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Novel Influenza A (H1N1) Declarations
– HHS: Downgraded to Phase 1 – Awareness (9 May 2009)
– WHO: Pandemic Phase 5 (29 Apr 1600 EDT)
– USG: Public Health Emergency declared (26 Apr 2009)
– SLTT Declarations: 10
• CA, TX, WI, FL, NE, VA, MD, IA, OH, American Samoa
US Cases:
– Confirmed/Probable: 4,298 cases ( 342), 46 States + DC
– Total Deaths 3: (2-TX, 1-WA )
International Cases: 6,497 in 33 Countries
• Ecuador, Costa Rica, Colombia, Mexico, Guatemala Deployments: 107 deployed, 3 pending
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Novel Influenza A (H1N1) Cases as of 14 May 2009 1100 EDT (page 1 of 2) Total Conf. + Prob.
Total Conf. + Prob.
State HHS Cases Hosp Dead
State HHS Cases Hosp Dead
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Novel Influenza A (H1N1) Cases as of 14 May 2009 1100 EDT (page 1 of 2) Total Conf. + Prob.
State HHS Cases Hosp Dead
Affected
US TOTAL 4298*
Cases INCL
Total SLTT
Affected
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• States were given the option to report aggregate numbers
(instead of line listing) beginning May 13, 2009
• The following variables are collected (by age group)
•Total # of “confirmed or probable”* cases
•Total # of cases hospitalized
•Total # of deaths
• 5 states and New York City began using the aggregate
reporting system on May 13, 2009
•Connecticut, Georgia, Illinois, Kentucky, Louisiana
• 7 states plan to begin aggregate reporting May 14, 2009
•Arizona, Indiana, Massachusetts, Mississippi, New Jersey, Oregon,
*CDC will no longer be able to differentiate between “confirmed” and “probable”cases in aggregate reports; also, onset date will not be available Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 5
Descriptive Epidemiology of Hospitalized Confirmed Cases of Novel 67 female (51%), 65 male (49%)
Median age: 17 years (range: 1 month-87 years)
Underlying medical conditions (n=44):
63% (median age: 18 years)
Median time from illness onset to hospital admission
(n=32): 4 days (range: 1-13 days)
Median length of hospital stay (n=32): 5 days (range 2-31)
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Descriptive Epidemiology of Hospitalized Confirmed Cases of Novel Indicators of Severity
24% (20/85) were admitted to the ICU
– 9 required mechanical ventilation; 6 had ARDS
– 4 required pressor support
– 1 person had septic shock and is recovering
– 1 had cardiogenic shock after myocardial infarction
Three deaths
– Infant with multiple medical problems including
chronic hypoxia
– Pregnant woman with underlying illness
– Man in late 30s with unclear past medical history, died
of sudden death
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Assessment:
– New cases continue to be reported although rate
appears to have slowed
– Relative impact of decreased disease transmission vs.
decreased testing is unknown
– Epidemiology of novel H1N1 cases appears unchanged
– Adjust daily surveillance reports to clearly reflect
increased use of aggregate reporting by states
– Continue to follow up special studies currently ongoing
in 7 states and municipalities
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Current Influenza Surveillance -as of 14 May 2009; 1100 EDT WHO/NREVSS Collaborating Laboratories (graph as of 5/13/2009)
Seasonal inf. A (H1), A (H3), and B viruses co-circulated with novel inf (H1N1)
Influenza-associated Pediatric Deaths
No new influenza-associated pediatric death were reported
2008-09 season total = 60
122 Cities Mortality Reporting System (graph as of 5/13/2009)
% of P&I deaths did not exceed the epidemic threshold for week ending 5/9/09
% of P&I deaths remains stable, based upon daily mortality reports
ILINet (graphs by region, EARS analysis as of 5/13/2009)
week ending 5/9/2009, % of ILI outpatient visits was above the national baseline
Overall, % of outpt visits for ILI decreased slightly, based upon daily ILI reports
Geographic Spread of Influenza as Assessed by State and Territorial
Epidemiologists
The influenza activity reported by state and territorial epidemiologists indicates
geographic spread of both seasonal influenza and novel influenza A (H1N1)
viruses and does not measure the severity of influenza activity.
6 states reported widespread activity, 14 states reported regional activity, the
District of Columbia and 15 states reported local influenza activity; 13 states
reported sporadic influenza activity, and two states did not report.
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Current Influenza Surveillance – ILINET 14 May 2009 Percentage of Visits for Influenza-like Illness (ILI) Reported by the US Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-09 and Previous Two Seasons NOTE: Week ending dates vary by influenza season
*Preliminary ILI data for week 18, as of May 12, 2009 (n=831 weekly ILI reports received from 47 states)
† There was no week 53 during the 2006-07 and 2007-08 seasons, therefore the week 53 data point for those seasons is an average of weeks 52 and 1.
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Current Influenza Surveillance – ILINet Regions I-III 14 May 2009 Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 11
Current Influenza Surveillance – ILINet Regions IV-VI 14 May 2009 Region IV - AL, FL, GA, KY, MS, NC, SC, TN Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 12
Current Influenza Surveillance – ILINet Regions VII-X 14 May 2009 Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 13
Pneumonia and Influenza Mortality for 122 U.S. Cities Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 14
WHO global case count: 6497 confirmed cases in 33 countries*
– New countries with confirmed cases:
– Countries with highest confirmed case count after the US and
• Canada: 389 Cases (↑41) Spain: 100 (↑2) UK: 71 (↑3),
Panama: 29 (=)
Cases in newest countries to confirm novel H1N1 (Cuba, Finland, Norway, Thailand) all have travel history to Mexico – Cuba case returned on 4/25, others were more recent
*Note: WHO case counts are current as of 05/14/09, 6:00 am EDT Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 15
Laboratories validated for RT-PCR Influenza Panel: 38
8 States with Multiple sites
APHL Survey: 20 States with no backlog
1 State with backlog exceeding 7500 samples
9 states accepting and testing all specimens
CDC has moved into survey status for U.S. and still
receiving samples for confirmation and international
verification
These data are considered provisional and preliminary and will not be officially released by the CDC until 1100 EDT.
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54 of 62 PHEP Project Areas have confirmed their vaccine
ship-to sites (870 total ship-to sites)
Federal Immunization Task Force meeting today to
discuss vaccine safety
ACIP pneumococcal workgroup concluded series of
discussions on the use of PPS vaccine
– At this time will be reemphasizing exiting recommendations – More specific and detailed summary in draft Sensitive But Unclassified (SBU) – --- Internal Use Only (FIUO)---For Official Use Only (FOUO) –NOT FOR FURTHER DISTRIBUTION 17
Division of Global Migration and Quarantine • Ports of Entry (POEs)
– Total 174 response events, 19 confirmed with H1N1 after
referral at POE (May 13)
– Maritime –Serenade of the Seas, 2 ILI cases among crew,
ship boarded May 12 by 2 Quarantine Officers while at port in
Sitka, AK
• Interviewed cases (2), review medical logs, completed
environmental assessment
• Shipboard protocols appropriate and being followed correctly
– Cruise Line International Association (CLIA) and CDC Quarantine
Branch Maritime Activity developing standards for entry
screening, ILI management for passenger and crew, and PPE
guidance
• Community Mitigation (CM)
– Epi-Aids: NPI – Seattle, NY, Chicago, Delaware
– Mexico Community Mitigation protocol being finalized for IRB
review at CDC and Insituto Nacional de Salud Publica (INSP)
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Channel Traffic
Web Page Views: 1,191,337 (-21%)
Public Inquires: 516 (-9%)
News Stories: Print/Internet: 149 (-23%); National TV: 4 (-20%); Local TV: 280 (-58%)
Print/Internet—Focus on International Themes
WHO warning countries to limit use of antiviral drugs to only high-risk patients New cases of swine flu: Belgium, Britain, China mainland Television News
Brief reporting of local case counts and increasing national cases Emerging themes (all news channels)
Outbreak could have been result of human error Effects of Tamiflu on fetus: risk from virus greater than unknown risk to fetus from Public Inquiries: CDC-INFO emails/calls from public
Travel recommendations (MX? US?)
Prevention precautions while traveling?
Cases in my community/city/state/country
Symptoms? Do you have to have all symptoms to have H1N1?
Where/how can you get tested?
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Source: http://file.wikileaks.info/leak/us-cdc-swine-flu-14-may-2009.pdf