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Centers for Disease Control and Prevention

April 29, 2009-H1N1 Flu - Congressional Update

We are providing this document to help inform Congress and congressional staff about the current status of the 2009-H1N1 flu 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 29, 2009 11:00 AM ET, a total of 91 confirmed human cases of 2009-H1N1 flu have been identified in the United States. Additional possible cases are currently being analyzed.  There has been one death from 2009-H1N1 flu in Texas.  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.

International Update

The World Health Organization (WHO) is providing information on international 2009-H1N1  flu 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. 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 4 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 28, 2009, the Government of Mexico has reported 26 laboratory confirmed cases of 2009-H1N1 flu. 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 28 2009, the World Health Organization reported laboratory confirmed cases of 2009-H1N1 flu with no deaths in the following countries: Austria (1), Canada (13), Germany (3), New Zealand (3), the United Kingdom (5), Israel (2) and Spain 4).

International Human Cases of 2009-H1N1 Flu Infection (As of April 28, 2009)
Country	# of laboratory confirmed cases reported by country with cases	# of deaths reported among laboratory confirmed cases
Austria	1 case	Â
Canada	13 cases	-
Israel	2 cases	-
Germany	3 cases	-
Mexico	26 cases	7 deaths
New Zealand	3 cases	-
Spain	4 case	-
United Kingdom	5 cases	-
Total Count	57 cases	7 deaths
Source: World Health Organization (http://www.who.int/csr/don/2009_04_29/en/index.html)

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 2009-H1N1 flu 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 2009-H1N1 Flu

Background information on 2009-H1N1 flu:

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

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

Most recent updates to information from CDC on 2009-H1N1 flu: http://www.cdc.gov/h1n1flu/whatsnew.htm

Guidance for professionals on 2009-H1N1 flu:

http://www.cdc.gov/h1n1flu/guidance/

Information for individuals on 2009-H1N1 flu:

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

Travel notices related to 2009-H1N1 flu:

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

Information on 2009-H1N1 flu and pork

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

http://www.cdc.gov/h1n1flu/pdf/brochure.pdf (2 pages)

2009-H1N1 Flu Vaccine

Does the seasonal flu vaccine protect against 2009-H1N1 flu?
No. The 2009-H1N1 flu viruses are very different from human H1N1 viruses and, therefore, vaccines for human seasonal flu would not provide protection from 2009-H1N1 flu viruses.

How long will it take to develop a vaccine?

Currently, FDA and the Centers for Disease Control and Prevention are developing virus reference strains, which provide information about a virus that is necessary to develop a vaccine. These strains should be distributed to approved vaccine manufacturers in a matter of months and production of the vaccine could begin as early as this summer.

As the vaccine is manufactured, the National Institutes of Health will also conduct clinical trials to determine the best vaccine dosage and formulation. The Food and Drug Administration will monitor the manufacturing of this vaccine and conduct strict oversight to ensure the vaccine is effective and safe for use. HHS anticipates that this vaccine will be ready for the public later this year, perhaps as early as the Fall.

Who determines whether to manufacture 2009-H1N1 vaccine?

Ultimately, this decision will be made by the U.S. Department of Health and Human Services (HHS) Secretary with input from the HHS Assistant Secretary for Preparedness and Response (ASPR), the Enterprise Governance Board, and the Countermeasure Steering Committee, who will advise on scientific, public health, contractual and budgetary considerations. 

Finally, lessons learned from past experience remind that the development of a vaccine is a separate decision from the decision to begin a mass immunization program.  This reinforces the need to build and require formal periodic assessments and reevaluation.

Strategic National Stockpile

Where can I learn about the Strategic National Stockpile?

http://emergency.cdc.gov/stockpile/

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. This includes 11 million courses of treatment with antiviral drugs.  All states have requested supplies from the stockpile and CDC is working with states on the distribution of supplies.  Distribution of antiviral drugs and supplies is prioritized to states with confirmed cases of 2009-H1N1 flu. It is anticipated that all of the 25 percent of the antiviral drug courses will be deployed by May 3, 2009. This step will enable states to have medications and supplies on hand locally should they be needed. In addition, individual state stockpiles are available for use at the discretion of the states.

Community Mitigation

What guidance does CDC have for states and communities with active 2009-H1N1 flu infections?

CDC has developed interim planning guidance for state, territorial, tribal, and local communities that focuses on several nonpharmaceutical measures that might be useful during this outbreak of 2009-H1N1 flu virus. The guidance will be updated as necessary as the situation evolves. The guidance is available at: http://www.cdc.gov/h1n1flu/mitigation.htm.

The guidance provides information on home isolation of infected persons, recommendations for household contacts of infected persons, guidance regarding school dismissal and childcare facility closure, and information on social distancing interventions.

What does CDC recommend regarding the closure of schools and childcare facilities?

CDC recommends that schools with a confirmed or suspected case epidemiologically linked to a confirmed case strongly consider dismissal of students.  Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of influenza like illness in the community.  If the school dismisses students or a childcare facility closes they should also cancel all school or childcare related gatherings and encourage parents and students to avoid congregating outside of the school.  

Schools and childcare facilities should dismiss students for a time period to be evaluated on an ongoing basis depending upon epidemiological findings.  When a school or childcare facility closes, they should consult with their local or state health departments for guidance on reopening.  If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.

In addition, schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure. This includes asking teachers, parents and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

What does CDC recommend regarding large gatherings?

Large gatherings linked to settings or institutions with laboratory-confirmed cases should be cancelled, for example a school event linked to a school with cases. Other large gatherings in the community may not need to be cancelled at this time. Additional social distancing measures are currently not recommended. Persons with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings.

Identification and Confirmation of Infections

What is CDC′s role in evaluating possible 2009-H1N1 flu infections?

CDC is collaborating with clinicians and state and local health departments to identify and confirm 2009-H1N1 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 2009-H1N1 flu infection. Clinicians are asked to obtain a respiratory swab for 2009-H1N1 flu 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 2009-H1N1 influenza be diagnosed?
To diagnose 2009-H1N1 flu 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 of 2009-H1N1 flu virus requires sending the specimen to CDC for laboratory testing at this time.

Travel and Border Control

What travel warnings has CDC issued?

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.

What is being done to protect travelers and flight crews from 2009-H1N1 flu infections?

CDC has issued guidance to assist airline flight deck and cabin crew members in identifying passengers that may have 2009-H1N1 flu.  The guidance is available at: http://www.cdc.gov/h1n1flu/aircrew.htm. CDC also issued guidance for airlines regarding flight crews returning from areas with 2009-H1N1 infections, available at: http://www.cdc.gov/h1n1flu/guidance/air-crew-dom-intl.htm.

The U.S. Department of Homeland Security (DHS) Customs and Border Protection (CBP) is monitoring incoming travelers to identify individuals experiencing symptoms entering the U.S. and is providing information about the 2009 H1N1 flu virus to travelers. Information is being provided to passengers arriving from areas with 2009-H1N1 infections regarding symptoms and steps to take if they develop symptoms.  This information is available at: http://wwwn.cdc.gov/travel/fileSwineFluPassengers.ashx.

White House Funding Request

On April 28, 2009 President Obama asked Congress to include in the fiscal year 2009 supplemental budget request an amount of $1.5 billion to enhance our nation's capability to respond to the potential spread of the current 2009-H1N1 flu virus. His letter requested that these funds be provided with maximum flexibility to allow the U.S. Government to address this emerging situation and that uses could include supplementing antiviral stockpiles, developing a vaccine, supporting the monitoring, diagnostic and public health response capabilities, and assisting international efforts to stem this outbreak.

HHS and CDC Roles

CDC is actively responding to and investigating the current outbreak of 2009-H1N1 flu.

CDC has fully activated its Emergency Operations Center. In addition to response and laboratory activities described above, staff have been deployed to California, Texas, New York City, and Mexico to assist with the public health investigation. In addition, CDC is working to deploy 25 personnel to 13 Quarantine stations.  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 2009-H1N1 flu 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 2009-H1N1 flu.

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 2009-H1N1 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 2009-H1N1 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 2009-H1N1 flu 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 2009-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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