Centers for Disease Control and Prevention

October 16, 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 16, 2009 (Fall 2009; Issue 3)

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

• Current 2009 H1N1 Situation Update
• Key Influenza Prevention Messages
• Recommendations for People 65 Years and Older
• General Seasonal Influenza Updates
• 2009 H1N1 Vaccine Information
• Protecting Healthcare Workers
• CDC Guidance on Prevention and Control
• Communication Tools for Members and Constituents
• Media Updates
• Morbidity and Mortality Weekly Report

Current 2009 H1N1 Situation Update

In the U.S. from August 30 – October 10, 2009, 4,958 laboratory-confirmed influenza associated hospitalizations, 292 laboratory-confirmed influenza associated deaths, 15,696 pneumonia and influenza syndrome-based hospitalizations, and 2,092 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 40 states reporting widespread influenza activity. See map below for updated view of influenza in the U.S.

Globally, the 2009 H1N1 influenza virus continues to be the dominant influenza virus in circulation. As of October 11, 2009, worldwide there have been more than 399,232 laboratory confirmed cases of 2009 H1N1 influenza and over 4,735 deaths reported to the World Health Organization.

As many countries have stopped counting individual cases, particularly of milder illness, the case count is significantly lower than the actually number of cases that have occurred.

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

More information about CDC's 2009 H1N1 influenza surveillance system is available 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.

2009 H1N1 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. Vaccination for 2009 H1N1 influenza began Monday, October 5.
• States and cities began placing orders for the 2009 H1N1 vaccine on Wednesday, September 30. All states and the District of Columbia have placed orders for vaccine. As of October 14, 11.4 million doses have been allocated and 5.9 million doses have been shipped. Shipments will continue each week into December. Vaccine shipment status by project area can be viewed here.
• Currently, only small amounts of vaccine are available for states to order. 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.
• 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 150,000 public and private health care providers.

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

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

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.
• There have been media reports of unpublished findings from seasonal influenza vaccine studies conducted in Canada suggesting that receiving the 2008-09 seasonal influenza vaccine was a risk factor for developing 2009 H1N1 influenza. Preliminary results of studies conducted in the U.S. using similar methods to the Canadian studies, however, do not indicate that receiving the 2009-09 seasonal influenza vaccine was a risk factor for developing 2009 H1N1 influenza. CDC continues to recommend seasonal flu vaccination. Read more regarding CDC’s response to the Canadian studies here.
• 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 are using several systems to monitor the safety of 2009 H1N1 monovalent influenza vaccine. Two primary systems 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 is being 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.

Protecting Healthcare Workers

On Wednesday, October 14, CDC released updated interim guidance on infection control measures to prevent transmission of the 2009 H1N1 influenza virus in healthcare facilities and protect healthcare workers against the virus.  The guidance recommends a comprehensive approach using a hierarchy of controls, including in order of importance: (1) eliminating potential exposures (e.g., taking steps to minimize outpatient visits by patients with mild influenza-like illness), (2) engineering controls (e.g., installing partitions in triage areas), (3) administrative controls (e.g., promoting and providing vaccination and enforcing exclusion of ill healthcare workers), and (4) personal protective equipment (e.g., respirators).  CDC's guidance continues to recommend the use of respiratory protection at least as protective as N95 respirators for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza.  If a healthcare facility experiences a shortage of respirators, the guidance recommends that the facility prioritize the use of respirators for healthcare workers at the greatest risk of exposure and with risk factors for influenza-related complications and that other healthcare personnel wear facemasks instead.

Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel can be viewed here.

CDC also released a document with questions and answers to provide additional information intended to assist healthcare facilities in optimizing implementation of recommended respiratory protection practices in the context of shortages of respiratory protection equipment.

Questions and Answers Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza among Healthcare Personnel are available here.

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

Guidance for Institutions of Higher Learning

Guidance for Childcare Facilities

Guidance for Business, Employers and Workplaces

Vaccination Guidance for State, Local, Tribal and Territorial Health Officials

Clinician Guidance Regarding Diagnostic Tests

Guidance for Individuals Handling 2009 H1N1 Clinical Specimens or Isolates

Guidance for Patients and Caretakers (and here)

Implementation Guidance for Managing Calls and Call Centers during a Large-Scale Influenza Outbreak

Guidance for Community Settings

Guidance for Travel and Travel Industry: Cruise Ships

Guidance for Travel and Travel Industry: Airlines

Guidance for the use of Antiviral Medications

Interim Guidance for State and Local Health Departments for Reporting Influenza-Associated Hospitalizations and Deaths for the 2009-2010 Season

Guidance for Parents of Patients/Patients with Asthma  

Guidance for Clinicians Regarding Patients with Asthma

Communication Toolkit for the Federal Workforce

Guidance for Pregnant Women

Healthcare Providers and Facilities: Decision Tree for 2009 H1N1 Vaccination

Healthcare Providers and Facilities: Template Letter for Providers about the Vaccine Adverse Event Reporting System (VAERS)

Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories

2009 H1N1 Flu and Seasonal Flu Information for People with Inflammatory Arthritis or Rheumatic Disease

2009 H1N1 Flu and Seasonal Flu Information for Rheumatology Health Professionals

Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel

Questions and Answers Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza among Healthcare Personnel

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, (2 pages) and here, (2 pages). Spanish versions are available here, (5 pages) and here, (4 pages). VIS in Mandarin are forthcoming.

Resources new this week include:

• A fact sheet providing information on flu antivirals, (2 pages)

• Informational flyers encouraging parents to get their child a second 2009 H1N1 flu vaccine dose are in English, (1 page) and Spanish., (1 page)

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.

The newest MMWR, Update on Influenza A (H1N1) 2009 Monovalent Vaccines, is available here.

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