Centers for Disease Control and Prevention (CDC) American Red Cross Employee / Volunteer Updates Update

[Guest guest]

Dear

Colleagues,

I

think that we can all welcome this good news regarding the decreased activity

of H1N1 in the US.

I

have heard from several of you that this experience on the front line did not

go as well as you would have liked, with delays in accessing testing supplies,

respirators and therapeutics as well as excessive delays on return reports on

test results.

Given

the reality that this experience may have been a dress rehearsal for next fall’s

flu season, I am interested in knowing more about your experiences.

Please

feel free to send them to me individually at Ryder@...,

or respond to the e-group by hitting “reply” to this email if you

would like to engage in a dialog among peers.

I

look forward to hearing from you. Your input will be helpful in

determining what kind of partnerships we need to begin forming now, in order to

be prepared for next fall.

Bobbi

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Mendoza , Assistant

(512) 312-2600

www.ncfh.org

From: Centers for Disease

Control & Prevention [mailto:cdc@...]

Sent: Friday, June 05, 2009 12:47 PM

ryder@...

Subject: Centers for Disease Control and Prevention (CDC) American Red

Cross Employee / Volunteer Updates Update

You are

subscribed to H1N1 influenza updates from Centers for Disease Control and

Prevention (CDC). This information has recently been updated, and is now

available.

FluView

Influenza Activity Update

·

Influenza

illness, including illness associated with the novel influenza A (H1N1) virus

is ongoing in the United States.

·

During week 21

(May 24 - 30, 2009), the May 29 FluView Report shows that influenza

activity decreased in the United States overall; however, there are still

higher levels of influenza-like illness than is normal for this time of year

and novel H1N1 outbreaks are ongoing in parts of the United States, in some

cases with intense activity.

31.1% of

specimens tested by U.S. World Health Organization (WHO) and National

Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating

laboratories and reported to CDC/Influenza Division were positive for

influenza.

This

percentage is what is often seen at the peak of the influenza season and

is very unusual for this time of year.

The increase

in the percentage of specimens testing positive for influenza by WHO and

NREVSS collaborating laboratories may be due in part to changes in

testing practices by health care providers, triaging of specimens by

public health laboratories, an increase in the numbers of specimens

collected from outbreaks, and other factors.

·

Novel H1N1

viruses now make up approximately 82% of all influenza viruses analyzed by the

U.S. WHO/NREVSS collaborating laboratories.

·

Overall the

nationwide level of outpatient visits to providers for influenza-like-illness

is below the national baseline.

·

Three of the 10

surveillance regions reported an influenza-like illness percentage above their

region specific baseline (Regions I, II and X).

o Region I: Connecticut, Maine, Massachusetts,

New Hampshire, Rhode Island and Vermont.

o Region II: New Jersey, New York,

Puerto Rico, and the U.S. Virgin Islands.

o

Region X: Alaska, Idaho, Oregon, and

Washington State.

·

Increases in

ILI in regions II and X likely represent increases in influenza activity in

large cities in those regions, such as New York City and Seattle/King County,

which are experiencing community outbreaks of novel H1N1. The increase in ILI

in region I cannot be explained by an increase in ILI in any one city, but

appears to represent an overall increase in ILI in the states within that

region.

·

Influenza-like

illness increased during week 21 in six of 10 regions compared to week

20.

·

Despite the

overall downward trend, localized outbreaks – in some cases with intense

influenza-like activity – are ongoing in some places.

Schools in some states continue to

close as a result of novel H1N1 flu activity based on local

considerations.

·

Five states in

the U.S. are reporting widespread influenza activity; nine states are reporting

regional influenza activity; 14 states and the District of Columbia are

reporting local influenza activity; 21 states are reporting sporadic activity;

and one state did not report.

·

The five states

reporting widespread influenza activity are Arizona, Delaware, New Jersey, Pennsylvania

and Virginia. (This is up from four states during week 20).

·

It is very

unusual for this time of year to still be having so many states reporting

regional and widespread activity.

·

The proportion

of deaths attributed to pneumonia and influenza (P & I) was below the

epidemic threshold.

·

Five

influenza-associated pediatric deaths were reported during Week 21.

o Three of these deaths were

associated with confirmed infections with novel influenza A (H1N1) viruses.

o One was confirmed as

seasonal influenza A (H1), and one was confirmed as influenza A virus of

unknown subtype.

o These deaths occurred between

February 8, 2009 and May 26, 2009.

·

Since September

28, 2008, CDC has received 67 reports of laboratory confirmed

influenza-associated pediatric deaths that occurred during the 2008-09

influenza season. (More information on pediatric deaths is provided in a

section below.)

·

It’s

uncertain at this time how severe this novel H1N1 outbreak will be over the

next weeks in terms of how many people infected will have severe complications

or death related to novel H1N1 infection.

·

It is a good

sign that nation-wide influenza-like-illness surveillance is trending downward.

·

However, it is

possible that localized outbreaks will continue to occur over the summer.

·

The real

uncertainty is the fall and how the novel H1N1 virus will affect the 2009-2010

influenza season in the United States.

·

We are still

learning about the severity and other epidemiological characteristics of the

novel H1N1 virus.

·

This

information is important and will be taken into account when making

recommendations with regard to vaccine and other preventive measures in the

fall.

So far, the

largest number of novel H1N1 confirmed and probable cases (57% of cases)

have been in people between the ages of 5 years and 24 years old.

Pregnancy and other previously

recognized medical conditions from seasonal influenza, like asthma and

diabetes, appear to be associated with increased risk of complications

from this novel H1N1 as well.

Pediatric Deaths

Influenza-related

deaths in children are tragic.

·

Because of confidentiality issues, CDC does not discuss or give

details on individual cases. (Additional questions may be referred to the

departments of health for each state).

The deaths in

children reported this week are a somber reminder of the importance of

protecting children from the flu.

·

During the past 5 years that CDC has tracked deaths among children

with influenza infections, the number of deaths reported to CDC each year has

ranged from 46 to 153 deaths.

o During the 2008-09

flu season, 67 influenza-related deaths in children have been reported to CDC

since September 28, 2008. Three of these deaths were associated with confirmed

infections with novel influenza A (H1N1) viruses

o During

the 2007-08 flu season, 88 influenza-related deaths in children were reported

to CDC.

o

During the 2006-07 season, 78 influenza-related deaths in

children* were reported to CDC.

o During

the 2005-06 season, 46 deaths in children were reported to CDC

o During

the 2004-05 season, 47 deaths in children were reported to CDC.

o During

the 2003-04 season (the first year that CDC collected information on pediatric

flu deaths), 153 flu-associated deaths in children were reported to CDC.

*Children are defined as people under the age of 18.

It’s

possible that more flu-related deaths in children will be reported and

will occur this year, and it’s likely that these will result from

novel H1N1 infection since seasonal influenza viruses are no longer widely

circulating at this time and novel H1N1 viruses continue to circulate and

cause illness in the U.S.

CDC will

continue to work with colleagues in state and local health departments to

monitor all reported influenza-related deaths among children.

Children at

highest risk from seasonal flu complications include:

Children

younger than 5 years old.

o Children

(of any age) with chronic medical conditions like asthma, diabetes or heart

disease.

·

CDC

recommends a yearly seasonal flu vaccine as the first and most important step

in protecting children against flu illness.

However, at

this time, a vaccine is not available against novel H1N1 flu. So, multiple

strategies should be used at the same time to reduce, as much as possible,

the risk of influenza and its complications, including:

o Hand

hygiene and cough etiquette (washing your hands often and covering coughs and

sneezes).

o Staying

away from people who are sick.

o Also,

it’s important to stay home from work and/or school when you are sick to

avoid spreading your illness to others.

and,

o The

appropriate use of influenza antiviral medications.

o

CDC has issued

interim guidance on the use of antiviral drugs for clinicians treating patients

with novel influenza A (H1N1) virus infection and their close contacts.

o

This

guidance is available at http://www.cdc.gov/h1n1flu/recommendations.htm

·

Flu-related deaths in children less than 18 years old should be

reported through a state health department to the Influenza Associated

Pediatric Mortality Surveillance System. The number of flu-associated

deaths among children will be updated each week and can be found at http://www.cdc.gov/flu/weekly.

MMWR

– Update on Novel H1N1 Flu in Mexico

On Thursday, June 4, 2009, the Morbidity

and Mortality Weekly Report (MMWR) published an update entitled Novel

Influenza A (H1N1) Virus Infection – Mexico, March-May, 2009

This report updates a previous

report on the outbreak in Mexico and summarizes public health actions

taken to date by Mexico to monitor and control the outbreak.

These public health actions

consist of steps to enhance surveillance of influenza viruses and control

measures designed to slow the spread of disease.

Some epidemiologic features of

the outbreak of this novel influenza virus strain in Mexico are consistent

with that in the United States and other countries, including:

Person-to-person transmission

during a period that is typically the low season for circulation of

influenza viruses.

An age distribution of

laboratory-confirmed cases that includes highest illness rates among

children and adults in Mexico who are younger than 60 years of age.

Some deaths among previously

healthy people

Several patients have

experienced an aggressive clinical course with severe pneumonia requiring

ventilator support and progression to acute respiratory distress

syndrome.

Evidence to date suggests that

the outbreak likely peaked nationally in Mexico in late April.

Trends in case counts in Mexico

suggest that novel influenza A (H1N1) activity is now decreasing, although

localized transmission continues to occur

The full report is available at

http://www.cdc.gov/mmwr/

Vaccine

·

We are

aggressively taking early steps in the vaccine manufacturing process, working

closely with manufacturing and the rest of the government.

·

Vaccines are a

very important part of a response to pandemic influenza.

·

CDC isolated

the new H1N1 virus, made a candidate vaccine virus, and has provided this virus

to industry so they can begin scaling up for production of a vaccine, if

necessary.

·

There are many

steps involved with producing a vaccine and we are committed to going forward

with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to

see about developing full scale vaccine production.

·

Where possible,

we are taking parallel steps to speed up the vaccine process.

If

things go well, and we develop a full scale production, it would be

several months until the vaccine were available.

So

vaccine is an important tool for the future.

Seasonal Flu Vaccine

·

Production of the seasonal flu vaccine for next season is nearly

complete.

·

Seasonal flu is responsible for causing an estimated 36,000

flu-related deaths and 200,000 flu-related hospitalizations in the United States

each year.

·

Seasonal flu vaccine is always a public health priority.

Based on serology data, CDC

does not believe that seasonal influenza vaccine will provide any

meaningful protection against novel influenza A (H1N1) virus.

Vaccination with seasonal

vaccine is still recommended to protect against the seasonal influenza

viruses in the vaccine.

More information on the

serology data as it relates to seasonal vaccine is available in the May 22

issue of the MMWR in the article entitled “Cross-reactive Serum

Antibody Response to the Novel Influenza A (H1N1) Virus After Vaccination

with Seasonal Influenza Vaccine.” This guidance is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5819a1.htm

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