The Tuskulėnų Vidurinė School was one of 43 closed in Vilnius Thursday because of the swine flu epidemic. It's not clear if the schools will be reopened Friday. Photo by Nathan Greenhalgh.

VILNIUS — A swine flu epidemic forced the closure 43 schools in Vilnius Thursday because of fears the disease would spread.

In addition to closing the schools, Lithuania’s Ministry of Health declared five new municipalities as flu epidemic areas, bringing the total number number up to ten.

“We are thinking that in two weeks we will reach the height of the epidemic in Lithuania,” Ieva Paulauskienė, adviser to the minister of health, told Baltic Reports.

Paulauskienė said that school closings were a matter for each individual municipality, and the ministry does not have the authority to mandate that schools shut down. “Every municipality has recommendations to close schools for this period,” she said.

Three more sites were under review for being declared epidemic areas, including the Kaunas municipal area, where Lithuania’s first A/H1N1 death occurred Wednesday. The confirmed epidemic areas are Visaginas, Utena, Marijampolė, Ukmergė, Alytus, Vilnius, Kėdainiai, Jonava, Kaišiadorys, and Širvintos. The other municipal districts under review are Švenčionys and Klaipėda district. Meanwhile several banks and other Lithuanian businesses are requiring their employees to wear surgical masks.

Despite the rise in reported cases, the European Center for Disease Prevention and Control have not received an update on epidemics in Lithuania since Nov. 4. Saulius Čeplinskas, director of Lithuania’s Center for Communicable Diseases and AIDS, which is responsible for updating those numbers, said that they compile their information every week and send it “by request.”

“If they are missing our data they need to ask and we will send it to them every Monday,” Čeplinskas said.

Even though the number of epidemic zones has doubled in the last 24 hours, Paulauskienė said that “treatment is stable and we have had no complications.” When asked about projected fatalities, she reiterated a point from a ministry statement released last night, saying that she does not expect a higher number of deaths than a normal flu season.

On Wednesday Paulauskienė told Baltic Reports that the A/H1N1 is being treated as “the same” as seasonal flu. Prompted to elaborate on whether the ministry was advocating the same treatment for A/H1N1 and seasonal flu, she said “you should talk to a doctor because I can’t explain the specifics of medicine.”

When asked by Baltic Reports if the death of the boy in Kaunas infected with swine flu will change how the ministry distinguishes between the viruses, she said that the ministry “will follow the recommendations of the World Health Organization, and their recommendation is not to do research in every case unless the person is in the hospital.” She also said that they will do random treatment.

According to the WHO website, “diagnostic testing to confirm the pandemic virus should be prioritized for patients at higher risk for severe illness. However, clinicians should not delay treatment of a patient with symptoms of an influenza-like illness to wait for laboratory confirmation of H1N1 virus infection.” WHO has not responded to requests by Baltic Reports for comment on this case.

When asked if the ministry should distinguish between A/H1N1 and seasonal flu, Čeplinskas said that it should and called Paulauskienė “not competent.”

Čeplinskas said that Kaunas has yet to be confirmed as an epidemic area because it has not reached the threshold of cases, which is 100 out of every 100,000 citizens. “An epidemic zone is not because of one child,” he said.

Because of the uptick in the flu, pharmacies have seen a shortage of flu medicines, specifically Tamiflu. Paulauskienė said that the government has reserves of 115,000 packages and will purchase 30,000 more. She said that the shortage was specifically with Tamiflu capsules, and that similar medicines in liquid and respirator form are still available.

“It’s a big problem with our doctors because they are prescribing Tamiflu in capsules,” Paulauskienė said. “Exactly in capsules we have a deficit.”

“That’s a problem because if a doctor prescribes Tamiflu in capsules, the pharmacists say we do not have it in capsule form and that’s it,” she added.