Flulike illness spreading but not too fast

Suspected cases of a flu-like illness appeared for the first time in five countries, but there were no new fatalities since the nine reported when the World Health Organization issued its unusual global alert over the weekend.

Experts said Monday that there "should not be panic" because the spread is not as aggressive as most forms of influenza.

WHO officials said they were investigating suspicious cases in England, France, Israel, Slovenia and Australia, all of which previously had none.

Doctors in Frankfurt, Germany, confirmed Tuesday that a man from Singapore and his wife have contracted the illness. The couple and the woman's mother have been in quarantine since they arrived in Germany on Saturday on a Singapore Airlines flight from New York.

The man, a doctor who had treated two patients suffering from severe acute respiratory syndrome, or SARS, in Singapore, showed symptoms on the flight.

Doctors said they believe the mother-in-law, who is running a fever, also has been infected, but so far she has not shown any other symptoms, including coughing and shortness of breath.

Most of the 167 cases of SARS that have appeared in the past three weeks are health workers in Hong Kong, Vietnam and Singapore. China said 300 people had what appeared to be the same illness in an outbreak that began last November in Guangdong province.

In the United States, the Centers for Disease Control and Prevention was skeptical that the four cases it was looking into would be verified as SARS.

The CDC already has ruled out 10 other suspicious cases.

Disease investigators said it could take weeks to determine the cause of the mysterious outbreak.

WHO officials also said China for the first time was allowing teams of experts into the country to take a closer look at its own earlier outbreak, which killed five people before it was brought under control. WHO investigators should be there by week's end, the U.N. agency said.

Experts believe that the most likely explanation for the respiratory illness is an exotic virus or -- the most feared scenario -- a new form of influenza.

However, WHO's communicable diseases chief, Dr. David Heymann, said the illness doesn't seem to spread as quickly a flu.

"It isn't contagious at the level of many other infectious diseases," he said. "A normal influenza would be very contagious to people sitting in the same room."

So far, experts say there is no evidence the infection spreads by casual contact, such as sitting next to somebody in an airplane.

"There should not be panic. This is a disease which, it seems, requires very close contact with patients and it is mainly hospital workers who have been infected in the first wave of infections. Now we are seeing that some other family members have been infected," Heymann said.

CDC head Dr. Julie Gerberding said she doubts the flu virus is responsible, since Hong Kong labs, which are very good at diagnosing influenza, have not been able to identify it.

The incubation period for SARS appears to be three to seven days. It often begins with a high fever and other flu-like symptoms, such as headache and sore throat. Victims typically develop coughs, pneumonia, shortness of breath and other breathing difficulties. Death results from respiratory failure.

The Chinese said 7 percent of patients there required breathing tubes, but most eventually got better, especially if they were not also stricken with a bacterial infection. In addition, the disease seemed to weaken as it passed from person to person.

That's encouraging, WHO officials say, adding that some of the patients in the latest outbreak seem to be recovering.

China's provision of a written summary of its outbreak was an unprecedented step of cooperation by Beijing in global disease surveillance, Heymann said. It was also an important one, partly because scientists have for years been warning that a new influenza pandemic is inevitable and new types of flu often develop in that part of the world, Heymann said.

"The big concern in this area of the world is that one day another influenza virus could hop the barrier between animals and humans. In the 20th century three viruses crossed, and the last two, in the '50s and '60s, occurred in the southern China area," Heymann said.

A Slovene woman suspected of suffering from the illness was listed in stable condition Monday at a hospital in the capital, Ljubljana. She had returned from a trip to Vietnam 10 days ago.

French health authorities said Monday that two people who returned from Asia were hospitalized in Paris after doctors suspected they might have the illness.

In Israel, doctors at Tel Aviv's Ichilov hospital said Monday they have quarantined a 33-year-old man who has flu symptoms and returned from Hong Kong three days ago.

On the Net: WHO: www.who.int/en/

CDC: www.cdc.gov/ncidod/sars/

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