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2009-H1N1 Flu - Congressional Update

Centers for Disease Control and Prevention

May 07, 2009-H1N1 Flu - Congressional Update

We are providing this document to help inform Congress and congressional staff about the current status of the Novel 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 7, 2009 11:00 AM ET, a total of 896 confirmed human cases of Novel 2009 H1N1 flu have been identified in the United States in 41 states. Forty-two cases, approximately 5% of confirmed cases, have been hospitalized. There are 35 known hospitalizations among confirmed cases in 14 states. There are 925 additional probable cases are currently being analyzed. There have been two deaths from Novel 2009 H1N1 flu, both occurred in Texas. 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 Novel 2009 H1N1 flu.

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.

U.S. Human Cases of Novel 2009 H1N1 Flu Infection
(As of May 7, 2009 11:00 AM ET)
State
# of laboratory confirmed cases
# deaths reported among laboratory confirmed cases
Alabama
4
-
Arizona
48
-
California
106
-
Colorado
17
-
Connecticut
4
-
Delaware
38
-
Florida
5
-
Georgia
3
-
Hawaii
3
-
Idaho
1
-
Illinois
204
-
Indiana
15
-
Iowa
5
-
Kansas
7
-
Kentucky*
2
-
Louisiana
7
-
Maine
4
-
Maryland
4
-
Massachusetts
71
-
Michigan
9
-
Minnesota
1
-
Missouri
4
-
Nebraska
4
-
Nevada
5
-
New Hampshire
2
-
New Jersey
7
-
New Mexico
8
-
New York
98
-
North Carolina
7
-
Ohio
5
-
Oklahoma
1
-
Oregon
15
-
Pennsylvania
2
-
Rhode Island
2
-
South Carolina
17
-
Tennessee
2
-
Texas
91
2
Utah
8
-
Virginia
11
-
Washington
23
Wisconsin
26
-
Total Count
896 cases
2 deaths
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 Novel 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 of May 7, 2009 6:00 PM GMT, the Government of Mexico has reported 1112 laboratory confirmed cases, including 42 deaths, of Novel 2009 H1N1 flu. The higher number of cases in Mexico reflects ongoing testing of previously collected specimens.

As of May 7, 2009 6:00 PM GMT, the World Health Organization reported laboratory confirmed cases of Novel 2009 H1N1 flu with no deaths in the following countries: Austria (1), Canada (201), China, Hong Kong Special Administrative Region (1), Columbia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (10), Guatemala (1), Ireland (1), Israel (6), Italy (5), Netherlands (2), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (81), Sweden (1), Switzerland (1) and the United Kingdom (32).


International Human Cases of Novel 2009 H1N1 Flu Infection
(As of May 7, 2009 6:00 PM GMT)
Country
# of laboratory confirmed cases reported by country with cases
# of deaths reported among laboratory confirmed cases
Austria
1
-
Canada
201
-
China, Hong Kong, Special Administrative Region
1
-
Columbia
1
-
Costa Rica
1
-
Denmark
1
-
El Salvador
2
-
France
5
-
Germany
10
-
Guatemala
1
-
Ireland
1
-
Israel
6
-
Italy
5
-
Mexico
1112
42
Netherlands
2
-
New Zealand
5
-
Poland
1
-
Portugal
1
-
Republic of Korea
3
-
Spain
81
-
Sweden
1
-
Switzerland
1
-
United Kingdom
32
-
Total Count
1475 cases
42 deaths
Source: World Health Organization (http://www.who.int/csr/don/2009_05_07a/en/index.html)

Background Information About Novel 2009 H1N1 Flu

New influenza vaccine production facility approved
The U.S. Food and Drug Administration (FDA) has approved a new manufacturing facility to produce influenza vaccines. If a decision is made to produce a vaccine for the Novel 2009 H1N1 virus, the facility could be used. This would bring the number of manufacturers in the U.S. with the ability to produce the vaccine to five. More information is available at: FDA Approves New Influenza Vaccine Production Facility

New publications on Novel 2009-H1N1 flu
The Morbidity and Mortality Weekly Report (MMWR) published an article on the current global picture of Novel 2009-H1N1. The article, Update: Novel Influenza A (H1N1) Virus Infections --- Worldwide, May 6, 2009, is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5817a1.htm?s_cid=mm5817a1_e

The New England Journal of Medicine published an article by CDC authors, Human Infections with Triple-Reassortant Swine Influenza A (H1) Viruses in the United State, 2005-2009, on the ten cases of swine associated H1N1 that occurred during the past four years. The article will be available at: http://www.nejm.org/ and concludes that from December 2005 until just before the current human epidemic of swine-origin influenza viruses, there was sporadic infection with triple-reassortant swine influenza A (H1) viruses in persons with exposure to pigs in the United States. Although all the patients recovered, severe illness of the lower respiratory tract and unusual influenza signs such as diarrhea were observed in some patients, including those who had been previously healthy.

The New England Journal of Medicine published an article by CDC authors, Emergency of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans, reviewing the first 241 cases of Novel 2009-H1N1 in the United States. The article will be available at: http://www.nejm.org/ and concludes a novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.

What is CDC doing to evaluate the risk of Novel 2009 H1N1 flu for healthcare workers?
CDC is continuing to evaluate the risk of Novel 2009 H1N1 flu for healthcare workers. We hope to gain a better understanding of the dynamics and whether there are particular practices that put healthcare workers at additional risk. As additional information is gathered, CDC guidance for healthcare workers will be updated as appropriate.

Guidance Documents

CDC has and continues to develop a number of guidance documents related to Novel 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 Novel 2009 H1N1 flu. All current guidance documents are available at: Novel 2009 H1N1 Flu Guidance. Guidance documents include:

Identification and Confirmation of Infections

What is CDC′s role in evaluating possible Novel 2009 H1N1 flu infections?
CDC is collaborating with clinicians and state and local health departments to identify and confirm Novel 2009 H1N1 flu virus infections. CDC has also provided guidance for clinicians with patients presenting with possible Novel 2009 H1N1 flu infection. Clinicians are asked to obtain a respiratory swab for Novel 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. A growing number of states are 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.

CDC is also assisting with the confirmation of cases of Novel 2009-H1N1 worldwide through the distribution of testing kits. Requests for testing kits have been received from 131 countries and kits have been provided to 78 countries thus far. CDC continues to work to provide kits to additional countries to increase their capacity to conduct laboratory confirmation of Novel 2009-H1N1 cases.

HHS and CDC Roles

CDC is actively responding to and investigating the current outbreak of Novel 2009 H1N1 flu.
CDC has fully activated its Emergency Operations Center. In addition to response and laboratory activities described above, 93 staff have been deployed in the U.S. and Mexico to assist with the public health investigation. Staff are currently in California, Delaware, Illinois, New York City, Texas, Washington DC, and at U.S. 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 Novel 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 Novel 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 Novel 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 Novel 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 Novel 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 Novel 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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