H1N1 (Swine Flu) Congressional Update

Centers for Disease Control and Prevention

July 8, Novel Influenza A (H1N1) - Congressional Update

After this issue, we will temporarily suspend the routine issuance of this Update unless events concerning Pandemic H1N1 Influenza Virus dictate. We will continue to ensure that important information reaches Congressional staff quickly. We remain happy to answer any questions, which can 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.

The World Health Organization renamed the H1N1 virus on June 15, 2009 to the "Pandemic H1N1 Influenza Virus"

A Pandemic Is Declared by the World Health Organization

On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway. It is important to understand that this change is based on the geographic spread of the virus to other parts of the world and does not necessarily reflect any change in the severity of the virus or associated illness. At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.

More than 130 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

On July 2, 2009 HHS Secretary Kathleen Sebelius announced that the United States will provide 420,000 treatment courses of Tamiflu (Oseltamavir) to the Pan-American Health Organization (PAHO) to fight the novel H1N1 influenza in Latin America and the Caribbean.

The Secretary made the announcement while attending a series of high-level meetings for health ministers throughout the Americas in Cancun, Mexico.

"The U.S. is committed to supporting and enhancing the health security in the region by reducing transmission and severity of illness," Sebelius told officials in Cancun. "Viruses know no borders. The US recognizes that a novel virus such as the H1N1 is a burden borne by all nations, and all of us have a responsibility to help support one another in the face of this challenge"

On June 23, HHS received a request from PAHO to partner with the U.S government to increase the PAHO stockpile of Tamiflu in the regional stockpile available for Latin America and the Caribbean countries. PAHO is working to ensure that its member countries have the capacity and resources to respond to outbreaks of H1N1.

HHS holds approximately 50 million courses of antiviral medications in the Strategic National Stockpile (SNS). In April, HHS deployed 11 million treatment courses from the SNS to the states across the country to fight the H1N1 influenza. Since then, HHS has purchased antiviral drugs to replenish the SNS along with an additional 2 million treatment courses.

The United States supports the goal of improving access to vaccines and antiviral drugs for developing countries, particularly in the context of public-health emergencies as part of its broader commitment to protect global public health. The United States has provided significant support to the World Health Organization's vaccine programs and will continue to work to support international partners and developing nations around the world.

Transmission of the virus within the region and throughout the Americas is a significant U.S. health security concern because of the vast amount of travel and commerce in the hemisphere.

The U.S. is working closely with the World Health Organization and PAHO to monitor the virus in the southern hemisphere. The information collected will assist the U.S. in making future decisions about the use of vaccine, antiviral medications and the steps needed to protect our communities.

Secretary Sebelius announces advanced development contract for new way to produce influenza vaccine on June 23, 2009

Secretary Kathleen Sebelius announced that HHS will work with Protein Sciences Corporation, Inc., of Meriden, CT., under a new $35 million contract to pursue advanced development of a new way to make influenza vaccine. HHS Announces Advanced Development Contract for New Way to Make Flu Vaccine

Statements by HHS Secretary Kathleen Sebelius and DHS Secretary Janet Napolitano on WHO Decision to Declare Novel H1N1 Virus Outbreak a Pandemic on June 11, 2009

U.S. Department of Health and Human Services Secretary Kathleen Sebelius and U.S. Department of Homeland Security Secretary Janet Napolitano issued the following statements in response to the World Health Organization′s (WHO) decision to raise the pandemic threat level on the novel H1N1 virus. http://www.hhs.gov/news/press/2009pres/06/20090611a.html

US Update

As of July 2, 2009 2:30 PM ET, a total of 33.902 confirmed and probable human cases of Pandemic H1N1 Influenza Virus have been identified in the United States in all 50 states plus the District of Columbia, Puerto Rico and the Virgin Islands. There have been 170 deaths from Pandemic H1N1 Influenza Virus, 44 in New York, 21 in California, 17 in Texas, 13 in Illinois, 10 each in Arizona and Utah, 9 in New Jersey, 7 in Michigan, 6 in Connecticut, 5 in Florida, 4 in Oregon, Pennsylvania, Washington and Wisconsin, 3 in Massachusetts, 2 in North Carolina, 1 each in Maryland, Minnesota, Missouri, Ohio, Oklahoma, Rhode Island, and Virginia.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 Pandemic H1N1 Influenza Virus Web sites for each state are located at http://www.cdc.gov/h1n1flu/states.htm.

U.S. Human Cases of Pandemic H1N1 Influenza Virus Infection (As of July 2, 2009 2:30 PM ET)
State	# of laboratory confirmed and probable cases	# deaths reported among laboratory confirmed cases
Alabama	330	-
Alaska	60	-
Arkansas	42	-
Arizona	761	10
California	1985	21
Colorado	136	-
Connecticut	1247	6
Delaware	316	-
Florida	1302	5
Georgia	118	-
Hawaii	616	-
Idaho	92	-
Illinois	3166	13
Indiana	267	-
Iowa	92	-
Kansas	117	-
Kentucky	130	-
Louisiana	183	-
Maine	82	-
Maryland	591	1
Massachusetts	1308	3
Michigan	484	7
Minnesota	576	1
Mississippi	161	-
Missouri	65	1
Montana	67	-
Nebraska	111	-
Nevada	301	-
New Hampshire	224	-
New Jersey	1159	9
New Mexico	232	-
New York	2499	44
North Carolina	255	2
North Dakota	57	-
Ohio	120	1
Oklahoma	128	1
Oregon	366	4
Pennsylvania	1748	4
Rhode Island	158	1
South Carolina	160	-
South Dakota	29	-
Tennessee	174	-
Texas	3991	17
Utah	920	10
Vermont	49	-
Virginia	191	1
Washington	588	4
Washington, D.C.	33	-
West Virginia	154	-
Wisconsin	5861	4
Wyoming	81	-
Territories
Puerto Rico	18	-
Virgin Islands	1	-
*Total Count (53)**	33,902 cases	170 deaths
Source: CDC (http://www.cdc.gov/h1n1flu/update.htm#statetable) * includes the District of Columbia , Puerto Rico and Virgin Islands 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.

With the onset of summer, much attention has been placed on summer camp outbreaks of H1N1. There are currently 52 outbreaks in 20 states. Most outbreaks involve campers from several states and some involve international visitors. In general, camps are urged to take precautions, including: isolating sick campers, delaying sessions, closing for the summer, sending kids home, and testing for influenza-like illness by rapid test.

International Update

Viruses resistant to oseltamivir (Tamiflu) identified

8 JULY 2009 | GENEVA -- WHO has been informed by health authorities in Denmark, Japan and the Special Administrative Region of Hong Kong, China of the appearance of H1N1 viruses which are resistant to the antiviral drug oseltamivir (known as Tamiflu) based on laboratory testing.
These viruses were found in three patients who did not have severe disease and all have recovered. Investigations have not found the resistant virus in the close contacts of these three people. The viruses, while resistant to oseltamivir, remain sensitive to zanamivir. See WHO′s for more: http://www.who.int/csr/disease/swineflu/newsbriefs/
h1n1_antiviral_resistance_20090708/en/index.html

On June 11, 2009 WHO raised the level of influenza pandemic alert from phase 5 to phase 6. Information on WHO′s pandemic influenza phases is available at: http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

WHO′s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not a change in the assessment of the severity of illness caused by the virus. To read WHO Director Margaret Chan′s statement: http://www.who.int/mediacentre/news/statements/2009/
h1n1_pandemic_phase6_20090611/en/index.html

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

WHO welcomes Sanofi-aventis's donation of 100 million doses of pandemic H1N1 vaccine.

http://www.who.int/mediacentre/news/statements/2009/vaccine_donation_20090617/en/index.html

As of July 6, 2009 6:00 GMT, 60,610 cases have been reported outside of the United States. A summary of the cases is provided in the table below. As of July 6, 2009 6:00 GMT, the Government of Mexico has reported 10,262 laboratory confirmed cases, including 119 deaths, of Pandemic H1N1 Influenza Virus.

International Human Cases of Pandemic H1N1 Influenza Virus (As of July 6, 2009 6:00 (GMT)
Country	# of laboratory confirmed cases reported by country with cases	# of deaths reported among laboratory confirmed cases
Algeria	5	-
Antigua and Barbuda	2	0
Argentina	2485	60
Australia	5298	10
Austria	19	-
Bahamas	7	-
Bahrain	15	-
Bangladesh	18	-
Barbados	12	-
Belgium	54	-
Bermuda, UKOT	1	-
Bolivia	416	-
Bosnia and Hezegovina	1	-
Brazil	737	1
British Virgin Islands, UKOT	2	-
Brunei Darussalam	124	-
Bulgaria	10	-
Cambodia	7	-
Canada	7983	25
Cap Verde	3	-
Cayman Islands, UKOT	14	-
Chile	7376	14
China	2040	-
Columbia	118	2
Costa Rica	277	3
Cote d'Ivoire	2	-
Cuba	85	-
Cyprus	109	-
Czech Republic	15	-
Denmark	66	-
Dominica	1	-
Dominican Republic	108	2
Ecuador	204	-
Egypt	78	-
El Salvador	319	-
Estonia	13	-
Ethiopia	3	-
Fiji	2	-
Finland	47	-
France	310	-
France, French Polynesia, FOC	4	-
France, Martinique, FOC	3	-
France, New Caledonia, FOC	12	-
France, Saint Martin, FOC	1	-
Germany	505	-
Greece	151	-
Guatemala	286	2
Guyana	2	-
Honduras	123	1
Hungary	11	-
Iceland	4	-
India	129	-
Indonesia	20	-
Iran, Islamic Republic	1	-
Iraq	12	-
Ireland	74	-
Israel	681	-
Italy	146	-
Jamaica	32	-
Japan	1790	-
Jordan	23	-
Kenya	15	-
Korea, Republic of	202	-
Kuwait	35	-
Laos	5	-
Latvia	1	-
Lebanon	49	-
Libya	1	-
Lithuania	3	-
Luxembourg	6	-
Macedonia	2	-
Malaysia	112	-
Malta	24	-
Mauritius	1	-
Mexico	10,262	119
Montenegro	10	-
Morocco	17	-
Myanmar	1	-
Nepal	5	-
Netherlands	135	-
Netherlands, Aruba	5	-
Netherlands, Curacao, OT	8	-
Netherlands Antilles, Saint Maarten	7	-
New Zealand	1059	3
Nicaragua	321	-
Norway	41	-
Oman	4	-
Palau	1	-
Panama	417	-
Papua New Guinea	1	-
Paraguay	106	-
Peru	916	-
Philippines	1709	1
Poland	25	-
Portugal	42	-
Qatar	23	-
Romania	41	-
Russia	3	-
Saint Lucia	1	-
Samoa	1	-
Saudi Arabia	114	-
Serbia	15	-
Singapore	1055	-
Slovakia	18	-
Slovenia	14	-
South Africa	18	-
Spain	776	1
Sri Lanka	19	-
Suriname	11	-
Sweden	84	-
Switzerland	76	-
Syria	1	-
Thailand	2076	7
Trinidad and Tobago	65	-
Tunisia	5	-
Turkey	40	-
Uganda	1	-
Ukraine	1	-
United Arab Emirates	8	-
United Kingdom	7447	3
Guernsey, Crown Dependency	5	-
United Kingdom, Isle of Man, Crown Dependency	1	-
United Kingdom, Jersey, Crown Dependency	11	-
Uruguay	195	1
Vanuatu	2	-
Venezuela	206	-
Viet Nam	181	-
West Bank and Gaza Strip	60	-
Yemen	8	-
Total Count *	60,616 cases	259 deaths

>Background Information About Pandemic H1N1 Influenza Virus

Background information on novel Influenza A (H1N1):

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

Most recent updates to information from CDC on Pandemic H1N1 Influenza Virus:

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

Information for individuals and parents on Pandemic H1N1 Influenza Virus:

Travel notices related to Pandemic H1N1 Influenza Virus:

http://wwwn.cdc.gov/travel/

Information on Pandemic H1N1 Influenza Virus and pork:

Resources and Information in Spanish:

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:

CDC: H1N1 Resources for the Deaf and Hard of Hearing
CDC has developed resources on novel Influenza A (H1N1) for the deaf and hard of hearing at: http://www.cdc.gov/h1n1flu/deaf.htm. The resources include a sign language hand washing video and a public service announcement on Pandemic H1N1 Influenza Virus.

New Novel Influenza A (H1N1) MMWR Publication
The Morbidity and Mortality Weekly Report (MMWR) published an article, "Update: Novel Influenza A (H1N1) Virus Infection --- Mexico, March--May, 2009." The article (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5821a2.htm?s_cid=mm5821a2_e) provides an update on novel Influenza A (H1N1) in Mexico and summarizes public health actions taken to date by Mexico to monitor and control the outbreak.

Novel Influenza A (H1N1) Virus Infections Among Health-Care Personnel United States, April--May 2009 MMWR Publication
To better understand the risk for acquiring infection with the virus among Hospital Care Personnel (HCP) and the impact of infection-control recommendations, CDC solicited reports of infected HCP from state health departments. The article http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5823a2.htm?s_cid=mm5823a2_e provides findings suggesting that transmission of Pandemic H1N1 Influenza Virus to HCP is occurring in both health-care and community settings and that additional messages aimed at reinforcing current infection-control recommendations are needed.

Dynasty: Influenza Virus in 1918 and Today

The influenza virus that wreaked worldwide havoc in 1918-1919 founded a viral dynasty that persists to this day, according to scientists from the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health. In an article published online on June 29 by the New England Journal of Medicine, authors Anthony S. Fauci, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and David M. Morens, M.D., argue that we have lived in an influenza pandemic era since 1918, and they describe how the novel 2009 H1N1 virus now circling the globe is yet another manifestation of this enduring viral family. The press release offers additional information: http://www.nih.gov/news/health/jun2009/niaid-29.htm and the publication reference DM Morens et al. The persistent legacy of the 1918 influenza virus. "New England Journal of Medicine." DOI: 10.1056/NEJMp0904819 (2009)

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

CDC is still learning about the severity of the Pandemic H1N1 Influenza Virus. At this time, there is not enough information to predict with certainty how severe this Pandemic H1N1 Influenza Virus 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.
With H1N1, confirmed cases have predominated among the young. There have been 3,663 hospitalizations. 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 Pandemic H1N1 Influenza Virus. 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

Clinician Guidance

Clinician Guidance for Specific Audiences

Infection Control

Infection Control for Patients In a Healthcare Setting

Laboratory Testing

Useful resources

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.

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/.

FDA, FTC Warn Public of Fraudulent 2009 H1N1 Influenza Products The U.S. Food and Drug Administration and the Federal Trade Commission are alerting the public to be wary of Internet sites and other promotions for products that claim to diagnose, prevent, mitigate, treat or cure the 2009 H1N1 influenza virus. The agencies are also advising operators of offending web sites that they must take prompt action to correct and/or remove promotions of these fraudulent products or face enforcement action. Visit http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm166801.htm to learn more.

Guidance for Patients

Guidance for Pregnant and Breastfeeding Women

Workplace Guidance

General Business and Workplace Guidance for Prevention in Workers Updated!

Emergency Personnel Guidance

EMS and 9-1-1 Personnel: Managing Confirmed or Suspected Infections

Guidance for Community Settings

Guidance for Schools, Colleges and University

Interim CDC Guidance on Day and Residential Camps

Travel & Travel Industry Guidance

PSA for Children

New Audio Public Service Announcement (PSA) for Kids

Podcast

Podcast: Novel H1N1 Flu and Camp. This podcast gives tips to stay healthy and help prevent infection with Pandemic H1N1 Influenza if your child or someone you know is going to camp.

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.

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 Pandemic H1N1 Influenza Virus 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 Pandemic H1N1 Influenza Virus 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.

To The Top

Historical Document: June 8, 2009
Content source: CDC Washington
Content Management: Office of Enterprise Communication
Notice: Linking to a non-federal site does not constitute an endorsement by HHS, CDC or any of its employees of the sponsors or the information and products presented on the site.

2009-H1N1 Flu - Congressional Update