As more swine flu cases were reported Monday from Mexico to Spain and...

Jane Wooldridge

Apr. 28, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- As more swine flu cases were reported Monday from Mexico to Spain and New York to New Zealand, cruise lines pondered itineraries, airlines shifted refund policies and South Florida travelers debated canceling cancel vacations.

The death toll in Mexico rose to 159, and the U.S. State Department advised Americans to defer all nonessential travel there.

By midday Monday, agents at MK Tours in Miami had handled 40 calls from anxious travelers bound for Mexico, said company president Amelia Calchadora. Most delayed trips or switched to beach destinations elsewhere in the Caribbean, she said.

At Travel Network of Kendall, president Elsa Cristobal said she fielded calls from three families that had requested a vacation and four-day cruise later this summer. "All called today and said they did not want Mexican ports on their trips," she said.

Callers included Andres Garcia of Hialeah, who is set to sail next week with 25 family members on a Caribbean cruise that includes a stop in Cozumel. They're hoping the cruise line will rework the itinerary to avoid Mexico altogether; if not, they may not take the trip, Garcia says. "We have children in our group. Our main concern is our health," he said.

If they cancel, his group likely will lose their trip payments. Several major cruise lines -- including Carnival and Royal Caribbean (NYSE:RCL) -- announced Monday they will stick with itineraries that include Mexican ports. No cases have been reported on cruise ships.

Though its Mexico itineraries have ended for the summer, NCL announced it will carry antiviral medications on board and will ask guests to take a health questionnaire prior to embarkation. The onboard medical team will evaluate ill patients and determine further action, said spokeswoman AnneMarie Mathews.

American Airlines (NYSE:AMR) , Mexicana Airlines and AeroMexico said they will allow passengers bound for Mexico until early May to make changes without penalty, though conditions vary.

Local airports and Central Florida theme parks also reported they were operating normally but staying in contact with health authorities. "We haven't had any incidents of concern or any guest inquiries," said Becca Bides, director of public affairs at SeaWorld in Orlando. No cases had been reported in Florida as of Monday.

Whether travelers stay home or travel afar, the U.S. Centers for Disease Control and Prevention is urging them to follow the advice moms have been dispensing for decades: Wash hands frequently; cover your mouth and nose when you sneeze or cough; avoid close contact with those who appear ill. The CDC also advised high-risk travelers to take an antiviral medicine, either Tamiflu or Relenza, before they go.

Shifting vacation plans from Mexico to other destinations makes sense to Dr. Joan Pfinsgraff, director of health intelligence at iJET Intelligent Risk Systems, a risk management firm that late last week advised its clients to do just that.

"It's likely that Mexico is about a month ahead of us in the U.S. We may see many more outbreaks spreading quickly." But, she noted, "influenza viruses tend to be very unpredictable. It could be that summer weather in the northern hemisphere slows it down."

Bottom line: It's OK to go on vacation, says Carol L. De Rosa of Passport Health, a national chain of travel clinics with a South Florida office. Just avoid large crowds and areas where outbreaks have erupted. In other words, a New York vacation is fine, but you may want to dodge the baseball game.

Herald wire sources and Miami Herald staff writer Nirvi Shah contributed to this report.

Newstex ID: KRTB-0123-34488888