Centers for Disease Control and Prevention (CDC) H1N1 Update

[Guest guest]

Here

is the latest from CDC on the H1N1Influenza. FYI¡Ä.

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

FluView

Influenza Activity Update

·

Influenza

illness, including illness associated with the pandemic influenza A (H1N1)

virus, is ongoing in the United States.

·

As of June 19,

2009, 21,449 confirmed and probable infections with pandemic influenza A (H1N1)

virus have been identified by CDC and state and local public health departments

with 87 deaths.

·

During week 23

(June 7 – 13, 2009), the June 19 FluView Report shows that influenza

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

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

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

cases with intense activity.

·

11 states in

the U.S. are reporting widespread influenza activity (Arizona, Connecticut, Delaware,

Hawaii, Maine, New Jersey, New York, Pennsylvania, Rhode Island, Utah, and Virginia);

6 states and Puerto Rico are reporting regional influenza activity; 13 states

and the District of Columbia are reporting local influenza activity; and 20

states are reporting sporadic activity.

·

It is very

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

regional and widespread activity.

·

Pandemic H1N1

viruses now make up approximately 98% of all subtyped influenza A 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, but one of the 10 surveillance regions reported

an influenza-like illness percentage above its region-specific baseline (Region

II).

o This was in Region II, which includes New Jersey,

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

o Increases in ILI in region

II likely represent an increase in influenza activity in large cities in that

region, such as New York City, which is experiencing community outbreaks of

pandemic H1N1.

·

Influenza-like

illness decreased during week 23 in six of 10 regions compared to week 22.

·

The proportion

of deaths attributed to pneumonia and influenza (P & I) was slightly above

the epidemic threshold.

·

One

influenza-associated pediatric death was reported and was associated with

pandemic influenza A (H1N1) virus infection during Week 23.

·

Since September

28, 2008, CDC has received 71 reports of laboratory confirmed

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

influenza season, six of which were due to pandemic influenza A (H1N1) virus

infections.

·

It¡Çs uncertain

at this time how severe this H1N1 pandemic will be in terms of how many people

infected will have severe complications or death from pandemic H1N1-related

illness.

·

It is likely

that localized outbreaks will continue to occur over the summer and that we

will see pandemic H1N1 virus, illness and death during the upcoming U.S. flu

season in the fall and winter.

·

The real

uncertainty is how widespread and severe the pandemic H1N1 virus will be during

the 2009-2010 influenza season in the United States.

·

We are still

learning about the severity and other epidemiological characteristics of the

pandemic H1N1 virus and are watching the Southern Hemisphere very carefully to

see how pandemic H1N1 affects their influenza season, which is just beginning.

·

This

information is important and will be taken into account when making

recommendations with regard to vaccine and other preventive measures in the

fall.

Enhanced

Influenza Surveillance in the Southern Hemisphere

· The Centers for

Disease Control and Prevention (CDC) is working closely with countries in the

Southern Hemisphere to enhance surveillance for influenza viruses circulating

in the Southern Hemisphere, including pandemic H1N1 flu.

The Southern

Hemisphere is just going into its flu season now and how this virus

behaves will give us some clues about what we can expect for the Northern

Hemisphere.

· CDC is providing

real-time, reverse transcriptase polymerase chain reaction (rRTPCR) reagents to

all national influenza centers (NICs) in the Southern Hemisphere region and is

working with the Pan American Health Organization (PAHO)* to increase

laboratory testing capacities in South/Central America by supplying resources

and training.

* PAHO is a regional

office of the World Health Organization (WHO).

·

In addition, CDC is providing to all NICs in the PAHO region a

supplemental WHO Influenza kit containing reagents for identification of

pandemic H1N1 influenza virus in the Hemagglutination Inhibition (HI) assay.

·

CDC's

Influenza Division has provided the necessary

documents and forms with instructions for sending influenza virus isolates and

specimens to CDC to 28 NICs in PAHO.

· As part

of CDC¡Çs efforts to enhance surveillance in the Southern Hemisphere, CDC has

developed guidance for national laboratories within PAHO to send their most

recent and representative

influenza virus isolates to CDC more frequently: as often as every two weeks,

if possible.

·

The

World Health Organization has offered to help countries ship influenza virus

isolates and specimens to CDC for testing by

supplying financial and logistical support.

·

In addition to laboratory assistance, CDC has deployed two

epidemiologists, one to Peru and one to Chile, to assist with planning enhanced

surveillance activities.

·

A recent mission to Chile, Argentina, and Bolivia has met with the

ministries of health in each of those countries to map out a strategy for

enhancing surveillance.

·

CDC has provided $200,000 (U.S. Dollars) to the Central America

Project in Guatemala to enhance surveillance for severe acute respiratory

illness in five countries of Central America.

Summer Camp Guidance

· CDC has heard

reports of pandemic H1N1 outbreaks in summer camps in the U.S.

· This is not

surprising given the fact that children and young adults have been the most

affected by the outbreak of pandemic H1N1 flu so far.

· CDC has developed

guidance for day and residential camps in response to human infections with

pandemic H1N1 influenza and posted this information on our website.

· It is important

that camp staff members, parents and others are aware of, and use measures to

protect themselves and also the public¡Çs health by making plans for how to

prevent and control outbreaks in camps and other places that children and young

adults gather.

· CDC is recommending

that the primary way to reduce spread of influenza in camps is to focus on identifying

ill campers and staff as soon as possible, moving ill persons away from well

campers, treating ill campers, educating campers and staff about good

cough and hand hygiene etiquette, and educating camp facilitators and

administrators about environmental controls that should be in place to

encourage use of these practices.

· CDC is recommending

that people who currently have or have had influenza-like symptoms in the

previous seven days should not attend, work or volunteer in a camp until at

least seven days AFTER their symptoms began or until they have been

symptom-free for 24 hours, whichever is longer.

· Camp staff,

volunteers, and campers should be aware of the symptoms of pandemic H1N1 flu

and rapidly report to camp staff if they recognize any of them in campers or

themselves.

· CDC is encouraging

camp administrators and facilitators to work with parents to plan ahead for

what to do in the event that their child becomes ill while at camp.

· Camps should work

with local public health authorities to develop plans for addressing potential

camp outbreaks and establish an open line of communication.

· Hand washing

facilities, including running water and soap, should be available to all

campers and staff. Everyone should be reminded to use good hand hygiene (hand

washing and appropriate use of alcohol-based gels) and good cough etiquette

(covering coughs and sneezes).

· Aspirin or

aspirin-containing products should not be given to any person 18 years old or

younger with a confirmed or suspected case of influenza, due to the risk of

Reye¡Çs syndrome.

MMWR:

Novel H1N1 virus infections among healthcare personnel

On June 19, 2009 the Morbidity

and Mortality Weekly Report (MMWR) published a report entitled ¡ÈNovel

Influenza A (H1N1) Virus Infections Among Healthcare Personnel ¨¡ United States, April – May 2009¡É

As of May 13, 2009, CDC had received

information on 48 confirmed or probable pandemic H1N1 infections reported

to have occurred in people who worked in the healthcare profession; 26

with detailed information.

Of the 26 cases, CDC found

that:

o 13 healthcare

personnel (HCP) (50%) were deemed to have acquired infection in a healthcare

setting which could have been from provider-to-provider (1) contact or

patient-to-provider (12) contact.

o 11 healthcare

workers (42%) were deemed to have been infected in the community.

o 2 HCP (8%) had no

reported exposures in either healthcare or community settings.

Two infected HCP were

hospitalized, one of whom reported underlying medical conditions. Neither

hospitalized HCP was admitted to the intensive care unit; neither died.

None of the HCP with potential

patient-to-provider transmission of pandemic H1N1 influenza reported

adhering to all recommended infection control practices for all contacts

with possible source patients.

These findings cannot

definitely establish whether these instances of patient-to-provider

transmission were related to non-adherence to certain parts of personal

protection equipment.

Whatever the risk of infection

to HCP, this report suggests that much of it exists in the outpatient

setting, such as outpatient clinics and emergency rooms.

Current CDC infection control

recommendations for the care of patients with pandemic H1N1 infections

include:

o Administrative

actions such as exclusion of ill HCP from work

o The use of

fit-tested N-95 respirators

o Eye protection

o Use of gloves and

gowns

o Aerosol-generating

procedures should be performed in an airborne infection isolation room with

negative pressure air handling

HCP were defined as employees,

students, contractors, clinicians or volunteers whose activities involved

contact with patients in a healthcare or laboratory setting.

These case reports do not

contain enough information to determine effectiveness of specific types of

personal protection equipment to protect against infection of pandemic

H1N1 infection.

WHO Declaration Phase 6

· On June

11, 2009, the World Health Organization (WHO) raised the worldwide pandemic

alert level to Phase 6.

Designation of

this phase indicates that a global pandemic is underway.

·

There are now

community level outbreaks ongoing in other parts of the world.

·

While U.S.

influenza surveillance systems indicate that overall flu activity is decreasing

in the United States, pandemic H1N1 outbreaks are ongoing in different parts of

the U.S., in some cases with intense activity.

·

In the United

States, this virus has been spreading efficiently from person-to-person since

April and, as we have been saying for some time, we do expect that we will see

more cases, more hospitalizations and more deaths from this virus.

·

Because there

is already widespread pandemic H1N1 disease in the United States, the WHO Phase

6 declaration does not change what the United States is currently doing to keep

people healthy and protected from the virus.

·

Thus, there is

no change to CDC¡Çs recommendations for individuals and communities.

·

WHO¡Çs decision

to raise the pandemic alert level to Phase 6 is a reflection of epidemiological

changes in other parts of the world and not a reflection of any

change in the pandemic H1N1 virus or associated illness.

·

At this time,

most of the people who have become ill with pandemic H1N1 in the United States

have not become seriously ill and have recovered without hospitalization.

·

In the United

States, we have been preparing for this for some time.

·

And we are

actively and aggressively implementing our pandemic response plan.

Phase

6 is an indicator of spread and not of severity.

·

It¡Çs uncertain

at this time how serious or severe this pandemic H1N1 pandemic will be in terms

of how many people infected have severe complications or death related to

pandemic H1N1 infection.

There were

three influenza pandemics in the last century and they varied widely in

severity.

The 1918

pandemic killed tens of millions of people.

The 1957

pandemic is thought to have resulted in at least 70,000 deaths in the United

States.

Deaths from

the 1968-69 pandemic were about the same as for seasonal influenza.

This pandemic

certainly poses the potential to be at least as serious as seasonal flu,

if not more so.

Because this

is a new virus, many people will not have immunity to it and illness may

be more severe and widespread as a result.

We are still

learning about this virus and expect that, like all influenza viruses, it

will continue to change.

We are taking action:

The Federal

Government is mounting an aggressive response to this newly declared

pandemic.

CDC¡Çs goals

during this public health emergency are to reduce transmission and illness

severity, and provide information to assist health care providers, public

health officials and the public in addressing the challenges posed by this

newly identified influenza virus.

To

this end, CDC continues to update guidance.

Visit

the CDC website at http://www.cdc.gov/h1n1flu/ for more

information or call 1-800-CDC-INFO.

·

Everyday, we

learn more about this virus and what we learn will continue to inform the

actions that we take in response.

·

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 pandemic 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.

Pandemic Severity

·

Influenza

pandemics can range in severity, mainly in terms of the number of people that

have severe illness and die.

·

Pandemic

severity may also change over time and will differ across regions of the world,

in different countries and even within different communities within a country.

·

Pandemic

disease severity will vary depending on several factors: a nation¡Çs ability to

provide health care to their people, the availability of antiviral medications

to treat those who are sick, differences in how the disease affects people in

different age groups, and the effectiveness of efforts to reduce

person-to-person transmission of influenza.

·

An

evaluation of pandemic severity should be based on local circumstances for this

reason.

·

A

pandemic severity index helps pubic health officials to match the timing of the

spread and severity of the outbreak with the appropriate use of public health

and community resources to minimize the number of people who get sick and the

number of people who die.

WHO has a

three point scale to determine pandemic severity: mild, moderate and

severe.

At this time,

WHO has indicated this seems to be a moderately severe pandemic.

U.S. Pandemic Severity Index (PSI)

CDC developed

the U.S. Pandemic Severity Index (PSI) to describe the severity of a

pandemic in terms of illness and death.

The U.S. PSI

scale is based on the case-fatality ratio; the likelihood of people dying

from the disease.

The PSI scale

ranges from Category 1 to Category 5 and is comparable to the U.S.

hurricane severity index.

Category 1 is

the least severe and Category 5 is the most severe.

·

At the current

time, CDC estimates that the pandemic situation in the U.S. would be equivalent

to a pandemic severity index of 2. (This would be most similar to the 1957

influenza pandemic, however, it¡Çs uncertain how the current situation will

evolve over the coming months so it¡Çs not possible to make a predication about

deaths at this time.)

CDC

will re-evaluate the classification of the Pandemic Severity Index should

there be evidence that the pandemic has become more severe.

The

PSI will be adjusted based on that evaluation and appropriate guidelines

and recommendations provided.

CDC emphasizes that unnecessary weight

not be given to the numeric categorization of the pandemic.

According to

the U.S. PSI:

A category 1

pandemic has the following:

Case

fatality ratio of less than 0.1 percent

Excess death

rate of less than 30 per 100,000 people

Illness rate

of 20-40% of the population

Less than

90,000 potential deaths (based on 2006 U.S. population)

Similar to a

more severe seasonal flu year in the United States

A category 2

pandemic has the following:

¡ø

Case

fatality ratio of 0.1 percent to less than 0.5 percent.

¡ø

Between

90,000 and 450,000 deaths in the U.S. (based on 2006 U.S. population)

¡ø

Excess

death rate of between 30 to less than 150 per 100,000 people

¡ø

Illness

rate of between 20 and 40 percent.

¡ø

Similar

to 1957 pandemic.

A category 5

pandemic has the following:

Case

fatality ratio of greater or equal to 2 percent

Excess death

rate of more than 600 per 100,000 people

Illness rate

of 20-40% of the population

Greater than

or equal to 1.8 million potential deaths (based on 2006 U.S. population)

Similar to

the 1918 pandemic

The importance of identifying a

category of severity is only to help guide the public health interventions

recommended for individuals and communities.

The PSI scale

helps public health officials match the range of public health

intervention efforts to the severity of a pandemic.

For

a Category 1 to 3 pandemic:

Ill adults

and children are asked to stay home voluntarily.

If someone

in the household is sick, well adults and children do not need to

stay at home.

School and

child care dismissal is not generally recommended, but may be considered

depending on the local impact of the disease.

Workplace and Community adult social distancing

efforts (e.g., encouraging teleconferences instead of meetings, reducing

density, meaning the number of people crowded into an enclosed space, in

public transit and the workplace, postponing or canceling selected

public gatherings, encouraging people to telework, or take staggered

shifts) are generally not recommended.

For a

Category 4 to 5 pandemic

Ill adults

and children are asked to stay home voluntarily.

If someone

in the household is sick, well adults and children should stay at home

too.

School and

child care dismissal is recommended for up to 12 weeks.

Workplace and Community adult social distancing

efforts (e.g., encouraging teleconferences instead of meetings, reducing

density, meaning the number of people crowded into an enclosed space, in

public transit and the workplace, postponing or canceling selected

public gatherings, encouraging people to telework, or take staggered

shifts) are recommended

Declaration of Phase 6 and Travel

At this time,

CDC does not recommend against travel to any country.

CDC will

continue to monitor the pandemic H1N1 situation around the world and will

provide recommendations to U.S. travelers based on the changing situation.

Travelers

should check the CDC travelers¡Ç health website (www.cdc.gov/travel) for

information related to this outbreak, as well as for health information on

the prevention and management of flu.

Travelers

should also check the website of the embassy of the country to which they

are traveling for the latest updates on entry or exit screening procedures

which may impact their travel.

CDC recommends

that ill persons postpone travel both for their protection and that of

other travelers.

Public:

So

far, most people who have been ill with this virus have recovered.

We

are monitoring hospitalization and death rates.

At

this point, whether you are tested and actually diagnosed with pandemic

H1N1 is less important than what you do if you become sick.

It¡Çs

possible that this summer, people around you may get sick and you may get

sick.

Certainly

in the fall, with our flu season, people around you will be getting sick

and you may get sick.

Be

prepared to stay home for a week or so if you are ill.

Most

people infected with this virus so far have experienced the regular

symptoms of flu (fever, cough, body aches, and a significant number of

people have reported vomiting and diarrhea).

For

people who are critically ill, we do have antiviral medications in our

arsenal against flu.

The

priority use for influenza antiviral drugs at this time is to treat severe

influenza illness.

·

Influenza

antiviral drugs are prescription medicines (pills, liquid or an inhaler) with

activity against influenza viruses, including swine influenza viruses.

·

There are two

influenza antiviral medications that are recommended for use against swine

influenza. These are oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza

®).

·

Influenza

antiviral drugs work best when stated soon after illness onset (within two 2

days), but treatment with antiviral drugs should still be considered after

48 hours of symptom onset, particularly for hospitalized patients or people at

high risk for influenza-related complications.

·

You have a role

in protecting yourself and your family.

Stay informed.

Health officials will provide additional information as it becomes

available. Visit www.cdc.gov

Everyone

should take these everyday steps to protect your health and lessen the

spread of this new virus:

Cover your nose and mouth with a tissue when you

cough or sneeze. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water,

especially after you cough or sneeze. Alcohol-based hand cleaners are

also effective.

Avoid touching your eyes, nose or mouth. Germs

spread this way.

Try to avoid close contact with sick people.

If you are sick with a flu-like

illness, stay home for 7 days after your symptoms begin or until you have

been symptom-free for 24 hours, whichever is longer. This is to

keep from infecting others and spreading the virus further.

Follow public

health advice regarding school closures, avoiding crowds and other social

distancing measures.

If

you don¡Çt have one yet, consider developing a family emergency plan as a

precaution.

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