Centers for Disease Control and Prevention

April 28, 2009-H1N1 Flu - Congressional Update

We are providing this document to help inform Congress and congressional staff about the current status of the swine influenza events. 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 April 28, 2009 11:00 AM ET, a total of 64 confirmed human cases of swine influenza A (H1N1) have been identified in the United States. Additional possible cases are currently being analyzed. A summary of the cases is provided below. Five of the patients have been hospitalized, including three in California and two in Texas. The median age of patients is 16 and range from seven to 54. The incubation period in the U.S. appears to be two to seven days, which is typical of influenza virus. Thus far, the severity of the infections in the U.S. has been mild and patients are recovering.

U.S. Human Cases of Swine Flu Infection
(As of April 28, 2009 11:00 AM ET)

State	# of laboratory confirmed cases
California	10 cases
Kansas	2 cases
New York City	45 cases
Ohio	1 case
Texas	6 cases
Total Count	64 cases

International Update

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

WHO has raised the level of influenza pandemic alert from the current phase 3 to phase 4. As CDC was operating under the assumption that the outbreak would expand, the change in WHO's alert phase does not change our activities. As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase. CDC will continue to adjust our response to changing events, and will make information available as we confirm it.

As of April 27, 2009, the Government of Mexico has reported 26 laboratory confirmed cases of swine influenza A (H1N1). Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country's 32 states.

As of April 27, 2009, Canada reported 6 cases and Spain reported 1 case of swine influenza A (H1N1). Two cases were reported in Scotland.

International Human Cases of Swine Flu Infection
(As of April 27, 2009)

Country	# of laboratory confirmed cases reported by country with cases	# of deaths reported among laboratory confirmed cases
Canada	6 cases	-
Mexico	26 cases	7 deaths
Scotland	2 cases	-
Spain	1 case	-
Total Count	35 cases	7 deaths
Source: World Health Organization (http://www.who.int/csr/don/2009_04_27/en/index.html) and Pan American Health Organization (http://new.paho.org/hq/index.php?option=com_content&task=view&id=1261&Itemid=1)

The U.S. has deployed teams to Mexico to assist in the investigation as part of a WHO team and as part of a tri-lateral team with Canada and Mexico. The U.S. is assisting with the epidemiologic investigation in Mexico to better understand which illnesses are from swine influenza A (H1N1) versus other pathogens, how infection is spreading, how easily it is transmitted, and what factors increase or decrease the risk of infection. The U.S. teams are also helping to strengthen the laboratory capacity in Mexico to increase the ability to detect this new virus on-site. The U.S. teams are also on standby to assist with communication, infection control guidance, and other similar possible needs in Mexico. In addition to the work as a part of these two teams, the U.S. is engaged in routine infectious disease surveillance along the border between the U.S. and Mexico.

Background Information About Swine Flu

Where can I obtain information about swine flu?
CDC has provided information on swine flu online at:
http://www.cdc.gov/h1n1flu/swineflu_you.htm
http://www.cdc.gov/h1n1flu/key_facts.htm

New swine flu updates to CDC′s Web site are listed at:
http://www.cdc.gov/h1n1flu/whatsnew.htm

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that cause regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited.

Does the seasonal flu vaccine protect against this swine flu?
No. The H1N1 swine flu viruses are very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from H1N1 swine flu viruses.

What can people do to limit the spread of the virus and to decrease their risk?
Guidance for Residents of Affected Regions
CDC has identified human cases of swine influenza A (H1N1) virus infection in people and is working with local and state health agencies to investigate these cases. We have determined that this virus is contagious and is spreading from human to human. As with any infectious disease, we are recommending precautionary measures for people residing in affected areas.

• Cover your nose and mouth with a tissue when you cough or sneeze.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Try to avoid close contact with sick people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
• Avoid touching your eyes, nose or mouth. Germs spread that way.

There is no vaccine available at this time, so it is important for people living in affected areas to take steps to prevent spreading the virus to others. If people are ill, they should attempt to stay at home and limit contact with others.

People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed.

What medications are available to treat swine flu infections in humans?
There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. While most swine influenza viruses have been susceptible to all four drugs, the most recent seven swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses. More information on treatment recommendations can be found at www.cdc.gov/flu/swine/recommendations.htm.

Who does CDC recommend receive oseltamivir and zanamivir medication?
Interim guidance from CDC recommends treatment be considered for confirmed, probably, or suspected cases of swine influenza A (H1N1) infection, with priority to hospitalized patients and patients at higher risk for influenza complications. Treatment should begin as soon as possible after the onset of symptoms.

CDC interim guidance also recommends pre-exposure and post-exposure treatment with oseltamivir or zanamivir for specific populations, including:

1. Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed, probable or suspected case.
   
2. School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.
   
3. Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women).
   
4. Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an ill confirmed, probable, or suspect case of swine influenza A (H1N1) virus infection during the case′s infectious period.

In addition, pre-exposure treatment may be considered for:

1. Any health care worker who is at high-risk for complications of influenza who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.
   
2. Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
   

What is the Strategic National Stockpile (SNS)?
CDC's Strategic National Stockpile (SNS) has large quantities of medicine and medical supplies to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquake) severe enough to cause local supplies to run out. Once Federal and local authorities agree that the SNS is needed, medicines will berapidlydelivered to any state in the U.S.Each state has plans to receive and distribute SNS medicine and medical supplies to local communities as quickly as possible.

How is the Strategic National Stockpile (SNS) being used?
CDC has released 25 percent of states and localities allocation of SNS held antiviral drugs, personal protective equipment, and respiratory protection devices. All states have requested supplies from the stockpile and CDC is working with states on the distribution of supplies. This step will enable states to have the supplies on hand locally should they be needed.

What is CDC doing to develop a vaccine for the virus?
As a precautionary step, CDC is working with this virus to prepare it as a vaccine seed strain should there be a need to make a vaccine against this particular virus. CDC is also working with partners across the government to understand the virus.

Can people get swine flu by eating pork?
Swine flu viruses are not transmitted through food, so you cannot get swine flu from eating pork or pork products. Cooking pork to an internal temperature of 160°F kills viruses and other foodborne pathogens.

Does CDC recommend the use of masks or respirators?
If used correctly, facemasks and respirators may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene. A respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through a respirator for long periods of time. More information on facemasks and respirators can be found at www.cdc.gov/swineflu.

When crowded settings or close contact with others cannot be avoided, the use of facemasks or respirators in areas where transmission of swine influenza A (H1N1) virus has been confirmed should be considered as follows:

1. Whenever possible, rather than relying on the use of facemasks or respirators, close contact with people who might be ill and being in crowded settings should be avoided.
   
2. Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others; the time spent in crowded settings should be as short as possible.
   
3. Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (e.g., family member with a respiratory infection) at home.

Identification and Confirmation of Infections

What is CDC′s role in evaluating possible swine flu infections?
CDC is collaborating with clinicians and state and local health departments to identify and confirm swine flu virus infections. State public health laboratories generally conduct initial laboratory tests and are being asked to send all unsubtypable influenza A specimens to CDC for further diagnostic testing. CDC has also provided guidance for clinicians with patients presenting with possible swine flu infection. Clinicians are asked to obtain a respiratory swab for swine influenza testing. Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.

How can human infections with swine influenza be diagnosed?
To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some people, especially children, may shed virus for 10 days or longer. Identification ofswine influenza A virus requires sending the specimen to CDC for laboratory testing at this time.

Travel Recommendations

On April 27th, CDC recommended that travelers avoid all non-essential travel to Mexico. CDC is providing recommendations to reduce risk of infection and help travelers stay healthy. Information is available at: http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx.

HHS and CDC Roles

CDC is actively responding to and investigating the current outbreak of swine influenza.
CDC has fully activated its Emergency Operations Center. In addition to response and laboratory activities described above, staff have been deployed to California, Texas, and Mexico to assist with the public health investigation. 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.

As a part of the U.S. Department of Health and Human Services (HHS), CDC is coordinating and communicating closely with HHS officials. On April 26th, as a consequence of confirmed cases of Swine Influenza A (H1N1) in California, Texas, Kansas, and New York and after consultation with public health officials, including CDC, the Acting Secretary of HHS, Charles Johnson, declared a national public health emergency involving Swine Influenza A.

HHS, in turn, is closely coordinating with other state, local and Federal Agencies, including Department of Homeland Security, Department of Agriculture, and Department of State; and our international counterparts.

For more information regarding CDC′s swine flu activities, go to: http://www.cdc.gov/h1n1flu/

Pandemic Planning Investments at Work

In recent years, CDC has received congressional appropriations pandemic influenza activities.

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 swine flu 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 swine influenza cases and CDC′s related activities. CDC is providing daily updates on our Web site. Information is available at: http://www.cdc.gov/flu/swine/investigation.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 swine 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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