The swine flu epidemic crossed new borders with the first cases confirmed in the Middle East and the Asia-Pacific region, as world health officials said they suspect American patients may have transmitted the virus to others in the U.S.
Most people confirmed with the new swine flu were infected in Mexico, where the number of deaths blamed on the virus has surpassed 150.
But confirmation that people have been infecting others in locations outside Mexico would indicate that the disease was spreading beyond travelers returning from Mexico. The source of some infections in the United States, Canada and Britain was unclear.
The swine flu has already spread to at least six countries besides Mexico, prompting WHO to raise its alert level but not call for travel bans or border closings. Countries, including Canada, Israel and France, warned their citizens to avoid nonessential travel to Mexico.
World Health Organization is advising countries to provide sick people with treatments such as Tamiflu, and make sure national plans are in place to ease the impact of a larger outbreak.
WHO raised the alert level to Phase 4, meaning there is sustained human-to-human transmission causing outbreaks in at least one country. WHO's pandemic alert system was revised after bird flu in Asia began to spread in 2004 and it was the first time it has ever been raised above Phase 3.
Flu deaths are nothing new in the United States or elsewhere. The Atlanta-based Centers for Disease Control and Prevention estimates that about 36,000 people died of flu-related causes each year, on average, during the 1990s in the United States. But the new flu strain is a combination of pig, bird and human viruses that humans may have no natural immunity too.
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