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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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Epidemiology/SurveillanceNovel Influenza A (H1N1) - 20 May 2009 1100 EDT
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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Epidemiology/SurveillanceNovel Influenza A (H1N1) - 20 May 2009 1100 EDT
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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Epidemiology/SurveillanceNovel Influenza A (H1N1) - 20 May 2009 1100 EDT
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
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 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
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 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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BioSense% Patients Presenting With ILI as a Chief Complaint by Age
April 18-May 16, 2009
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BioSense% Patients Presenting With ILI as a Chief Complaint by Age
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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I n t er n
al
U s e Onl y
( F I U
O ) ---F or
Of f i ci al
U s e Onl y
( F O U O ) N
OT F
ORF
URT HE RDI S T RI B
UT I ON- S
en
s i t i v
e
B u t Un
c l a
s s if
E pi d
emi ol o
g y / S ur v ei l l an
c e
NY C E DI L I
C o un
t s b y A
g e Gr o
u p
O c t 2
0 0 8 -M
a
y 1 6 ,2
0 0 9
2 0 M
a y 2
0 0 9
1 1 0 0 E DT
0 5 0 0
1 0 0 0
1 5 0 0
2 0 0 0
2 5 0 0
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
e ek
# ILI
A g e 0 -4
A g e 5 -2 4
A g e2
5 - 6 4
A g e 6 5 an
d ol d
er
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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
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