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Centers for Disease Control and Prevention

May 21, Novel Influenza A (H1N1) - Congressional Update

We are providing this document to help inform Congress and congressional staff about the current status of the novel Influenza A (H1N1) events.  Beginning this week, Congressional Update will be issued on Mondays and Thursdays unless events dictate otherwise. Any questions should be directed to CDC/Washington at 202-245-0600.

Note: Green text indicates new information. Black text indicates background and other information also included in previous updates.

U.S. Update

As of May21, 2009 11:00 AM ET, a total of5764 confirmed and probable human cases of novel Influenza A (H1N1) have been identified in the United States in 47 states and the District of Columbia. The states that have reported the most novel H1N1 activity are Arizona, California, Illinois, New York, Texas, Washington state and Wisconsin. There have been nine deaths from novel Influenza A (H1N1), 3 in Texas, 2 in Arizona, and 1 each in Missouri, New York, Utah, and Washington. The number of confirmed and probably cases is thought to represent a small proportion of the total number of people who have been infected with the novel H1N1 virus, because many people ill with influenza-like symptoms do not seek medical care and many who do seek medical care are not tested for influenza. CDC has 116 personnel deployed to CA, DE, IL, NYC, OH, TX, WA, and Washington, DC and at quarantine stations. Internationally, CDC has staff in Guatemala and Mexico. CDC has validated labs in 40 states, including multiple labs in 8 states, so that they may confirm cases directly.

A summary of the cases is provided below. All questions related to specific cases should be directed to the state health department in the state in which the case occurred. A full list of state health departments and their contact information is available at http://www.astho.org/Programs/Infectious-Disease/H1N1/ under State H1N1 Information.

Total Count 5764cases 9deaths

Source: CDC ( http://www.cdc.gov/h1n1flu/update.htm#statetable
** Case is a resident of Kentucky but currently hospitalized in Georgia.
NOTE: Because of daily reporting deadlines, the state totals reported by CDC may not always be consistent with those reported by state health departments. If there is a discrepancy between these two counts, data from the state health departments should be used as the most accurate number.

International Update

The World Health Organization (WHO) is providing information on international novel Influenza A (H1N1) outbreaks at: http://www.who.int/csr/disease/swineflu/en/index.html.

On April 29, 2009 WHO raised the level of influenza pandemic alert from phase 4 to phase 5. Information on WHO′s pandemic influenza phases is available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html.

As of May 21, 2009 6:00 GMT, 5324 cases have been reported in 40 countries outside of the United States. A summary of the cases is provided in the table below. As of May21, 2009 6:00 GMT, the Government of Mexico has reported 3892 laboratory confirmed cases, including 75 deaths, of novel Influenza A (H1N1). The higher number of cases in Mexico reflects ongoing testing of previously collected specimens.

Total Count 5324 cases 77 deaths

Source: World Health Organization http://www.who.int/csr/don/2009_05_21/en/index.html

Background Information About Novel Influenza A (H1N1)

Background information on novel Influenza A (H1N1):

• http://www.cdc.gov/h1n1flu/swineflu_you.htm

Most recent updates to information from CDC on novel Influenza A (H1N1):

• http://www.cdc.gov/h1n1flu/whatsnew.htm
  

Information for individuals and parents on novel Influenza A (H1N1):

• http://www.cdc.gov/h1n1flu/sick.htm
  
• http://www.cdc.gov/h1n1flu/parents.htm
  
• http://www.cdc.gov/h1n1flu/talkingtokids.htm
  
• http://www.cdc.gov/h1n1flu/hiv_flu.htm
  

Travel notices related to novel Influenza A (H1N1):

• http://wwwn.cdc.gov/travel/
  

Information on novel Influenza A (H1N1) and pork:

• http://www.cdc.gov/h1n1flu/key_facts.htm
  
• http://www.cdc.gov/h1n1flu/pdf/brochure.pdf
• http://www.who.int/mediacentre/news/statements/2009/h1n1_20090430/en/index.html
  

Resources and Information in Spanish:

• http://www.cdc.gov/h1n1flu/espanol/influenza-porcina-info-general.htm
  
• http://www.cdc.gov/h1n1flu/espanol/psa/
  

Resources in other languages:

In addition to English and Spanish, several of CDC′s novel Influenza A (H1N1) resources are now also available in Arabic, French, Russian, and simplified Chinese. The materials can be accessed in these languages through the sidebar on the right at:

• http://www.cdc.gov/h1n1flu/key_facts.htm
• http://www.cdc.gov/h1n1flu/qa.htm

New Publications on Novel Influenza A (H1N1)

• The Morbidity and Mortality Weekly Report publishedan article entitled “Serum Cross-Reactive Antibody Response to a novel Influenza A (H1N1) Virus After Vaccination with Seasonal Influenza Vaccine” (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a1.htm?s_cid=mm5819a1_e) that provides details of a serology study of samples from children, younger adults and older adults vaccinated with recent seasonal influenza vaccines to try to determine whether seasonal vaccines offered any immune benefits against novel H1N1 virus. The results presented in this study found that recent seasonal influenza accines provide little or no immune benefit against the novel H1N1 flu virus.
• The Morbidity and Mortality Weekly Report published an article entitled - (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0518a1.htm?s_cid=rr58e0518a1_e). The report summarizes the 30 hospitalized cases of novel Influenza A (H1N1) in California as of May 17, 2009.
  

Guidance Documents

CDC has and continues to develop a number of guidance documents related to novel Influenza A (H1N1). The documents target a variety of clinical, professional, and individual audiences. The guidance documents are regularly updated as CDC continues to learn more about novel Influenza A (H1N1). All current guidance documents are available at: Novel Influenza A (H1N1) Guidance. Guidance documents include:

Epidemiology and Surveillance

• Case Definitions for Investigations of Cases
  
• Screening in Regions with Few or no Reported Cases
  

Clinician Guidance

• Identifying and Caring For Patients
  
• Antiviral Recommendations
  
• Emergency Use Authorization (EUA) of Medical Products
  

Clinician Guidance for Specific Audiences

• Patients With Cardiovascular Disease.
  
• HIV-Infected Adults and Adolescents
  
• Pregnant Women.
  
• Young Children
  

Infection Control

• Infection Control for Patients In a Healthcare Setting
  
• Biosafety Guidelines for Lab Workers
  

Laboratory Testing

• Specimen Collection, Processing, and Testing for Suspected Infection
  
• Use of Rapid Influenza Diagnostic Tests
  
• Submission of Tissue Specimens for the Pathologic Evaluation
  
• Protocol for Antiviral Susceptibility Testing by Pyrosequencing
  
• Sequencing Primers and Protocol
  
• >CDC Protocol of Realtime RTPCR for Swine Influenza A(H1N1)
  

Useful resources

1. A public service announcement to provide information and guidance for recent fraudulent activity surrounding ads for flu remedies. Visit http://www.cdc.gov/h1n1flu/psa/consumerfraud.htm to listen to the announcement.
   
2. A PowerPoint presentation to provide general information about H1N1 flu to employees, constituents and other partners is available at http://www.cdc.gov/h1n1flu/business/.

Guidance for Community Settings

• Public Gatherings
  

Guidance for Patients

• Patients With Cardiovascular Disease.
  
• Caring for a Sick Person in Your Home
  

Guidance for Pregnant and Breastfeeding Women

• Breastfeeding Your Baby: What Parents Should Know.
  
• Information for Pregnant Women in Education, Child Care, and Health Care.
  
• What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus
  

Emergency Personnel Guidance

• EMS and 9-1-1 Personnel:Managing Confirmed or Suspected Infections
  
• Other Facemask and Respirator Use
  

Guidance for Schools, Colleges and University

• Update on School (K – 12) and Child Care Programs
  
• Interim Guidance for Institutions of Higher Education
  

Travel & Travel Industry Guidance

• Guidance for Cruise Ships
  
• Flight Crews Arriving from Affected Areas
  
• Identifying Passengers Who May Have Swine Influenza
  

PSA for Children

PSA KidsNew Audio Public Service Announcement (PSA) for Kids

How does CDC conduct influenza surveillance?

The Epidemiology and Prevention Branch in the Influenza Division at CDC collects, compiles and analyzes information on influenza activity year round in the United States and produces a weekly report from October through mid-May. The U.S. influenza surveillance system is a collaborative effort between CDC and its many partners in state and local health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics and emergency departments. Information in five categories is collected from nine different data sources.

• Viral Surveillance — About 80 U.S. World Health Organization (WHO) Collaborating Laboratories and 70 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories, located throughout the United States, participate in virologic surveillance for influenza. All state public health laboratories participate as WHO collaborating laboratories along with some county public health laboratories and some large tertiary care or academic medical centers. Most NREVSS laboratories participating in influenza surveillance are hospital laboratories. In 2007, human infection with a novel influenza A virus became a nationally notifiable condition. The 2009 influenza A (H1N1) virus is a novel virus. Novel influenza A virus infections include all human infections with influenza A viruses that are different from currently circulating human influenza H1 and H3 viruses.
  
• Outpatient Illness Surveillance — Information on patient visits to health care providers for influenza-like illness is collected through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet).
  
• Mortality Surveillance — Rapid tracking of influenza-associated deaths is done through two systems:
  
• 122 Cities Mortality Reporting System. Each week, the vital statistics offices of 122 cities report the total number of death certificates received and the number of those for which pneumonia or influenza was listed as the underlying or contributing cause of death by age group. The percentage of all deaths due to pneumonia and influenza (P&I) are compared with a seasonal baseline and epidemic threshold value calculated for each week.
  
1 Surveillance for Influenza-associated Pediatric Mortality. Influenza-associated deaths in children (persons less than 18 years) was added as a nationally notifiable condition in 2004. Laboratory-confirmed influenza-associated deaths in children are reported through the Nationally Notifiable Disease Surveillance System.

• Hospitalization Surveillance — Two systems monitor hospitalizations with laboratory confirmed influenza infections.
  
• Emerging Infections Program (EIP). The EIP Influenza Project conducts surveillance for laboratory-confirmed influenza related hospitalizations in children (persons less than 18 years) and adults in 60 counties covering 12 metropolitan areas of 10 states (San Francisco CA, Denver CO, New Haven CT, Atlanta GA, Baltimore MD, Minneapolis/St. Paul MN, Albuquerque NM, Las Cruces, NM, Albany NY, Rochester NY, Portland OR, and Nashville TN).
  
1 New Vaccine Surveillance Network (NVSN). The New Vaccine Surveillance Network (NVSN) provides population-based estimates of laboratory-confirmed influenza hospitalization rates for children less than 5 years old residing in three counties: Hamilton County OH, Davidson County TN, and Monroe County NY.

• Summary of the Geographic Spread of Influenza — State health departments report the estimated level of spread of influenza activity in their states each week through the State and Territorial Epidemiologists Reports. States report influenza activity as no activity, sporadic, local, regional, or widespread.
  

For a more detailed explanation of these influenza surveillance systems visit: Flu Activity and Surveillance

Travel

As the summer travel season begins, CDC recognizes that both you and your constituents are concerned about the possible impact of flu on travel plans. At this time, CDC is not recommending exit screening of travelers, but is encouraging people who are feeling ill to defer their travel plans until they are well.

CDC is continuing to develop updated travel guidance and resources for business and recreational travelers. Please go to www.cdc.gov/travel for more information, and check back at this site, or call 1-800-CDC-INFO, for more information about healthy and safe travel.
How is CDC addressing consumer complaints about airline travel policies related to Novel Influenza A (H1N1)?

CDC does not have any jurisdiction over airline policies. Policies for passengers who need or wish to change their travel plans due to Novel Influenza A (H1N1) vary by airline. Typically, airline policies are posted on the individual airline′s Web site. If consumers feel that an airline is not following their policy, complains can be filed with the Department of Transportation′s Aviation Consumer Protection Office (http://airconsumer.ost.dot.gov/problems.htm)

Mexico travel warning downgraded: On May 15, 2009 CDC′s Travel Health Warning recommending against non-essential travel to Mexico, in effect since April 27, 2009 was downgraded to a Travel Health Precaution for Mexico. CDC decided to downgrade this warning because of new information on disease spread and severity in Mexico and because the novel H1N1 flu virus appears to be present in the U.S. and in many other countries. CDC continues to recommend that travelers at high risk for complications from influenza discuss with their physicians the risks and benefits of travel in the context of their planned itinerary to Mexico. Travelers at high risk for complications may want to consider postponing travel.

HHS and CDC Roles

CDC is actively responding to and investigating the current outbreak of novel Influenza A (H1N1). CDC has fully activated its Emergency Operations Center. In addition to response and laboratory activities described above, 116 staff have been deployed and 34 pending deployment in the U.S., Mexico, and Guatemala to assist with the public health investigation. Staff are currently in California, Delaware, Illinois, New York City, Texas, Washington DC, and at U.S. quarantine stations. On April 21st CDC described the first two cases in a Morbidity and Mortality Weekly Report (MMWR), Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March--April 2009 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0421a1.htm). An MMWR describing additional cases was published on April 24th and is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm?s_cid=mm58d0424a1_e. An MMWR Dispatch describing the effects of seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related
to influenza infection and cases concerning the Novel Influenza A (H1N1).

Novel Influenza A (H1N1) Virus Infections in Three Pregnant Women --- United States, April--May 2009 is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0512a1.htm?s_cid=mm58d0512a1_e

An example of CDC′s response is the use of new communications modes to inform the public. Through its National Center for Health Marketing, CDC is using social media (www.cdc.gov/socialmedia) to provide H1N1 flu-related information when, where and how Americans want it. Ongoing social media activities include: posting information to CDC Facebook, MySpace, and DailyStrength social networking profiles; posting videos and podcasts to the CDC YouTube Channel; reaching out to blog writers to ensure credible information is being shared in blogs; sending email updates to users who have subscribed to receive information about the flu; developing widgets so that CDC flu information can be posted on other Web sites and blogs; and providing updated information to mobile phones. Congressional offices can point constituents to these interactive tools to get information, including:

Signing up for email updates, RSS feeds, or Twitter to getting alerts about updated H1N! Flu information on CDC.gov

Listening to podcasts and subscribing to podcast series on Flu information

Watching videos on Flu and tips for prevention on CDC TV and CDC's YouTube channel

Visiting any of CDC's social networks: Facebook, MySpace, or DailyStrength
Adding a widget and/or a Web image to your Web page or personal blog

For more information regarding CDC′s novel Influenza A (H1N1) activities, go to: http://www.cdc.gov/h1n1flu/.

Pandemic Planning Investments at Work

In recent years, CDC has received congressional appropriations pandemic influenza activities.
CDC′s Pandemic Influenza Appropriations
Fiscal Year Amount
2007 $70,000,000
2008 $154,632,000
2009 $156,046,000

Total Appropriations $380,678,000

These recent investments have enhanced many areas critical to pandemic influenza preparedness and response, including health monitoring, epidemiology, laboratory capabilities, response, and recovery. The appropriated resources have allowed CDC to work with states and territories to test national infrastructure and develop operational plans, strengthen crisis communication plans and tools, expand the Strategic National Stockpile, improve surveillance systems, and work with international partners to prepare for a pandemic. All of these activities have increased both CDC′s and our partners′ capacity and capabilities for dealing with the current novel Influenza A (H1N1) outbreak.

For more information about CDC′s pandemic influenza activities and appropriations, please contact CDC/Washington, at (202) 245-0600.

Where to Find Updates

CDC is committed to ensuring Congress, public health partners, the media, and the public are able to obtain up-to-date and accurate information regarding the human novel Influenza A (H1N1) cases and CDC′s related activities. CDC is providing daily updates on our Web site. Information is available at: http://www.cdc.gov/h1n1flu/index.htm.

In addition, the World Health Organization (WHO) has additional information on the global situation at: http://www.who.int/csr/disease/swineflu/en/index.html. Many state health departments are adding or updating information on novel Influenza A (H1N1) flu on their Web sites. A full list of state health departments and their contact information is available at http://www.astho.org/Programs/Infectious-Disease/H1N1/ under State H1N1 Information.

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