The Ministry of Health has reported the fourth A(H1N1) case in the Chinese mainland on Tuesday.

The 59-year-old man surnamed Yang is a Guangzhou resident who recently returned from the US and Canada. He arrived in Hong Kong on May 13 and took a train to Guangzhou two days later. A total of 75 out of the 93 people exposed to Yang on the train have been quarantined.

The Ministry of Health says an Italian tourist is also suspected of having the A(H1N1) flu.

The ministry says the 42-year-old woman is in a stable condition at a Tibet Autonomous Region hospital. Twenty-three foreign tourists travelling with her are currently under observation at a local hotel.

As of 5pm Tuesday Beijing time, the World Health Organization says nearly 10,000 cases of the A(H1N1) flu have been confirmed in 42 countries and regions. The number of cases in Japan has risen to 178, making it the most affected nation in Asia.