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2009-H1N1 Flu - Congressional Update

Centers for Disease Control and Prevention

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October 9, 2009

We are providing this update to help inform Congress and congressional staff about the current status of 2009 H1N1 Influenza and related topics. This update will be issued on Fridays unless events dictate otherwise. HHS’ Assistant Secretary for Legislation will also be hosting periodic telebriefings on 2009 H1N1. 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.

October 9, 2009 (Fall 2009; Issue 2)

In This Email (in Outlook and on some Blackberry devices, you can click on these headings and express to these sections):

Current Situation Update

In the U.S. from August 30 – October 3, 2009, 3,874 laboratory-confirmed influenza associated hospitalizations, 240 laboratory-confirmed influenza associated deaths, 12,384 pneumonia and influenza syndrome-based hospitalizations, and 1,544 pneumonia and influenza syndrome-based deaths were reported to CDC. Because of the new case definitions, however, comparison with numbers of hospitalizations and deaths reported before August 30 is not advised.

Currently, flu activity is increasing in most of the United States with 37 states reporting widespread influenza activity. See map below for updated view of influenza in the U.S.

H1N1 FLU Map

Globally, the 2009 H1N1 influenza virus continues to be the dominant influenza virus in circulation. As of October 2, 2009, the World Health Organization (WHO) regions have reported over 343,298 laboratory-confirmed cases of 2009 H1N1 with at least 4,108 deaths, which is an increase of at least 24,373 cases and 191 deaths since September 20. The laboratory-confirmed cases represent a substantial underestimation of total cases in the world, as many countries focus surveillance and laboratory testing only on people with severe illness

More information regarding 2009 H1N1 Influenza activity can be viewed here.

Key Influenza Prevention Messages

All individuals should take these everyday steps to protect themselves from flu:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol–based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth.
  • Try to avoid close contact with sick people.
  • If you are sick with flu–like illness, stay home for at least 24 hours after your fever is gone (without the use of a fever–reducing medicine) except to get medical care or for other necessities. Keep away from others to keep from making others sick.
  • Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
  • Be prepared in case you get sick and need to stay home. A supply of over–the–counter medicines, alcohol–based hand rubs, tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious.

Vaccination Information

Vaccine Production and Distribution

  • The U.S. has purchased vaccine in sufficient quantity to cover every American that wants to be vaccinated, from five U.S. licensed vaccine manufacturers.
  • States and cities began placing orders for the 2009 H1N1 vaccine on Wednesday, September 30. The first shipments of vaccine have already shipped and vaccination for 2009 H1N1 influenza began Monday, October 5. Vaccine shipments will continue each week into December.
  • Currently, only small amounts of vaccine are available for states to order and all currently available vaccine is in the nasal spray (rather than injectable) form. Given the limited early supply, states will initially be conducting very targeted vaccination efforts that consider: 1) those people who can receive nasal spray vaccine (healthy, non–pregnant people between the ages of 2 and 49, including healthy, non–pregnant healthcare workers who do not work with severely immune compromised persons, and 2) their local situation with H1N1 disease.
  • CDC chose to distribute limited quantities of the vaccine as soon as they became available rather than waiting until large quantities were available for shipment. While this creates some challenges, it also allows us to start protecting vulnerable individuals against 2009 H1N1 Influenza as soon as possible.
  • Currently, it is projected that that 45 to 52 million doses are expected to be available by mid October and approximately 20 million doses are expected to be available in each of the following weeks.
  • The number of doses available to each state will be determined by the state’s population.
  • 2009 H1N1 Influenza vaccine distribution will be a state health department managed process similar to the process for the Vaccines for Children (VFC) Program, with state–directed distribution to up to 90,000 public and private health care providers.

See questions and answers about 2009 H1N1 Influenza vaccine distribution See questions and answers about 2009 H1N1 Influenza vaccine distribution

To find out where 2009 H1N1 or seasonal flu vaccine is available near you, access the flu.gov vaccine locator here.

Vaccine Recommendations

Inactivated vaccines against both the seasonal and 2009 H1N2 flu influenza viruses can be received on the same day. The seasonal vaccine is already available in many locations, however, and individuals are encouraged to get their seasonal flu vaccine as soon as possible. Further guidance regarding the timing of the administration of live, attenuated vaccines (e.g. nasal spray) for both seasonal and 2009 H1N1 viruses is pending. For individuals needing more than one dose of the 2009 H1N1 vaccine, CDC recommends that the two doses be separated by four weeks. If the second dose is separated from the first dose by at least 21 days, however, the second dose can be considered valid. Vaccine will become increasingly available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.

H1N1 FLU View map

Vaccine Safety

  • We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record.
  • The CDC and FDA closely monitor the safety of seasonal influenza and other vaccines licensed for use in the United States in cooperation with state and local health departments, healthcare providers, and other partners.
  • Clinical trials on 2009 H1N1 influenza vaccine began in July and are ongoing. Early information from trials indicates the vaccines are safe, and that one dose of vaccine provides protection to most healthy adults and children 10-17 years old. Children younger than 10 years should receive two doses of 2009 H1N1 flu vaccine. The trials are also seeking information on pregnant women and on immune-compromised individuals.
  • CDC and its partners will use several systems to monitor the safety of 2009 H1N1 monovalent influenza vaccine. Two primary systems that will be used are the Vaccine Adverse Event Reporting System (VAERS), which is jointly operated with FDA, and the Vaccine Safety Datalink (VSD) Project.
  • Read more about the clinical trials here and 2009 H1N1 Influenza vaccine safety here.

Vaccine Financing and Reimbursement

  • Novel H1N1 vaccine will be procured and purchased by the federal government and made available for vaccinators at no cost.
  • Vaccination providers can not charge or bill for the 2009 H1N1 vaccine, though some may charge for administration of the vaccine.
  • Vaccine will be administered free of charge in public clinics and settings, and patients will not be charged for administration of 2009 H1N1 vaccine in such settings. Most private health insurers are expected to reimburse providers for the cost of administration.

CDC Guidance on Prevention and Control

CDC has issued (or updated) guidance to help individuals, schools, businesses, and others take steps to avoid the flu and deal with its consequences. All guidance can be accessed at
http://www.cdc.gov/h1n1flu/guidance/. Below, we have provided direct links to key guidance that may be of interest.

Guidance for Schools
http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm.

Guidance for Institutions of Higher Education
http://www.cdc.gov/h1n1flu/institutions/guidance/

Guidance for Childcare Facilities
http://www.cdc.gov/h1n1flu/childcare/guidance.htm

Guidance for Business, Employers and Workplaces
http://www.cdc.gov/h1n1flu/business/guidance/

Vaccination Guidance for State, Local, Tribal and Territorial Health Officials
http://www.cdc.gov/h1n1flu/vaccination/statelocal/
Accompanying checklist for planning: http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm

Clinician Guidance Regarding Diagnostic Tests
http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm

Guidance for Individuals Handling 2009 H1N1 Clinical Specimens or Isolates
http://www.cdc.gov/h1n1flu/guidelines_labworkers.htm

Guidance for Patients and Caretakers
http://www.cdc.gov/h1n1flu/guidance_homecare_directions.htm and: http://www.cdc.gov/h1n1flu/guidance_homecare.htm

Implementation Guidance for Managing Calls and Call Centers during a Large-Scale Influenza Outbreak
http://www.cdc.gov/h1n1flu/callcenters.htm.

Guidance for Community Settings
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm and: http://www.cdc.gov/h1n1flu/masks.htm

Guidance for Travel and Travel Industry
http://www.cdc.gov/h1n1flu/guidance/cruiseships.htm and: http://www.cdc.gov/h1n1flu/guidance/air-crew-dom-intl.htm

Guidance for the use of Antiviral Medications
http://www.cdc.gov/H1N1flu/recommendations.htm

Interim Guidance for State and Local Health Departments for Reporting Influenza-Associated Hospitalizations and Deaths for the 2009-2010 Season
http://www.cdc.gov/H1N1flu/hospitalreporting.htm

Guidance for Parents of Patients/Patients with Asthma
http://www.cdc.gov/h1n1flu/asthma.htm

Guidance for Clinicians Regarding Patients with Asthma
http://www.cdc.gov/h1n1flu/asthma_clinicians.htm

Communication Toolkit for the Federal Workforce
http://www.cdc.gov/h1n1flu/federalworkforce/toolkit/

Guidance for Pregnant Women
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm

Healthcare Providers and Facilities
Decision Tree for 2009 H1N1 Vaccination:
http://www.cdc.gov/H1N1flu/vaccination/decisiontree.htm
Template Letter for Providers about the Vaccine Adverse Event Reporting System (VAERS)
http://www.cdc.gov/H1N1flu/vaccination/statelocal/letter_template_HCP.htm

Communication Tools for Members and Constituents

CDC recognizes that H1N1 flu is of significant interest and concern to your constituents. With this in mind, we offer cutting edge CDC communication tools you can use to effectively communicate information about 2009 H1N1 flu during the upcoming flu season:

  • Short (less than 140 characters) messages that you or your member can post to their Twitter account provide effective messages and shortened links to further information on H1N1
  • CDC and Flu.gov Twitter feeds (@CDCemergency, @CDCFlu, @CDC_ehealth, and @FluGov) that provide regularly updated information (and can be “re-tweeted” by members that use Twitter to disseminate information to constituents)
  • Buttons (in both English and Spanish), widgets, e-cards, and other tools that can be used on websites or in email newsletters
  • CDC’s image library, containing H1N1 flu-related images that can be used in your web materials and newsletters
  • CDC’s dedicated Youtube channel and other videos containing H1N1 and other health information
  • Podcasts of H1N1 and other health information, featuring CDC experts

All of these resources can be found at http://www.cdc.gov/SocialMedia/Campaigns/H1N1/. If you need technical assistance in using these tools, please contact Justin Cormier (jcormier@cdc.gov) or Andi Lipstein (alipstein@cdc.gov) in the CDC Washington Office.

We also have produced a variety of materials that can be printed at a local (or commercial) printer and distributed. We do not stock these documents, but they can be useful handouts at district events. You can access these resources here.

Additionally, vaccine information statements (VIS) have been developed for both the inactivated and the live, intranasal 2009 H1N1 vaccines. English versions can be viewed here and here. Spanish versions are available here and here. VIS in Mandarin are forthcoming.

Media Updates

CDC conducts regular media updates and briefings regarding 2009 H1N1 Influenza. Transcripts of these briefings, as well as audio recordings, are available here.

Morbidity and Mortality Weekly Report (MMWR)

The MMWR, including 2009 H1N1 Influenza related reports, can be accessed here.

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  • Historical Document: October 9, 2009
  • Content source: CDC Washington
    Content Management: Office of Enterprise Communication
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