Key Points re: novel H1N1

[Guest guest]

Dear Colleagues,

Below are

today's key points re: novel H1N1 influenza.

Thanks,

CDC Community

Health Education and Outreach Team

Situation Update

CDC is

reporting 403 laboratory confirmed human infections with novel H1N1 flu in

38 states in the United States.

CDC will be

verbally reporting probable cases at the daily telebriefings.

This virus is

spreading from person-to-person without regard for borders, race or

ethnicity. However, children have been more likely to be identified as

infected with this virus compared to adults.

While this

virus has been reported in 21 other countries according to WHO, there is

no evidence of sustained person-to-person transmission beyond two

generations outside of North America.

This kind of

sustained transmission in other parts of the world would need to occur in

order for WHO to raise the pandemic alert phase to level 6.

The

list of states with the numbers of people who are confirmed cases is

updated daily at approximately 11 a.m. at http://www.cdc.gov/h1n1flu/.

CDC expects

that more cases, more hospitalizations and more deaths from this outbreak

will occur over the coming days and weeks.

Influenza is

always serious – each year in the United States, seasonal influenza

results, on average, in an estimated 36,000 deaths and more than 200,000

hospitalizations from flu-related causes.

This outbreak

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

if not more so, especially given the fact that there currently is no

vaccine against this virus.

Because this

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

be more severe and widespread as a result.

The Southern Hemisphere is just

going into their flu season and how this virus behaves might give us some

clues about what we can expect for the Northern Hemisphere.

We are taking action:

The Federal

Government is mounting an aggressive response to this outbreak.

CDC’s

goals during this public health emergency are to reduce transmission and

illness severity, and to 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 continuously as more

information becomes available.

This

includes updated interim guidance for clinicians on how to identify and care for people

who are sick with novel H1N1 flu illness now that more widespread illness

has been detected in the United States.

CDC recommends that testing and antiviral

treatment be prioritized for those with severe respiratory illness and

those at highest risk of complications from seasonal influenza.

This includes children younger than 5 year old,

pregnant women, people with chronic medical conditions, and people 65

years and older.

Much of

CDC’s guidance is informed by studies and past experience with

seasonal (human) influenza and past influenza pandemics.

CDC believes

this information applies to the novel H1N1 (swine flu) viruses as well,

but studies on this virus are ongoing to learn more about its

characteristics and to learn what groups are at highest risk.

This is a

rapidly evolving situation and guidance should be considered interim and

will be updated frequently as more information becomes available.

Visit

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

information or call 1-800-CDC-INFO.

As of May 5,

2009, deployment of 25 percent of the supplies the SNS has been completed

to 60 states or project areas.

·

Deployment

to 2 project areas is en route. Shipments

to American Samoa and Guam are en route and expected to arrive by 8 May.

·

There

are currently 86 CDC staff persons deployed in the field to support the

outbreak response.

· Everyday, we learn

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

that we take in response.

·

Distribution to states of the CDC-developed PCR diagnostic test to

detect this virus has begun. Assay kits have been received by 44 states and Puerto

Rico.

·

All remaining states will receive test kits and equipment today

(May 5, 2009).

· Additionally, CDC

has sent testing kits internationally to 16 countries with more kits going out

every day.

· This will allow

states and other countries around the world to test for this virus.

· But soon, we will

likely reach a point where it will become impossible to count individual cases.

At that point, we will be transitioning to using reporting systems similar to

those used for seasonal flu.

· We don’t

count individual cases for seasonal flu, we just monitor activity levels

through a nationwide surveillance system, which we will be using to monitor

spread of illness caused by this new virus.

Testing & Reporting

CDC will

verbally report the total number of “probable” cases of

infection with novel influenza A (H1N1) virus nationwide. (CDC will not be

reporting probable cases at the state level.)

Probable cases

are reported to CDC by state health departments and occur in people who

test positive for influenza A virus infection at their state health

department laboratory, but whose test samples have not had confirmatory

testing for the novel H1N1 flu strain.

To date, 99

percent of “probable” cases sent to CDC by state health

departments have been laboratory confirmed as cases of novel H1N1 flu

infection.

Reporting

probable cases will better reflect the true impact of novel H1N1 flu on

the United States.

State health

departments can currently determine when a positive flu sample collected

from a patient is a new or unusual flu virus in humans; however, health

departments cannot currently determine if that sample is the same novel

H1N1 flu virus that has caused illness in the United States and elsewhere.

CDC is providing

state public health laboratories with testing kits that can identify the

novel H1N1 virus. Once states have these test kits and have verified that

their testing is running properly, they will no longer need to send

samples to CDC for lab confirmation.

This will

speed up the ability of states to identify new cases.

Given rapid

spread of this virus and subsequent increase in the number of people with

novel H1N1 infection, soon it will become difficult to count individual

cases.

CDC will count

individual cases for as long as possible and then will transition to using

reporting systems similar to those used for seasonal flu.

We don’t count

individual cases for seasonal flu. Instead, we monitor activity levels

through a nationwide surveillance system, which we will use to monitor

spread of illness caused by this new virus.

Novel H1N1 Flu Virus

·

The hallmark of influenza viruses is their ability to undergo

constant and dramatic change.

·

Many different animals and, of course, humans get infected with

influenza viruses, but the viruses generally stick with one species or

another.

·

However, sometimes flu viruses jump from one species to another,

and sometimes, viruses from different species can infect the same host and

result in a new combination of virus genes.

·

This last scenario is what happened and resulted in the novel H1N1

flu virus.

·

This is a very unusual virus. This particular genetic combination

of influenza virus segments has not been recognized before in the U.S. or

elsewhere.

·

Testing of a number of the virus samples submitted to CDC show

that they are very similar, which means that they likely originated from the

same source.

It’s too

soon to predict what will happen or how the virus might change.

It is

important that we continue to watch this virus carefully to look for

changes that may occur.

The Southern Hemisphere is just

going into their flu season and how this virus behaves will give us some

clues about what we can expect for the Northern Hemisphere.

Vaccine

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 influenza, including novel influenza that may become

pandemic.

CDC has isolated the novel H1N1

flu virus and is working to make a candidate vaccine virus that can be

provided to industry so that manufacturers can scale 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.

If

things go well, and we achieve full scale production, it will be several

months until the vaccine will be available.

So

a vaccine is an important tool for the future.

Public:

We

do have antiviral medications in our arsenal against flu.

The

priority use for influenza antiviral drugs during this outbreak 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.

Antivirals work differently

than vaccines or antibiotics and need to be taken according to your

doctor’s directions.

There are two influenza

antiviral medications that are recommended for use against swine

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

(trade name 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.

Stay home if you are sick 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.

Children, especially younger children,

might potentially be contagious for longer periods. CDC is studying the

virus and its capabilities to try to learn more and will provide more

information as it becomes available.

Follow local public health advice regarding school

closures, avoiding crowds and other social distancing measures based on

illness in specific communities.

If you

haven’t developed a family emergency plan yet, consider developing

one now as a precaution. This should include storing a supply of extra

food, medicines, facemasks and other essential supplies.

·

CDC continues

to issue and update interim guidance daily on the website and through health

alert network notices as information becomes available.

Other Key Points

Virus Name

·

This is a

rapidly evolving situation and current guidance and other web content may

contain variations in how the novel H1N1 flu virus is referred to. Over the

coming days and weeks, these inconsistencies will be addressed, but in the

interests of meeting the agency's response goals, all guidance will remain

posted and new guidance will continue to be issued. CDC’s highest

priority is on providing guidance to save lives and limit the impact of this o

utbreak on public health.

Pork

· The novel H1N1 flu

virus is not transmitted by food. You cannot get novel H1N1 flu from eating

pork products.

Seasonal Flu Vaccine

· Production

of the seasonal flu vaccine for next season is nearly complete and will be

completed. Seasonal flu is responsible for causing an estimated 36,000 flu-related

deaths and 200,000 flu-related hospitalizations in the U.S. each year. Seasonal

flu vaccine is always a public health priority.

Seasonal Influenza Activity

· Regular

seasonal influenza activity continues in the United States at this time.

· There

are seasonal influenza A H1, influenza A H3 and type B viruses circulating and

causing illness in the United States – these are viruses that regularly

circulate among humans -- in addition to the novel influenza A H1N1 virus.

· There

is the possibility of reassortment (swapping virus genes) between this novel

influenza A (H1N1) virus and circulating seasonal influenza viruses.

· Such a

reassortant virus could be resistant to the antiviral drugs oseltamivir and

zanamivir because most of currently circulating seasonal H1 viruses are

resistant to oseltamivir and zanamivir.

· That is

one reason why it’s important to continue to watch the novel H1N1 virus

and human seasonal viruses carefully over the coming weeks and months and to

continue to be prepared and proactive.

· In

addition, as always, we must continue to look for emergence of other flu

viruses with pandemic potential.

Modify/Update

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