MEXICO CITY (Reuters) - The new H1N1 flu killed its first patient in Canada, making it the third country after Mexico and the United States to report a death from the virus that has sickened more than 3,000 people in 27 countries.
Alberta's chief medical officer said on Friday that the woman in her 30s who died on April 28 had not traveled to Mexico, the epicenter of the swine flu outbreak, which suggests a more sustained spread of the infection.
Her death raised the confirmed global death toll to 48 from the virus, a strange coupling between a triple-hybrid virus with pig, human and bird elements and a European swine virus not seen before in North America.
Alberta was also where a herd of pigs became infected with the H1N1 swine flu, apparently infected by a man who had traveled to Mexico.
The World Health Organization kept its global pandemic alert at 5 out of 6 because the new virus was not spreading rapidly outside North America, where U.S. officials expect it to spread to all 50 states.
Japan reported its first three confirmed cases, a man in his 40s and two teenagers who had spent time in Canada. Italy also reported the first case of the H1N1 flu strain transmitted within the country -- a 70-year-old man in Rome caught the virus from his grandson, who returned from a holiday in Mexico.
In Mexico, authorities reported one more death, based on lab tests of patients who died in days past, to raise the total to 45. A quarter of the dead were obese, the government said.
The virus has also killed two people in the United States, where President Barack Obama said, "... we're seeing that the virus may not have been as virulent as we at first feared but we're not out of the woods yet."
Researchers have yet to determine where it originated.
The U.S. Centers for Disease Control and Prevention reported 1,639 U.S. cases on Friday, up from 896 on Thursday, a jump that has been expected as a backlog of lab tests were confirmed. The Mexican case total climbed to 1,364 from 1,204.
That pushed the global figures to at least 3,413 cases, according to the WHO, the CDC and national health authorities.
But U.S. health officials were encouraged that more people were washing their hands as a result of the outbreak.
Swine flu briefly rattled financial markets after Mexico announced it had detected a new virus on April 23, and it temporarily depressed hog futures after several countries imposed trade restrictions, which came even though health officials said there was no risk of spreading the virus by eating pork.
Mexico, already in recession, has said the flu crisis could knock 0.3 to 0.5 percentage points off gross domestic product as tourism revenues suffer and after the country shut down all non-essential businesses for five days to control infection.
A senior executive at HSBC told the Reuters Latin American Investment Summit the flu outbreak will delay economic recovery in Mexico, saying lending will suffer.
In Asia, countries whose health diplomacy skills were honed by SARS in 2003 and ongoing outbreaks of H5N1 avian influenza pledged to boost drug stockpiles, share essential supplies and tighten surveillance against what they called an "imminent health threat" to the region.
"We cannot afford to let our guard down," ASEAN Secretary General Surin Pitsuwan told a meeting of health ministers from the 10-member Association of South East Asian Nations plus China, Japan and South Korea.
In Hong Kong, authorities freed nearly 300 guests and staff of a hotel after quarantining them for a week.
In Mexico, where diabetes is the nation's leading cause of death, officials said 24 percent of the dead were obese and half of those were morbidly obese, meaning the patients were at least twice their ideal weight.
Diabetes was associated with many of the victims, as were cardiovascular problems such as angina and high blood pressure, Health Minister Jose Angel Cordova told a news conference.
These conditions can raise the risk of complications and death from seasonal influenza, which kills 250,000 to 500,000 people every year globally and 36,000 in the United States alone.
Officials said their fast implementation of social distancing, disinfecting public spaces and education about hand hygiene helped control the spread of the virus, which is acting much like a typical seasonal flu.
But that failed to assuage soccer clubs from throughout Latin America who refused to play against the two remaining Mexican teams in the Copa Libertadores tournament pitting clubs from several countries against each other. The Mexican teams withdrew from the cup on Friday.
Additional reporting by Scott Haggett in Calgary, Carlos Pacheco in Mexico City, Kittipong Soonprasert in Bangkok, Julie Steenhuysen in Chicago, Laura MacInnis, Stephanie Nebehay and Jonathan Lynn in Geneva, Michael Kahn in London; Writing by Daniel Trotta in Mexico City; Editing by Eric Beech and Maggie Fox