Title: INFLUENZA UPDATE
1INFLUENZA 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
2World 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.
3World 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
4World 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.
5World 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.
6World 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.
7World 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
8World Activity by Outbreak Severity
http//upload.wikimedia.org/wikipedia/commons/0/0c
/H1N1_map.svg
9World Activity by Outbreak Size
http//en.wikipedia.org/wiki/FileH1N1_map_by_conf
irmed_cases.svg
10World Activity by Number of H1N1-Confirmed Deaths
11World 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
12Big Cleaning Day in Bangkok
13Students 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.
19H1N1 in the USA by Outbreak Severity
http//commons.wikimedia.org/wiki/FileH1N1_USA_Ma
p.svg
20Tuesday 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
21H1N1 in the USA by outbreak size
http//upload.wikimedia.org/wikipedia/commons/6/6c
/H1N1_USA_Map_by_confirmed_cases.svg
22H1N1 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
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25New 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.
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