Cdc Swine Flu 20 May 2009

8/2/2019 Cdc Swine Flu 20 May 2009

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Internal Use Only (FIUO)---For Official Use Only (FOUO) NOT FOR FURTHER DISTRIBUTION -Sensitive But Unclassified (SBU) 1

Directors Update Brief

Wednesday

20 May 2009 1100 EDTDay 32

Day of Supplemental


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Novel Influenza A (H1N1) Key Events20 May 2009

Novel Influenza A (H1N1) Declarations

WHO: Pandemic Phase 5 (29 Apr 1600 EDT) USG: Public Health Emergency declared (26 Apr 2009) SLTT Declarations: 11

CA, TX, WI, FL, NE, VA, MD, IA, OH, American Samoa, ME

US Cases:

Deployments : 66 deployed, 5 pending, 207 potential New countries with confirmed cases : Greece Laboratory: 44 states validated: 9 states with multiple sites; 582

genes have been sequenced

Cases Hosp Deaths

5710 247 8

48 35 5US TOTAL StatesAffected INCL DC

Total Confimed andProbable

US TOTAL CasesINCL DC


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Epidemiology/SurveillanceConfirmed and Probable Novel Influenza A (H1N1)

Cases By Onset Date* and Report Date as of 20 May 2009 1100 EDT

0

100

200

300

400

500

2 8 - M a r

3 0 - M a r

1 - A p r 3 - A p r

5 - A p r 7 - A p r

9 - A p r

1 1 - A p r

1 3 - A p r

1 5 - A p r

1 7 - A p r

1 9 - A p r

2 1 - A p r

2 3 - A p r

2 5 - A p r

2 7 - A p r

2 9 - A p r

1 - M a y 3 - M a y

5 - M a y 7 - M a y

9 - M a y

1 1 - M a y

1 3 - M a y

1 5 - M a y

1 7 - M a y

1 9 - M a y DDate of Illness onset lness Onset

N o .

o f C a s e s

Onset Date (n=1,632)

Report Date (n=5,605)

*Information on onset date no longer presented after May 12 due to change to aggregate reporting


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Epidemiology/SurveillanceNovel Influenza A (H1N1) - 20 May 2009 1100 EDT

Selected Underlying ConditionsPersons Hospitalized with H1N1, 2009

6 (6%)Obesity4 (4%)Chronic Renal Disease

7 (8%)Pregnant

10 (11%)Chronic cardiovascular disease

11 (12%)Immunocompromised

14 (15%)Diabetes

3 (3%)Cancer

37 (40%) Asthma or COPDNo. (%)Condition

66 (71%) of hospitalized patients had an underlying chronic condition


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200-400

51-200

1-50

0

>400

Epidemiology/SurveillanceNumber of cases of H1N1 reported to CDC by state

as of 17:30 EDT on 19 May 2009 (n=5710)


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Age of Persons Hospitalized with H1N1, 2009 n=164

18 16 18

29

61

22

0

10

20

30

40

50

60

70

0-23 mos. 2-4 Yrs 5-9 Yrs 10-18 Yrs 19-49 Yrs 50 Yrs

Age

N u m

b e r o

f C a s e s

11% 10% 11%

18%

37%

13%

Median Age = 19 years


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Antiviral and Antimicrobial UsagePersons Hospitalized with H1N1, 2009

63/88 (60%) treated with antivirals

Median time from illness onset to antiviral initiation 4 days(1-25 days)

Median time from admission to antiviral initiation 1 day(6-13 days)

70 (75%) treated with antibiotics

100% initiated on day of admission


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Indicators of SeverityPersons Hospitalized with H1N1

26/118 (22%) were admitted to the ICU

13 (50%) required mechanical ventilation

9 had ARDS

Median age of ICU patients (n=23)

23 years (1 month-86 yrs) Median length of ICU stay (n=14)

9 days (2-34 days)

Time from onset to ICU admit (n=13)

6 days (2-14 days)


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Epidemiology/SurveillanceCurrent Influenza Surveillance, 20 May 2009 1100 EDT

These data are considered provisional and preliminary and will not be officially released by the CDC until 1100 EDT.

WHO/NREVSS Collaborating Laboratories (graph as of 5/19/2009) Seasonal influenza A (H1), A (H3), and B viruses co-

circulated with novel influenza A (H1N1) viruses Influenza-associated Pediatric Deaths

No new influenza-associated pediatric death were reported 2008-09 season total = 61 ILINet

During week ending 5/16/2009, the percentage of ILIoutpatient visits was below the national baseline

Overall, the percentage of outpatient visits for ILI remainsstable, based upon daily ILI reports from the US OutpatientInfluenza-like Illness Surveillance Network (ILINet)


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122 Cities Mortality Reporting System (graph as of 5/19/2009) As weekly mortality reports continue to be received at CDC for week ending 5/9/2009, the percentage of pneumonia and influenzadeaths is not expected to be significantly elevated

Percentage of deaths due to pneumonia and influenza remainsstable, based upon daily mortality reports from the 122 Cities

Mortality Reporting System Geographic Spread of Influenza as Assessed by State andTerritorial Epidemiologists The influenza activity reported by state and territorial

epidemiologists indicates geographic spread of both seasonalinfluenza and novel influenza A (H1N1) viruses and does notmeasure the severity of influenza activity.

Eight states reported geographically widespread influenza activity,14 states reported regional activity, the District of Columbia and 15states reported local influenza activity; and 13 states reportedsporadic influenza activity.

Epidemiology/SurveillanceCurrent Influenza Surveillance, 20 May 2009 1100 EDT


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Percent of Specimens Positive for InfluenzaReported by WHO and NREVSS Labs:

Novel Influenza A(H1N1) vs. Seasonal Influenza, by Week20 May 2009 1100 EDT

0

5

10

15

20

25

30

1 0 / 4

1 0 / 1

8 1 1

/ 1

1 1 / 1

5 1 1

/ 2 9 1 2

/ 1 3 1 2

/ 2 7

1 / 1 0

1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

5 / 3 0

6 / 1 3

6 / 2 7

7 / 1 1

7 / 2 5 8 /

8 8 /

2 2

Week Ending Date

P e r c e n t

P o s

i t i v e

All Flu Seasonal Flu Novel Influenza A(H1N1)

Influenza % Positiveby Season (Week 18):

05-06: 8.70%06-07: 6.75%07-08: 4.38%


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NOTE: Week ending dates vary by influenza season

*Preliminary ILI data for week 19, as of May 19, 2009 (n=667 weekly ILI reports received from 47 states)

There was no week 53 during the 2006-07 and 2007-08 seasons, therefore the week 53 data point for those seasons is an average of weeks 52 and 1.

0

1

2

3

4

5

6

7

1 0 / 4

1 0 / 1 8

1 1 / 1

1 1 / 1 5

1 1 / 2 9

1 2 / 1 3

1 2 / 2 7

1 / 1 0

1 / 2 4

2 / 7

2 / 2 1

3 / 7

3 / 2 1

4 / 4

4 / 1 8

5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

2006-07 2007-08 2008-09 National Baseline

Epidemiology/SurveillancePercentage of Visits for Influenza-like Illness (ILI) Reported by

the US Outpatient Influenza-like Illness Surveillance Network (ILINet),National Summary 2008-09 and Previous Two Seasons

20 May 2009 1100 EDT


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Region II - NJ, NY

0

2

4

6

1 0 / 4

1 0 / 1

8 1 1

/ 1 1 1

/ 1 5

1 1 / 2

9 1 2

/ 1 3

1 2 / 2

7 1 /

1 0 1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

Region III - DE, DC, MD, PA, VA, WV

0

1

2

3

4

5

6

7

8

1 0 / 4

1 0 / 1

8 1 1

/ 1 1 1

/ 1 5

1 1 / 2

9 1 2

/ 1 3

1 2 / 2

7 1 /

1 0 1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r I

L I

Region I - CT, ME, MA, NH, RI, VT

0

1

2

3

4

5

1 0 / 4

1 0 / 1

8 1 1

/ 1 1 1

/ 1 5

1 1 / 2

9 1 2

/ 1 3

1 2 / 2

7 1 /

1 0 1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

NOTE: Scales differ between regions

NOTE: There was no week 53 during the 2006-07 and 2007-08 seasons, therefore the week 53 data point for those seasons is an average of weeks 52 and 1.

2006-07 2007-08 2008-09 Baseline

Epidemiology/SurveillanceCurrent Influenza Surveillance ILINet Regions I-III

20 May 2009 1100 EDT


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Region IV - AL, FL, GA, KY, MS, NC, SC, TN

0

1

2

3

4

5

6

1 0 / 4

1 0 /

1 8 1 1

/ 1

1 1 /

1 5

1 1 / 2 9

1 2 /

1 3

1 2 /

2 7 1 / 1

0 1 / 2

4 2 /

7 2 / 2

1 3 /

7 3 / 2

1 4 /

4 4 / 1

8 5 /

2 5 / 1

6

Week Ending Dates

% o

f V i s i t s f o r I

L I

Region V - IL, IN, MI, MN, OH, WI

0

2

4

6

1 0 / 4

1 0 / 1

8 1 1

/ 1 1 1

/ 1 5

1 1 / 2

9 1 2

/ 1 3

1 2 / 2

7 1 /

1 0 1 / 2 4 2 / 7 2 /

2 1 3 / 7 3 / 2 1 4 / 4 4 /

1 8 5 / 2 5 / 1 6

Week Ending Dates

% o f V i s i t s f o r

I L I

Region VI - AR, LA, NM, OK, TX

0

2

4

6

8

10

12

1 0 / 4

1 0 / 1

8 1 1

/ 1 1 1

/ 1 5

1 1 / 2

9 1 2

/ 1 3

1 2 / 2

7 1 /

1 0 1 / 2 4 2 / 7 2 /

2 1 3 / 7 3 / 2 1 4 / 4 4 /

1 8 5 / 2 5 / 1 6

Week Ending Dates

% o f V i s i t s f o r

I L I



2006-07 2007-08 2008-09 Baseline

Epidemiology/SurveillanceCurrent Influenza Surveillance ILINet Regions IV-VI

20 May 2009 1100 EDT


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Region X - AK, ID, OR, WA

0

2

4

6

8

10

1 0 / 4

1 0 / 1

8 1 1

/ 1

1 1 / 1

5 1 1

/ 2 9

1 2 / 1

3 1 2

/ 2 7

1 / 1 0

1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

Region IX - AZ, CA, HI, NV

0

2

4

6

8

1 0 / 4

1 0 / 1

8 1 1

/ 1

1 1 / 1

5 1 1

/ 2 9

1 2 / 1

3 1 2

/ 2 7

1 / 1 0

1 / 2 4 2 /

7 2 /

2 1 3 / 7

3 / 2 1 4 /

4 4 /

1 8 5 / 2

5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

Region VIII - CO, MT, ND, SD, UT, WY

0

1

2

3

4

5

1 0 / 4

1 0 / 1 8 1 1

/ 1 1 1

/ 1 5 1 1

/ 2 9 1 2

/ 1 3 1 2

/ 2 7 1 / 1 0

1 / 2 4 2 / 7 2 /

2 1 3 / 7 3 / 2 1 4 / 4 4 /

1 8 5 / 2 5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I

Region VII - IA, KS, MO, NE

0

2

4

6

8

1 0 / 4

1 0 / 1 8 1 1

/ 1 1 1

/ 1 5 1 1

/ 2 9 1 2

/ 1 3 1 2

/ 2 7 1 / 1 0

1 / 2 4 2 / 7 2 /

2 1 3 / 7 3 / 2 1 4 / 4 4 /

1 8 5 / 2 5 / 1 6

Week Ending Dates

% o

f V i s i t s f o r

I L I



2006-07 2007-08 2008-09 Baseline

Epidemiology/SurveillanceCurrent Influenza Surveillance ILINet Regions VII-X

20 May 2009 1100 EDT


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BioSense% Patients Presenting With ILI as a Chief Complaint by Age

April 18-May 16, 2009


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April 18-May 16, 2009


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April 18-May 16, 2009


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Epidemiology/Surveillance - Percentage of Visits for ILINYC ED and Other ILINet Providers, 2008-09 and Previous Two Seasons

20 May 2009 1100 EDT

*Consists of 50 ED sites across NYC; An average of 19 sites reporting each week from across NYC of various practice types (Family Practice,Pediatrics, Internal Medicine, and Student Health)

0

1

2

3

4

5

6

7

2 0 0 6

4 0

2 0 0 6

4 4

2 0 0 6

4 8

2 0 0 6

5 2

2 0 0 7

0 4

2 0 0 7

0 8

2 0 0 7

1 2

2 0 0 7

1 6

2 0 0 7

2 0

2 0 0 7

2 4

2 0 0 7

2 8

2 0 0 7

3 2

2 0 0 7

3 6

2 0 0 7

4 0

2 0 0 7

4 4

2 0 0 7

4 8

2 0 0 7

5 2

2 0 0 8

0 4

2 0 0 8

0 8

2 0 0 8

1 2

2 0 0 8

1 6

2 0 0 8

2 0

2 0 0 8

2 4

2 0 0 8

2 8

2 0 0 8

3 2

2 0 0 8

3 6

2 0 0 8

4 0

2 0 0 8

4 4

2 0 0 8

4 8

2 0 0 8

5 2

2 0 0 9

0 3

2 0 0 9

0 7

2 0 0 9

1 1

2 0 0 9

1 5

2 0 0 9

1 9

Week

% o

f V i s i t s f o r

I L I

NYC ED Sites* Other NYC Sites


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0 5 0 0

1 0 0 0

1 5 0 0

2 0 0 0

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10/4/2008

10/11/2008

10/18/2008

10/25/2008

11/1/2008

11/8/2008

11/15/2008

11/22/2008

11/29/2008

12/6/2008

12/13/2008

12/20/2008

12/27/2008

1/3/2009

1/10/2009

1/17/2009

1/24/20091/31/2009

2/7/2009

2/14/2009

2/21/2009

2/28/2009

3/7/2009

3/14/2009

3/21/20093/28/2009

4/4/2009

4/11/2009

w

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A g e 0 -4

A g e 5 -2 4

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InternationalNovel Influenza A (H1N1) - 20 May 2009 1100 EDT

WHO global case count: 10,243 confirmed cases in 41 countries*

New countries with confirmed cases: Greece

Countries with highest confirmed case count after the US and

Mexico:

Canada: 496 (=) Japan: 210 ( 51)

Spain: 107 ( 4) UK: 102 ( 1)

Increases in case counts expected in countries receiving CDC PCR

kits as testing capabilities are improved

*Note: WHO case counts are current as of 05/20/09, 9:00 am EDT


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55,765

169,000

245,449

329,834

468,282

369,237

197,985

118,033

61,697 11,79417,6634,83800

100,000

200,000

300,000

400,000

500,000

4/29 4/30 5/1 5/4 5/5 5/6 5/7 5/8 5/11 5/12 5/15 5/18 5/19

Date

N u m

b e r o

f S t u d e n

t s

Source: ED and CDC Confirmed School Closing Reports released each weekday at 2:00pm.

Division of Global Migration and QuarantineNovel Influenza A (H1N1)

Students Dismissed by Date (ED as of 1400 EDT 19 May 2009)

19 May 2009: 24schools closed due to

H1N1 in 5 states

NH, NY (n=18), PA, TX,and WI.


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Communications SummaryNovel Influenza A (H1N1) - 20 May 2009 1100 EDT

Themes

2 deaths linked to H1N1: St. Louis man and 16-month old boy in NYC

School closings in NYC WHO meeting vaccine development

proving much tougher than expected; taking longer than expected; now delayed

Nations urge WHO to change criteria, consider severity not just spread

Emerging Themes

Controversy over change in school closing guidelines,

NYC: Guidelines did not call for that school to be closed and public is upsetschoolshould have been closed sooner

Schools across the country continue to close

Strong local reaction to deaths in the community: NYC hospitals -- seeing hundredsmore people than usual

1,216,785547,371512,254927,305Web

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