FW: H1N1 Key Points May 8, 2009

[Guest guest]

Here

is the latest update from CDC, FYI. Bobbi

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Mendoza , Assistant

(512) 312-2600

www.ncfh.org

From: Centers for Disease

Control & Prevention [mailto:cdc@...]

Sent: Friday, May 08, 2009 10:06 AM

ryder@...

Subject: H1N1 Key Points May 8, 2009

Dear Partner:

Below is the

latest update on the H1N1 influenza outbreak. This is for your information;

please distribute but do not post to websites.

Situation Update

CDC is

reporting 1,639 laboratory confirmed human infections with novel H1N1 flu

in 42 states and the District of Columbia (D.C.) in the United States.

An additional

849 probable cases have been reported nationwide. (CDC will not be

reporting probable cases at the state level.)

This is a

total of 2,488 confirmed and probable cases in 43 states and the District

of Columbia in the United States.

·

Two deaths in

the U.S. have been confirmed from this outbreak to date.

·

Any flu-related

death is tragic. Sadly about 36,000 people in the United States die from

flu-associated causes in the U.S. each year, on average.

·

This virus is

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

·

CDC anticipates

that there will be more cases, more hospitalizations and more deaths associated

with this new virus in the coming days and weeks because the population has

little to no immunity against it.

While this

virus has been reported in 24 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/.

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.

CDC has issued

updated “Interim Guidance on Antiviral Recommendations for Patients with

Novel Influenza A (H1N1) Virus Infection and Their Close Contacts.”

This document

provides guidance for clinicians on the use of antiviral agents for

treatment and prevention of novel influenza (H1N1) virus infection.

The guidance

is intended to help clinicians prioritize use of antiviral medications.

People who are at high risk of serious seasonal

flu-related complications include children younger than 5 years old,

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

years and older.

CDC has issued revised guidance on

school closures in the U.S. (See below for key messages.)

Much of CDC’s

guidance is informed by studies and past experience with seasonal (human)

influenza and past influenza pandemics.

CDC believes

this information from seasonal flu 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.

·

Deployment

of 25 percent of the supplies the SNS has been completed to 61 states or

project areas. The only shipment remaining is to American Samoa. This is en

route and expected to arrive tonight (May 8, 2009).

·

There

are currently 97 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.

· CDC-developed PCR

diagnostic test kits to detect this virus test kits have been distributed

throughout the U.S. and internationally..

·

This

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

· This increase in

testing capacity in the United States likely will result in a rapid jump in the

number of confirmed cases in this country once states start doing their own

testing.

· This will be an

artifact of testing, but will actually present a more accurate picture of the

true scope of novel H1N1 disease in the United States.

· As previously noted

during telebriefings, the confirmed number of cases in the U.S. has likely been

a gross underestimation of the actual number of cases in the U.S.

· Increased testing

capacity in the United States will give us a more accurate and rapid picture of

the burden of disease in this country.

· But soon, states

may 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.

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.

CDC issued an

MMWR Dispatch on May 7, 2009. The report looked at the situations in Mexico

and the United States.

“Update: Novel

Influenza A (H1N1) Virus Infections --- Worldwide, May 6, 2009” is

available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5817a1.htm.

In addition,

on May 7, a number of articles and editorials related to novel influenza A

(H1N1) appeared in the New England Journal of Medicine online edition at

http://h1n1.nejm.org/

Antiviral

Guidance

The updated

interim antiviral guidance recommends that hospitalized patients be

treated with antiviral medications and that sick patients who are at high

risk of serious seasonal flu-related complications also receive antiviral

treatment.

For prevention

(chemoprophylaxis), CDC recommends that clinicians consider use of

antivirals in:

o

People

who are at high risk of serious seasonal flu-related complications and have

been in close contact with someone who is ill with novel H1N1 virus.

o

Health

care workers, public health workers and emergency responders who have been in

close unprotected contact (ie, no personal protective equipment) with persons

who are sick with novel H1N1.

CDC recommends

that health care workers, public health workers and emergency responders

use appropriate personal protective equipment during exposures with

persons who are ill with novel H1N1.

Pregnant

health care workers whose job brings them in daily close contact with

people who are potentially ill with novel H1N1, should consider temporary

reassignment to a position that does not involve direct patient contact.

Possible

High Risk Groups

Certain groups of people are at greater risk of

serious influenza-related 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.

·

It would not be

surprising to find a pattern where these groups of people also are at higher

risk of serious complications from this novel H1N1 virus.

Studies on

this virus are ongoing to learn more about what groups are at highest

risk.

Pregnancy

CDC has

reported 6 confirmed and 5 probable cases of novel H1N1 infection in

pregnant women in the United States.

This rate of

hospitalization in pregnant women is about would be expected during a more

severe regular flu season.

·

However,

pregnant women are at high risk for serious complications from seasonal flu and

have been disproportionately affected in influenza pandemics.

·

Pregnancy

weakens a woman’s immune system and places her at increased risk for serious

flu-related complications. The greatest risks for pregnant women can be

pneumonia or dehydration. There can also be risks to their unborn babies

including pre-term labor.

·

For novel

influenza A (H1N1), CDC has determined that the benefits of treatment or

chemoprophylaxis with zanamivir or oseltamivir “likely outweigh the theoretical

risks of antiviral use.”

·

Therefore, CDC

is recommending that if a clinician suspects that a pregnant woman is infected

with this virus, she should receive antiviral treatment without confirmatory

testing.

·

Thus CDC

recommends that antiviral use recommendations be applied to pregnant women as

it is applied to other groups of persons at high risk of influenza-related

complications.

·

This is a more

forward-leaning approach than what is taken with seasonal flu because the

burden of illness on pregnant women of the novel H1N1 virus is unknown and we

know from the past that influenza can be a serious disease in pregnant women.

·

We are taking

steps to protect pregnant women and others who may be at high risk of serious

flu-related complications by pushing out our recommendations on how to

aggressively treat swine influenza.

·

On our

website, we have posted:

o

Pregnant

Women and Novel H1N1 Considerations for Clinicians.

o

What

Pregnant Women Should Know

o

Breastfeeding

Your Baby: What Parents Should Know

o

Info

for Pregnant Women in Education, Child Care, and Health Care

In

addition, we are reaching out through partners to get the word out to these

groups that they should take precautions; be aware of warning signs; and seek

medical care sooner rather than later.

School

Closure Guidance

Children

are susceptible to novel H1N1 flu, and schools or childcare facilities may

act as a point of spread.

Parents and guardians should monitor

their school-aged children, and faculty and staff should self-monitor

every morning for symptoms of flu-like illness.

Students, faculty and staff who appear

to have flu-like illness or become ill during the school day should be

isolated promptly in a room separate from other students and sent home.

Students,

faculty, and staff who have flu-like illness should stay home for 7 days

after symptoms have started or at least 24 hours after symptoms resolve,

whichever is longer, seeking medical care if symptoms are severe.

School dismissal is not advised for a

suspected or confirmed case of novel H1N1 flu, unless absenteeism is so

high that the school cannot function.

Any

dismissal must be done working closely with the local or state health

departments.

Any

students sent home from school because they are ill or because school has

been dismissed should not attend other childcare or group activities.

Schools

and childcare facilities do not need to do extra cleaning (such as washing

walls) before children can return.

Schools can

help teach students and staff how to reduce the spread of novel H1N1 flu

through hand hygiene and cough etiquette.

Probable Cases

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.

Testing

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 process

is ongoing.

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/Personal Responsibility:

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.

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 (including those who are hospitalized or

ill people who are considered at high risk of serious influenza-related

complications).

Influenza antiviral drugs are

prescription medicines (pills, liquid or an inhaler) with activity against

influenza viruses, including novel influenza H1N1 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 novel influenza

H1N1. 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.

·

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. (They are sensitive to zanamivir and the adamantane

drugs amantadine and rimantidine.)

· 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.

" Swine Flu Parties "

·

CDC does not recommend " swine flu parties " as a way to

protect against novel H1N1 flu in the future. While the disease seen in the

current novel H1N1 flu outbreak has been mild for many people, it has been

severe and even fatal for others. There is no way to predict with certainty

what the outcome will be for an individual or, equally important, for others to

whom the intentionally infected person may spread the virus.

·

CDC recommends that people with novel H1N1 flu avoid contact with

others. They should stay home from work or school for 7 days after the onset of

illness or until at least 24 hours after symptoms have resolved, whichever is

longer.

( " Swine flu

parties " have received media attention lately. These are gatherings during

which people have close contact with a person who has novel H1N1 flu in order

to become infected with the virus. The intent of these parties is to become infected

with what for many people has been a mild disease, in the hope of having

natural immunity to the novel H1N1 flu virus should it circulate later and

cause more severe disease.)

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