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INFLUENZA UPDATE

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Title: INFLUENZA UPDATE


1
INFLUENZA UPDATE Tuesday 8/4/09
Ms. Beverly Lawrence, former Administrative
Assistant in the Respiratory Virus Infections
Unit at the Centers for Disease Control and
Prevention, was shown here in this 1968
photograph handling test tubes containing frozen
throat swab specimens that were to be tested for
influenza. CDC photo
2
World Updates
W.H.O. Laboratory-confirmed cases of H1N1 as of
July 31
Given that countries are no longer required to
test and report individual cases, the number of
cases reported actually understates the real
number of cases.
3
World Updates
  • European Centre for Disease Prevention and
    Control data
  • 188,139 laboratory-confirmed cases worldwide
    with 1,265 confirmed deaths.
  • USA 43,771 confirmed cases, 339 deaths
  • Argentina 4,895 confirmed cases, 266 deaths
  • Mexico 16,442 confirmed cases, 146 deaths
  • Chile 11,860 confirmed cases, 96 deaths
  • Australia 23,692 confirmed cases, 70 deaths

4
World Updates
  • WHO Update 8/4/09
  • Most countries in North and South America
    experienced widespread activity. All North
    American countries reported decreasing
    respiratory diseases activity trend, while
    several South and Central American countries
    reported increasing respiratory diseases activity
    trend.
  • In Europe, only two countries, the United
    Kingdom and Portugal, experienced widespread
    activity, while several others experienced
    localized or regional activity. Among countries
    reporting in Europe, most countries reported an
    increasing or unchanged respiratory diseases
    activity trend during a period outside of the
    normal influenza season.
  • Among countries reporting from Asia, most
    experienced an increase in respiratory diseases
    activity trend.

5
World Updates
  • Antiviral resistance
  • WHO A total of six oseltamivir resistant
    pandemic H1N1 cases have now been detected from
    Denmark, Hong Kong, Japan and Canada. Of these
    three were from patients in Japan. All six
    patients had received oseltamivir with the
    exception of one and have recovered well. All
    resistant viruses had the characteristic mutation
    at position 274/275 associated with resistance.
  • Journal of Virology Australian researchers
    have reported what they say is the first evidence
    of resistance to zanamivir (Relenza) in seasonal
    influenza A (H1N1) strains researchers from the
    Melbourne-based WHO Collaborating Centre for
    Influenza say their analysis of 391 samples of
    H1N1 influenza virus from the region found that
    nine (2.3) had a markedly reduced zanamivir
    susceptibility. The H1N1 samples were collected
    from patients who were not being treated with the
    drug, and the resistance appeared to be conferred
    by a previously undescribed neuraminidase
    mutation.

6
World Updates
  • Jamieson et al. H1N1 2009 influenza virus
    infection during pregnancy in the USA. Lancet,
    published online July 29, 2009
  • Background Pandemic H1N1 2009 influenza virus
    has been identified as the cause of a widespread
    outbreak of febrile respiratory infection in the
    USA and worldwide. We summarised cases of
    infection with pandemic H1N1 virus in pregnant
    women identified in the USA during the fi rst
    month of the present outbreak, and deaths
    associated with this virus during the first 2
    months of the outbreak.
  • Methods After initial reports of infection in
    pregnant women, the US Centers for Disease
    Control and Prevention (CDC) began systematically
    collecting additional information about cases and
    deaths in pregnant women in the USA with pandemic
    H1N1 virus infection as part of enhanced
    surveillance. A confirmed case was defined as an
    acute respiratory illness with laboratory-confirme
    d pandemic H1N1 virus infection by real-time
    reverse-transcriptase PCR or viral culture a
    probable case was defined as a person with an
    acute febrile respiratory illness who was
    positive for influenza A, but negative for H1 and
    H3. We used population estimates derived from the
    2007 census data to calculate rates of admission
    to hospital and illness.

7
World Updates
  • Jamieson et al. H1N1 2009 influenza virus
    infection during pregnancy in the USA. Lancet,
    published online July 29, 2009
  • Findings From April 15 to May 18, 2009, 34
    confirmed or probable cases of pandemic H1N1 in
    pregnant women were reported to CDC from 13
    states. 11 (32) women were admitted to hospital.
    The estimated rate of admission for pandemic H1N1
    influenza virus infection in pregnant women
    during the first month of the outbreak was higher
    than it was in the general population (032 per
    100 000 pregnant women, 95 CI 013052 vs 0076
    per 100 000 population at risk, 95 CI
    007009). Between April 15 and June 16, 2009,
    six deaths in pregnant women were reported to the
    CDC all were in women who had developed
    pneumonia and subsequent acute respiratory
    distress syndrome requiring mechanical
    ventilation.
  • Interpretation Pregnant women might be at
    increased risk for complications from pandemic
    H1N1 virus infection. These data lend support to
    the present recommendation to promptly treat
    pregnant women with H1N1 influenza virus
    infection with anti-influenza drugs.
  • paper attached to email

8
World Activity by Outbreak Severity
http//upload.wikimedia.org/wikipedia/commons/0/0c
/H1N1_map.svg
9
World Activity by Outbreak Size
http//en.wikipedia.org/wiki/FileH1N1_map_by_conf
irmed_cases.svg
10
World Activity by Number of H1N1-Confirmed Deaths
11
World Updates
  • Recent news headlines
  • H1N1 flu spreads to remote corners of world
    Seychelles, St. Kitts, Netherlands Antilles,
    Belize, Tonga, Solomon Islands
  • Netherlands reports first death from H1N1 flu
  • Researchers discover A(H1N1) flu strain
    resistant to Relenza
  • Argentina Capitals lively theater district
    grows quiet with arrival of H1N1
  • Royal Carribean crew striken by H1N1 docked in
    France
  • India may have its own H1N1 vaccine by
    September
  • Vietnam has its first death from N1N1 flu
    virus
  • Israel prepares for H1N1 flu epidemic
  • Lebanon records first H1N1 death

12
Big Cleaning Day in Bangkok
13
Students of an Islamic school with a suspected
case of the H1N1 influenza virus lie in a
makeshift room at a hospital in Surabaya, July
27, 2009.
14
  • US Updates
  • CDC 7/31/09 5,514 hospitalized cases in 47
    states and US territories, with 353 deaths.
  • NM, OK, CO, UT sporadic activity TX, NV
    local AZ regional CA widespread
  • Interim Guidance for the Detection of Novel
    Influenza A Virus Using Rapid Influenza
    Diagnostic Tests http//www.cdc.gov/h1n1flu/guidan
    ce/rapid_testing.htm
  • Isolates sequenced at WHO and CDC suggest that
    the internationally circulating H1N1virus strains
    are similar to A/California/07/2009 strain
    selected by WHO as a potential candidate for the
    H1N1 vaccine.
  • Dr. Shuchat, CDC Pregnant women have a
    four-fold increase in the chance of being
    hospitalized. Early treatment and vaccination
    are, and will be, important.
  • The CDC and the US Department of Education have
    established a School Dismissal Monitoring System
    to report on H1N1-related school or school
    district dismissals in the US (ie, school
    closures). Reports may be made by online form,
    email, or fax. See http//www.cdc.gov/h1n1flu/scho
    ols/dismissal_form/index.htm

15
  • US Updates
  • CDC guideline, Preparing for Vaccination with
    Novel H1N1 Vaccine
  • Vaccine is being procured by the U.S. government
    from 5 manufacturers inactivated subunit (4)
    and live, attenuated vaccines (1). Inactivated
    vaccine will be available in single-dose
    syringes, or in multi-dose vials. Live attenuated
    vaccine will be available in limited number in
    inhaler sprayers. Single-dose syringes and
    inhaler sprayer products will be thimerosal-free.
  • State and local public health planners have been
    asked to plan for vaccine becoming available
    mid-October under the following scenarios 40,
    80, or 160 million doses becoming available over
    approximately a one month period, followed by
    weekly amounts of 10, 20 or 30 million doses. At
    this point, the planning assumption is that the
    vaccine will require 15 µg of antigen for an
    immunizing dose, and that two doses spanning over
    21 or more days will be needed for efficacy for
    most persons.

16
  • US Updates
  • CDC guideline, Preparing for Vaccination with
    Novel H1N1 Vaccine, continued
  • Clinical trials will be conducted to determine
    which age groups, if any, require only one dose.
    The majority of vaccine will be packaged in
    multidose vials but enough preloaded syringes
    will be manufactured for young children and
    pregnant women.
  • Prioritized populations include students and
    staff (all ages) associated with K-12 schools
    (K-12th grade) and child care centers pregnant
    women, children 6 months 4 years of age, new
    parents and household contacts of children lt6
    months of age, non-elderly adults with medical
    conditions that increase risk, and health care
    workers and emergency services personnel.

17
  • US Updates
  • CDC guideline, Preparing for Vaccination with
    Novel H1N1 Vaccine, continued
  • public health planners can make the assumption
    that health plans will provide reimbursement for
    the administration of a novel (A) H1N1 vaccine to
    their members by private sector providers in both
    traditional settings e.g., doctors office,
    ambulatory clinics, health care facilities, and
    in non-traditional settings, where contracts with
    insurers have been established.
  • A Vaccine Adverse Event Reporting System (VAERS)
    will collect and analyze reports.
  • A seasonal vaccine will be available beginning
    August or September 2009.
  • The process for ordering seasonal vaccine is
    unchanged from previous years.

18
  • US Updates
  • CDC Guideline, Novel H1N1 Vaccination
    Recommendations
  • http//www.cdc.gov/h1n1flu/vaccination/acip.htm .
    As previously reviewed
  • Pregnant women because of higher risk of
    complications and potential to provide protection
    to infants who cannot be vaccinated
  • Household contacts and caregivers for children
    younger than 6 months because vaccination of
    those in close contact with infants less than 6
    months old might help protect infants by
    cocooning them from the virus
  • Healthcare and emergency medical services
    personnel because infections among healthcare
    workers have been reported and this can be a
    potential source of infection for vulnerable
    patients. Also, increased absenteeism in this
    population could reduce healthcare system
    capacity
  • All people from 6 months through 24 years of age
  • Children from 6 months through 18 years of age
    because schools increase the likelihood of
    spread, and
  • Young adults 19 through 24 years of age because
    of high infection rates and frequent close
    proximity
  • Persons aged 25 through 64 years who have health
    conditions associated with higher risk of medical
    complications from influenza.

19
H1N1 in the USA by Outbreak Severity
http//commons.wikimedia.org/wiki/FileH1N1_USA_Ma
p.svg
20
Tuesday 4/28
Monday 5/4
Monday 5/11
Monday 5/18
Tuesday 5/26
Tuesday 6/2
Tuesday 6/9
Tuesday 6/16
Tuesday 7/14
Tuesday 7/7
Tuesday 6/23
Tuesday 6/30
Tuesday 8/4
Tuesday 7/21 7/28
21
H1N1 in the USA by outbreak size
http//upload.wikimedia.org/wikipedia/commons/6/6c
/H1N1_USA_Map_by_confirmed_cases.svg
22
H1N1 in the USA by number of deaths
http//upload.wikimedia.org/wikipedia/commons/e/ef
/H1N1_USA_deaths_-_CSS_map.svg
23
  • US Updates
  • Recent news headlines
  • Kentucky Prison locked down after inmates test
    positive with H1N1 virus
  • US officials to put less emphasis on school
    closings
  • Half of US should get N1N1 vaccination
    officials
  • MedImmune ramps up H1N1 vaccine
  • US begins H1N1 vaccine testing
  • Wal-Mart weighs role in US H1N1 vaccination
    plans
  • Six Flags posts deep Q2 loss impacted by
    H1N1
  • Six Senate pages come down with flu-like
    symptoms
  • Ark-La-Tex schools try to prevent H1N1
  • Indiana Son and daughter die from H1N1 virus

24
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25
New Mexico and UNM updates
  • NM DOH H1N1 Flu Resources website link ? 404
    Object Not Found
  • UNM activity highlights
  • main campus autumn planning meeting, drafting of
    influenza plan
  • SOM Incident Management Team autumn planning
    meeting
  • continuation of supplies stockpiling, N95 fit
    testing
  • seasonal and H1N1 vaccination planning
  • consultation with ENMU, provided educational
    materials, signage
  • developing a database for vaccination programs
  • Tricore Labs 7/18-7/24 75 requests, 10
    positives (mostly 12-64 yo)
  • reminder Pandemic Influenza and Immunization
    for the Coming Influenza Season, by Dr. Andrew
    Kroger of the CDC National Center for
    Immunization and Respiratory Diseases on Thursday
    8/20/09, 1230-1330 in the Domenici Auditorium,
    UNM HSC.

26
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