Swine flu cases suspected in Miami-Dade

Twenty possible but unconfirmed swine flu cases have been identified in Miami-Dade County, and an undetermined number in Broward, health officials said Wednesday. But it could be several days before the test results come back to confirm them.

The cases are considered ''suspect'' because the patients have flu symptoms and have traveled to Mexico or other areas where the swine flu has been identified, said Dr. Vincent Conte, chief epidemiologist with the Miami-Dade Health Department.

''If they have fever and respiratory symptoms and they've traveled, they meet the definition [for testing],'' Conte said.

Also on Wednesday, the World Health Organization took the unprecedented step of raising the infectious disease alert level to Phase 5, setting the stage for increased efforts to combat the infection.

The virus ''must be taken seriously because of its ability to spread to every country in the world,'' WHO director-general Dr. Margaret Chan said at a news conference. Phase 5 is considered a situation in which the likelihood of a pandemic ''is very high or inevitable,'' said Dr. Keiji Fukuda, assistant director-general.

The increased level came as the swine flu outbreak in the United States spread to four more states overnight, bringing the total to at least 92 cases. Texas authorities also announced the first U.S. death from the new virus, a 23-month-old who died in a Houston hospital.

The Miami-Dade viral samples, collected over the past few days, have been sent to the Florida Department of Health lab in Tampa, he said. Virologists there will analyze them to see if they can identify them as regular seasonal flu. If they can't, they will send them on to the Centers for Disease Control and Prevention in Atlanta for final analysis. Results might take five days or more, they said, because of a backlog of cases in Atlanta.

Suspected cases in Broward are also sent to a state lab in Miami, but Broward County Health Department spokeswoman Candy Sims wouldn't discuss numbers.

''There may have been many samples submitted for testing, but that's all I can say,'' she said.

The Dade health department is not seeking to quarantine the suspect individuals.

''We're asking their families and doctors to have them remain in voluntary isolation,'' said Dr. Fermin Leguen, an epidemiologist for the health department.

He said the individuals were identified by private physicians, hospitals and health clinics.

''The CDC is the only lab in the country that can do the analysis, and they're inundated with samples from the whole country,'' Conte said.