locales. That and other questions have left local residents unnerved and confused.

Each knock on the door brings a surprise to the Hernandezes: fumigators who sprayed their home but did not tell them for what; scientists who asked to take a swab of Edgar's throat; even the governor of Veracruz, who arrived by helicopter Monday with an entourage in tow and left Edgar with a soccer ball and a baseball cap.

On Monday, the local physician who treated the boy told Hernandez that her son had influenza but that it was not the swine-flu virus, she said. But a few hours before, Gov. Fidel Herrera Beltran walked into her home to check on Edgar. He had said publicly over the weekend that Edgar had tested positive for swine flu, and Health Secretary José Ángel Córdova had confirmed Monday that a boy from La Gloria, whom he refused to identify, had tested positive and then recovered.

"Shouldn't they tell the mother first?" said Hernandez, as her younger son, Jonathan, 3, let out a cough of his own.

In fact, it was not Edgar's case that tipped off health officials to the emergency.

It was the case of a 39-year-old woman, who came into a Oaxaca hospital with an unusual viral infection, that prompted Mexico's epidemiologists to act.

Maria Gutierrez had come into the hospital April 9 with an unusual viral infection after falling ill days before and visiting several doctors without getting help. After tests revealed an unusual illness, medical personnel isolated her and notified state and federal officials. She died April 13, and officials sent samples from her, Edgar and another patient in Mexico City to a Canadian lab for testing.

The results came back April 23, and both Gutierrez and Edgar would be found positive for a new strain of virus.

So many, so fast

Epidemiologists are likely to have many leads to follow in determining the flu's origins. La Gloria was not alone in experiencing a fierce outbreak in recent weeks. Public-health officials in other parts of Mexico said they noticed an unusual spike in cases in the beginning of April, when the normal flu season would usually be ending.

More than a month before the government confirmed the outbreak of swine flu, Veronica Ramos already knew something was amiss in La Gloria, where she is a teacher at the elementary school. First, she said, a fourth-grade girl became sick, and then more than half the rest of her class had flulike symptoms. The girl's sister came down with fever, cough and aches. Soon, a third of the school's 300 students were ill.

"Children get sick, I know that," Ramos said. "And they infect each other. But it's not common for so many to get sick so fast."

Information from the Los Angeles Times was used in this report.

Copyright © 2009 The Seattle Times Company


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