Centers for Disease Control and Prevention

May 08, 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 8, 2009 11:00 AM ET, a total of 1639 confirmed human cases of novel Influenza A (H1N1) have been identified in the United States in 42 states and the District of Columbia. Fifty-seven cases, approximately 3.5% of confirmed cases, have been hospitalized. The median age is 14 and range from 1 to 87 years. There are approximately 850 additional probable cases are currently being analyzed. There have been two deaths from novel Influenza A (H1N1), 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.

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 8, 2009 4:00 PM GMT, the Government of Mexico has reported 1204 laboratory confirmed cases, including 44 deaths, of novel Influenza A (H1N1). The higher number of cases in Mexico reflects ongoing testing of previously collected specimens.

As of May 8, 2009 4:00 PM GMT, the World Health Organization reported laboratory confirmed cases of novel Influenza A (H1N1) with no deaths in the following countries: Austria (1), Brazil (4), Canada (214), China, Hong Kong Special Administrative Region (1), Columbia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (6), Netherlands (3), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (88), Sweden (1), Switzerland (1) and the United Kingdom (34).

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	-
Brazil	4	-
Canada	214	-
China, Hong Kong, Special Administrative Region	1	-
Columbia	1	-
Costa Rica	1	-
Denmark	1	-
El Salvador	2	-
France	12	-
Germany	11	-
Guatemala	1	-
Ireland	1	-
Israel	7	-
Italy	6	-
Mexico	1204	44
Netherlands	3	-
New Zealand	5	-
Poland	1	-
Portugal	1	-
Republic of Korea	3	-
Spain	88	-
Sweden	1	-
Switzerland	1	-
United Kingdom	34	-
Total Count	1604 cases	44 deaths
Source: World Health Organization (http://www.who.int/csr/don/2009_05_08a/en/index.html)

Background Information About Novel 2009 H1N1 Flu

Background information on Novel 2009 H1N1 flu:

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

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

• http://www.cdc.gov/h1n1flu/whatsnew.htm
  

Information for individuals and parents on Novel 2009 H1N1 flu:

• http://www.cdc.gov/h1n1flu/sick.htm
  
• http://www.cdc.gov/h1n1flu/parents.htm
  
• http://www.cdc.gov/h1n1flu/talkingtokids.htm
  
  

Travel notices related to Novel 2009 H1N1 flu:

• http://wwwn.cdc.gov/travel/
  

Information on Novel 2009 H1N1 flu and pork

• http://www.cdc.gov/h1n1flu/key_facts.htm
  
• http://www.cdc.gov/h1n1flu/pdf/brochure.pdf, (1 page)
  
• http://www.who.int/mediacentre/news/statements/2009/h1n1_20090430/en/index.html
  

Resources and Information in Spanish:

• http://www.cdc.gov/h1n1flu/espanol/influenza-porcina-info-general.htm
  
• http://www.cdc.gov/h1n1flu/espanol/psa/
  

What is CDC′s recommendation regarding “swine flu parties?”
“Swine flu parties” are gatherings during which people have close contact with a person who has novel Influenza A (H1N1) in order to become infected with the virus. The intent of these parties is to become infected with what for many people has been a mild disease, in the hope of having natural immunity to the novel Influenza A (H1N1) virus that might circulate later and cause more severe disease.

“Swine flu parties” are not a safe or effective way to protect against novel Influenza A (H1N1) in the future. While the disease seen in the current novel Influenza A (H1N1) outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel Influenza A (H1N1) avoid contact with others as much as possible. They should stay home from work or school for 7 days after the onset of illness or until at least 24 hours after symptoms have resolved, whichever is longer.

New Materials to Assist Tribal Nations
CDC released a brochure, Preparing Tribal Nations to Receive Strategic National Stockpile Assets targeting American Indian and Alaska Native government leaders. The brochure is available at: http://www.cdc.gov/h1n1flu/pdf/preparing_tribal_national_stockpile.pdf, (2 pages).

Resources for Businesses and Employers
CDC has developed a Web site with resources for businesses and employers. The Web site includes guidance documents, podcasts and other resources developed by CDC to help prevent the further spread of this new virus available at: http://www.cdc.gov/h1n1flu/business/.

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:

Guidance for Schools, Colleges and University

• Update on School (K – 12) and Childcare Facilities
  
• Alert for Institutions of Higher Education
  

Guidance for Pregnant and Breastfeeding Women

• Breastfeeding Your Baby: What Parents Should Know.
  
• Information for Pregnant Women in Education, Child Care, and Health Care.
  
• What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus
  

Clinician Guidance for Patients

• Patients With Cardiovascular Disease.
  
• Caring for a Sick Person in Your Home
  
• Identifying and Caring For Patients
  
• Infection Control for Patients In a Healthcare Setting
  

Clinician Guidance for Specific Audiences

• Patients With Cardiovascular Disease.
  
• HIV-Infected Adults and Adolescents
  
• Pregnant Women.
  
• Young Children
  

Screening & Specimen Collection

• Guidelines for the Submission of Tissue Specimens for the Pathologic Evaluation of Influenza Virus Infections
  
• Case Definitions for Investigations of Cases
  
• Screening in Regions with Few or no Reported Cases
  
• Specimen Collection, Processing, and Testing for Suspected Infection
  
• Biosafety Guidelines for Lab Workers
  

Treatment Guidance

• Key Mental and Behavioral Health Issues Related to Social Distancing For State, Local, And Tribal Health Departments And Community Based Organizations
  
• Antiviral Recommendations
  
• Facemask and Respirator Use
  
• Emergency Use Authorization (EUA) of Medical Products
  
• Patients With Cardiovascular Disease
  

Laboratories

• Use of Rapid Influenza Diagnostic Tests
  
• Protocol for Antiviral Susceptibility Testing by Pyrosequencing
  
• Sequencing Primers and Protocol
  
• CDC Protocol of Realtime RTPCR for Swine Influenza A(H1N1)
  
  

Travel & Travel Industry Guidance

• Guidance for Cruise Ships
  
• Flight Crews Arriving from Affected Areas
  
• Identifying Passengers Who May Have Swine Influenza
  

Emergency Personnel Guidance

• EMS and 9-1-1 Personnel: Managing Confirmed or Suspected Infections
  
  

Protection of Migrant Farm Workers

• Guidance for Employers
  

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.
In addition to response and laboratory activities described above, 96 staff have been deployed in the U.S., Mexico, and Guatemala 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.

An example of CDC′s response is the use of new communications modes to inform the public. Through its National Center for Health Marketing, CDC is using social media (www.cdc.gov/socialmedia) to provide H1N1 flu-related information when, where and how Americans want it. Ongoing social media activities include: posting information to CDC Facebook, MySpace, and DailyStrength social networking profiles; posting videos and podcasts to the CDC YouTube Channel; reaching out to blog writers to ensure credible information is being shared in blogs; sending email updates to users who have subscribed to receive information about the flu; developing widgets so that CDC flu information can be posted on other Web sites and blogs; and providing updated information to mobile phones. Congressional offices can point constituents to these interactive tools to get information, including:

• Signing up for email updates, RSS feeds, or Twitter to getting alerts about updated H1N! Flu information on CDC.gov
• Listening to podcasts and subscribing to podcast series on Flu information
• Watching videos on Flu and tips for prevention on CDC TV and CDC′s YouTube channel
• Visiting any of CDC′s social networks: Facebook, MySpace, or DailyStrength
• Adding a widget and/or a Web image to your Web page or personal blog

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.

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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