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Centers for Disease Control and Prevention

May 28, 2009, 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 May27, 2009 11:00 AM ET, a total of7927 confirmedand probable human cases of novel Influenza A (H1N1) have been identified in the United States in 47 states plus the District of Columbia. There have been 11 deaths from novel Influenza A (H1N1), 3 in Texas, 3 in Arizona, 2 in New York, and 1 each in Missouri, 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.

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.  Links to novel Influenza A (H1N1) Web sites for each state are located at http://www.cdc.gov/h1n1flu/states.htm.

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.

In view of the threat posed by the current outbreak of new influenza A (H1N1), the Director-General of the World Health Organization convened a High-Level Consultation for all Member States at the start of the Sixty-second World Health Assembly on May 28, 2009. The consultation provided an opportunity for Member States to share experiences, to discuss lessons learned, and to highlight the challenges that now confront the world community. More information is available at http://www.who.int/csr/resources/publications/swineflu/High_Level_Consultation_18_May_2009.pdf.

As of May 27, 2009 6:00 GMT, 6634 cases have been reported outside of the United States.  A summary of the cases is provided in the table below.  As of May27, 2009 6:00 GMT, the Government of Mexico has reported 4541 laboratory confirmed cases, including 83 deaths, of novel Influenza A (H1N1). The higher number of cases in Mexico reflects ongoing testing of previously collected specimens.

International Human Cases of Novel Influenza A (H1N1) Infection (As of May27, 2009 6:00 GMT)
Country	# of laboratory confirmed cases reported by country with cases	# of deaths reported among laboratory confirmed cases
Argentina	19	-
Australia	39	-
Austria	1	-
Bahrain	1	-
Belgium	7	-
Brazil	9	-
Canada	921	1
Chile	86	-
China	22	-
Chinese Taipei	4	-
Columbia	16	-
Costa Rica	33	1
Cuba	4	-
Denmark	1	-
Ecuador	28	-
El Salvador	11	-
Finland	2	-
France	16	-
Germany	17	-
Greece	1	-
Guatemala	5	-
Honduras	1	-
Iceland	1	-
India	1	-
Ireland	1	-
Israel	9	-
Italy	23	-
Japan	360	-
Korea, Republic of	21	-
Kuwait	18	-
Malaysia	2	-
Mexico	4541	83
Netherlands	3	-
New Zealand	9	-
Norway	4	-
Panama	76	-
Peru	27	-
Philippines	2	-
Poland	3	-
Portugal	1	-
Russia	2	-
Singapore	1	-
Spain	138	-
Sweden	3	-
Switzerland	3	-
Thailand	2	-
Turkey	2	-
United Kingdom	137	-
Total Count	6634 cases	85 deaths
Source: World Health Organization http://www.who.int/csr/don/2009_05_27a/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

How does novel H1N1 flu compare to seasonal flu in terms of its severity and infection rates?

CDC is still learning about the severity of the novel H1N1 flu virus. At this time, there is not enough information to predict with certainty how severe this novel H1N1 flu outbreak will be in terms of illness and death over the full course of this flu season, how it will compare with seasonal influenza, and whether this will change if this same virus infects large numbers in the fall. With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu–related complications and more than 200,000 people are hospitalized from flu–related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.

So far, with novel H1N1 flu, the largest number of novel H1N1 flu confirmed and probable cases have occurred in people between the ages of 5 and 24–years–old. At this time, there are few cases and no deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this novel H1N1.

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
  
• Interim Guidance for Correctional and Detention Facilities on Novel Influenza A (H1N1) Virus  NEW!
  

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 UPDATED!
  
• Protocol for Antiviral Susceptibility Testing by Pyrosequencing
  
• Sequencing Primers and Protocol
  
• CDC Protocol of Realtime RTPCR for Swine Influenza A(H1N1)
  
• DSAT Guidance on CDC Import Permits for Swine–Originated Flu NEW!
  

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 UPDATED!
  

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

• New 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.
  
• 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).
  
• 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. 

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

CDC also maintains a presence online 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

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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