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2009-H1N1 Flu - Congressional Update

Centers for Disease Control and Prevention

May 04, 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 May 4, 2009 11:00 AM ET, a total of 286 confirmed human cases of 2009–H1N1 flu have been identified in the United States in 36 states.  The average age of cases is 16 and range from 3 months to 81 years; 62 percent of cases are under age 18. There are 35 known hospitalizations. Over 700 additional probable cases in 44 states are currently being analyzed. The total number of cases reported likely represents an underestimation of the actual total number of cases because in order for a case to be confirmed and reported infected individuals must visit a healthcare provider with flu–like symptoms and be tested for 2009–H1N1 flu. 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/index.php?template–regional_links.php under State H1N1 Information.

U.S. Human Cases of 2009–H1N1 Flu Infection
(As of May 4, 2009 11:00 AM ET)
State
# of laboratory confirmed cases
# deaths reported among laboratory confirmed cases
Alabama
4
–
Arizona
17
–
California
30
–
Colorado
7
–
Connecticut
2
–
Delaware
20
–
Florida
5
–
Idaho
1
–
Illinois
8
–
Indiana
3
–
Iowa
1
–
Kansas
2
–
Kentucky*
1
–
Louisiana
14
–
Maryland
4
–
Massachusetts
6
–
Michigan
2
–
Minnesota
1
–
Missouri
1
–
Nebraska
1
–
Nevada
1
–
New Hampshire
1
–
New Jersey
7
–
New Mexico
1
–
New York
73
–
North Carolina
1
–
Ohio
3
–
Oregon
3
–
Pennsylvania
1
–
Rhode Island
1
–
South Carolina
15
–
Tennessee
1
–
Texas
41
1
Utah
1
–
Virginia
3
–
Wisconsin
3
–
Total Count
286 cases
1 death
Source: CDC (http://www.cdc.gov/h1n1flu/)
* Case is a resident of Kentucky but currently hospitalized in Georgia.

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 May 4, 2009 6:00 PM GMT, the Government of Mexico has reported 590 laboratory confirmed cases, including 25 deaths, of 2009–H1N1 flu. The higher number of cases in Mexico reflects ongoing testing of previously collected specimens.

As of May 4, 2009 6:00 PM GMT, the World Health Organization reported laboratory confirmed cases of 2009–H1N1 flu with no deaths in the following countries: Austria (1), Canada (101), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (4), Germany (8), Ireland (1), Israel (4), Italy (2), Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (1), Spain (54), Switzerland (1) and the United Kingdom (18).


International Human Cases of 2009–H1N1 Flu Infection
(As of May 4, 2009 6:00 AM GMT)
Country
# of laboratory confirmed cases reported by country with cases
# of deaths reported among laboratory confirmed cases
Austria
1
–
Canada
101
–
China, Hong Kong, Special Administrative Region
1
–
Costa Rica
1
–
Columbia
1
–
Denmark
1
–
El Salvador
2
–
France
4
–
Germany
8
–
Ireland
1
–
Israel
4
–
Italy
2
–
Mexico
590
25
Netherlands
1
–
New Zealand
6
–
Portugal
1
–
Republic of Korea
1
–
Spain
54
–
Switzerland
1
–
United Kingdom
18
–
Total Count
799 cases
25 deaths
Source: World Health Organization (http://www.who.int/csr/don/2009_05_04a/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.  A laboratory with the ability to conduct 2009–H1N1 flu confirmation is now operational in Mexico.  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.

On April 30, 2009 an article describing the outbreak in Mexico was published in the Morbidity and Mortality Weekly Report (MMWR) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a2.htm?s_cid=mm58d0430a2_e). 

Background Information About 2009–H1N1 Flu

Background information on 2009–H1N1 flu:

Most recent updates to information from CDC on 2009–H1N1 flu:

Information for individuals and parents on 2009–H1N1 flu:

Travel notices related to 2009–H1N1 flu:

Information on 2009–H1N1 flu and pork

Resources and Information in Spanish:

What medications are available to treat swine flu infections in humans?
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. Information on influenza antiviral drugs, including oseltamivir and zanamivir is available from the Food and Drug Administration at: http://www.fda.gov/cder/drug/antivirals/influenza/default.htm

Water Safety
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of the novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza–contaminated drinking water.

Can the novel H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Recreational water that has been treated at CDC recommended disinfectant levels (13 parts per million [ppm or mg/L] for pools and 25 ppm for spas) does not likely pose a risk for transmission of influenza viruses. Currently, there are no documented human cases of influenza caused by exposure to influenza–contaminated swimming pool water. No research has been completed on the susceptibility of the novel H1N1 flu virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC are adequate to disinfect highly pathogenic H5N1 avian influenza virus. It is likely that other influenza viruses such as the novel H1N1 flu virus would also be disinfected by these chlorine levels.

2009–H1N1 Virus on Surfaces
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.

How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2–8 hours after being deposited on the surface.

What kills influenza virus?
Influenza virus is destroyed by heat (167–212F [75–100C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine–based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

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 and localities (localities include D.C., 8 U.S territories, New York City, Los Angeles, and Chicago) have requested supplies from the stockpile and CDC is working with states on the distribution of supplies.  As of May 4, 2009, distribution is complete in 60 of the 62 states and localities scheduled to receive supplies. HHS Secretary Kathleen Sebelius announced on April 30th, 2009 that the Federal government will purchase an additional 13 million treatment courses to help fight influenza, including the 2009 H1N1 flu virus. The additional treatment courses will be added to the Strategic National Stockpile. The Secretary also announced that HHS began moving 400,000 treatment courses to Mexico to help slow the spread of the H1N1 virus.
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. No shortages of antiviral drugs have been reported. 

Who is in charge of medicine in the Strategic National Stockpile (SNS) once it is deployed?
Local health officials have full control of SNS medicine once supplies are deployed to a city, state, or territory. Federal, state, and local community planners are working together to ensure that SNS medicines will be delivered to the affected area as soon as possible. Most cities, states, and territories have already received SNS supplies. After CDC sends medicine to a state or city, control and distribution of the supply is at the discretion of that state or local health department. Most states and cities also have their own medicines that they can access to treat infected persons.

Guidance Documents

CDC has and continues to develop a number of guidance documents related to 2009–H1N1 flu. The documents target a variety of clinical, professional, and individual audiences. The guidance documents are regularly updated as CDC continues to learn more about 2009–H1N1 flu. All current guidance documents are available at: 2009–H1N1 Flu Guidance. Guidance documents include:

Guidance for Pregnant and Breastfeeding Women

Clinician Guidance for Patients

Clinician Guidance for Specific Audiences

Screening & Specimen Collection

Treatment Guidance

Laboratories

Travel & Travel Industry Guidance

Emergency Personnel Guidance

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.  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. CDC has distributed diagnostic test kits to states to enable state laboratories to confirm cases directly. Texas and California are currently able to confirm cases in their states. CDC is working with additional states to ensure testing kits are functioning properly before they begin confirming cases independently and reporting information back to CDC, as is generally done for seasonal flu. Once states begin employing independent confirmation testing, the number of samples being tested will increase and may result in a rapid increase in case count. Some of this will likely be due to more widespread infection, but some of it may result from an increase in testing capacity and laboratory results.

Major investments in state laboratory capacity over the last five years have enhanced capabilities such that the confirmation testing can be conducted at the state level with distribution of testing kits.

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.

Travel and Border Control

What travel warnings have 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.

Where can I obtain information on quarantine stations?
A fact sheet with background information on the U.S. quarantine stations located at 20 ports of entry and land–border crossings is available at: Quarantine Stations Fact Sheet.

What is the WHO recommending concerning world travel?
WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts of the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community. See http://www.who.int/csr/disease/swineflu/guidance/public_health/travel_advice/en/index.html

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, 81 staff have been deployed in the U.S. and Mexico to assist with the public health investigation.  Deployment of 35 additional personnel is in process.  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.


CDC′s Pandemic Influenza Appropriations
Fiscal Year
Amount
2007
$70,000,000
2008
$154,632,000
2009
$156,046,000
Total Appropriations
$380,678,000

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/h1n1flu/index.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/index.php?template–regional_links.php under State H1N1 Information.

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