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INFLUENZA UPDATE Tuesday 8/11/09

INFLUENZA UPDATE Tuesday 8/11/09. “ A 1976 New Jersey Influenza (swine flu) Immunization Campaign.  .” – CDC photo. World Updates. WHO Global Influenza Surveillance Network Week 29 weekly report: 3,548 detections reported from 13 countries, primarily China Hong Kong, Australia, Italy

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INFLUENZA UPDATE Tuesday 8/11/09

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  1. INFLUENZA UPDATE Tuesday 8/11/09 “A 1976 New Jersey Influenza (swine flu) Immunization Campaign. .” – CDC photo

  2. World Updates • WHO Global Influenza Surveillance Network Week 29 • weekly report: 3,548 detections reported from 13 countries, primarily China Hong Kong, Australia, Italy • pandemic H1N1 accounted for 71% of all influenza virus detections • UK is experiencing widespread activity; other European countries are increasing or unchanged • North American countries are reporting a decreasing trend • South American and Asian countries are reporting an increasing trend, with Argentina and Chile reporting high intensity • no new cases of oseltamivir resistance (but see below) • all reported strains remain genetically similar

  3. World Updates • European CDC reports 212,008 laboratory-confirmed cases worldwide, 1,717 deaths • An oseltamivir-resistant strain of H1N1 has been reported in a Thai patient. This is the seventh such report worldwide to date. The Thai lab also reported an oseltamivir-resistant strain of seasonal (non-H1N1) influenza. • Egypt continues to report new cases of avian influenza. To date, there have been 83 reported cases with a 33% fatality rate. This is mentioned as an example of an organism that could lead to problematic recombinant mutations.

  4. World Updates • WHO 8/6/09, Safety of pandemic vaccines - http://www.who.int/csr/disease/swineflu/notes/h1n1_safety_vaccines_20090805/en/index.html • “WHO is aware of some media reports that have expressed concern about the safety of vaccines for pandemic influenza. The public needs to be reassured that regulatory procedures in place for the licensing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality controls.” • “Regulatory authorities have shown great flexibility in developing procedures for fast-tracking the approval and licensing of pandemic vaccines.” • “Influenza vaccines have been used for more than 60 years and have an established record of safety in all age groups. While some serious adverse events have been reported, these have been rare.” • “Nonetheless, special safety issues will inevitably arise during a pandemic when vaccine is administered on a massive scale. For example, adverse events too rare to show up even in a large clinical trial may become apparent when very large numbers of people receive a pandemic vaccine.”

  5. World Updates • WHO 8/6/09, Safety of pandemic vaccines - continued • “Some adverse events will be coincidental – that is, associated in time with vaccine administration, yet not directly caused by the vaccine. Genuine adverse events directly caused by the vaccine may also occur, but cannot be predicted in advance. Given the safety record of seasonal vaccines, such events are expected to be rare.” • “Time constraints mean that clinical data at the time when pandemic vaccines are first administered will inevitably be limited. Further testing of safety and effectiveness will need to take place after administration of the vaccine has begun.” • “For these reasons, WHO advises all countries administering pandemic vaccines to conduct intensive monitoring for safety and efficacy, and many countries have plans in place for doing so. On the positive side, mass vaccination campaigns can generate significant safety data within a few weeks.”

  6. World Updates • Shun-Shin et al. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ 2009; 339:b2172 • “Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.” • Median time to resolution was reduced 0.5-1.5 days, significant in 2 of 4 trials. • Post-exposure treatment resulted in an 8% decrease in the incidence of symptomatic influenza. • This article is attached to the update email.

  7. Number of worldwide confirmed deaths among pandemic influenza (H1N1) 2009 cases by week of notification, week 25 to week 32 of 2009 - ECDC http://ecdc.europa.eu/en/files/pdf/Health_topics/Situation_Report_090810_1700hrs.pdf

  8. World Activity by Outbreak Severity Influenza Deaths Confirmed Cases Probable Cases http://upload.wikimedia.org/wikipedia/commons/0/0c/H1N1_map.svg

  9. World Activity by Outbreak Size http://en.wikipedia.org/wiki/File:H1N1_map_by_confirmed_cases.svg

  10. World Activity by Number of H1N1-Confirmed Deaths

  11. World Updates • Recent news headlines: • “Former Taoiseach [head of the Irish government] in quarantine in France” • “First swine flu case in Pakistan” • “West Midlands [UK] paramedics reaching crisis point” • “H1N1 outbreak in central China school” • “Iran to ban Saudi flights to curb swine flu” • “Iraq reports first swine flu death” • Israel: “Fifteen in serious condition” • UK: “Healthy people are lying to get swine flu drug, warn GPs” • “First swine flu death in Republic of Ireland” • “Mexico City offers free health insurance to tourists”

  12. Members of the Indonesian Red Cross holding a rally to campaign on how to prevent influenza including swine flu (H1N1) and avian influenza (H5N1) in Jakarta recently — AFPpic

  13. US Updates • CDC 8/7/09: 6,506 hospitalized cases (up 1,980) in 50 states and US territories (up 3), with 436 deaths (up 83). • NM, OK, CO, UT report ‘sporadic’ activity; TX ‘local’; AZ, NV ‘regional’; CA ‘widespread’ • Over 98% of all subtyped influenza strains are pandemic H1N1. • HHS Region 6 (NM, OK, TX, LA, AR) is reporting that the percentage of outpatient visits for influenza-like illness is running below baseline. • No oseltamivir-resistant strains have been detected in the US. • The White House press secretary has released a North American Leaders’ Declaration on H1N1. “…we will remain vigilant and pledge to continue our close collaboration in addressing the H1N1 pandemic.”

  14. http://www.cdc.gov/flu/weekly/downloadimage.htm?w=30

  15. H1N1 in the USA by Outbreak Severity Influenza Deaths Confirmed Cases Probable Cases http://commons.wikimedia.org/wiki/File:H1N1_USA_Map.svg

  16. Tuesday 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 Influenza Deaths Confirmed Cases Probable Cases Tuesday 8/11 Tuesday 7/21 & 7/28 Tuesday 8/4

  17. H1N1 in the USA by outbreak size http://upload.wikimedia.org/wikipedia/commons/6/6c/H1N1_USA_Map_by_confirmed_cases.svg

  18. H1N1 in the USA by number of deaths http://upload.wikimedia.org/wikipedia/commons/e/ef/H1N1_USA_deaths_-_CSS_map.svg

  19. US Updates • CDC MMWR 8/7/09, Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus • Three Rapid Influenza Detection Tests (RIDT) were tested on 65 clinical samples. Standard PCR testing was the gold standard. • RIDT sensitivity for high viral titer samples was 89%, 100%, 100%. • RIDT sensitivity for all 45 H1N1-positive samples was 40%, 49%, 69%. • Overall sensitivity for H1N1 was 60-80%, and for seasonal H3N2 was 80-83%. • In summary, the three RIDT tested have relatively low sensitivity for H1N1 and do not yet appear to have clear clinical utility.

  20. US Updates • The CDC has developed a web page titled H1N1 Flu (Swine Flu): Resources for Child Care Programs, Schools, Colleges, and Universities, located at http://www.cdc.gov/h1n1flu/schools/ . It contains the following links (see subsequent slides): • Updated Guidance for K-12 Schools for the Fall Flu Season: Aug 7 • Guidance for State and Local Health Officials and School Administrators for School Responses to Flu during 2009-2010 School Year Aug 7 • Technical Report for State and Local Health Officials and School Administrators on CDC Guidance for School Responses to Flu during 2009-2010 School Year Aug 7 • Preparing for Flu: A Communication Toolkit for Schools (K-12) Aug 7 • Report K-12 School Dismissals Jul 30 • Infections Alert for Institutions of Higher Education • Guidance for Colleges, Universities, and Post-secondary Educational Institutions • Guidance on Day and Residential Camps

  21. US Updates • On August 5th the CDC updated its guidance on the amount of time persons with an influenza-like illness should be away from others. • “CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications.” • Epidemiologic data collected during spring 2009 found that most people with H1N1 who were not hospitalized had a fever that lasted 2 to 4 days. The new guidelines would therefore suggest an exclusion period of 3 - 5 days. Those with more severe illness are likely to have a fever for longer periods of time. • Of note is that a minority of H1N1 patients are without fever. • Several CDC guideline documents, including the guideline for institutions of higher education, have been revised accordingly.

  22. US Updates • CDC Novel H1N1 Vaccination Planning Q&A,updated 8/10/09 http://www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm. • This document is attached to the update email. Selected answers: • “Planners should assume novel H1N1 vaccine will be procured and purchased by the federal government and made available for vaccinators at no cost.” • “Planners should assume shipping of vaccine will begin mid-October, although there is a possibility that some vaccine will be available for shipping starting late September.” • “Vaccine will be allocated to each project area in proportion to its population (pro rata).” • NB: There will be no separate allocation for DoD dependents, IHS populations, or tribal communities. States will need to include these groups in their general population planning

  23. US Updates • CDC Novel H1N1 Vaccination Planning Q&A, continued • “There will be a separate allocation for active duty DoD.” • “HHS will provide needles, syringes, sharps containers and swabs.” • Clinical trials are exploring whether the seasonal vaccine and the H1N1 vaccine can be administered simultaneously. It is anticipated that this will be possible. • “CDC Minimum required record-keeping elements will include age group, 1st or 2nd dose, date of vaccination, and state. • “Private providers who have signed an H1N1 influenza vaccine Provider Agreement may charge uninsured patients up to the allowable Medicare charge for their region… Public health departments can bill (3rd party payers or cash) for an administration fee, but cannot turn anyone away due to inability to pay the fee.”

  24. US Updates • CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year,http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm. • This document is attached to the update email. • Recommendations are given depending on clinical severity of the autumn second-wave H1N1. • Under conditions with similar severity as in spring 2009: • Stay home when sick. • Separate ill students and staff. • Use basic hand hygiene and respiratory etiquette. • Routinely clean frequently-touched areas. • Early treatment of high-risk students and staff. • Selective school dismissal (see Technical Report).

  25. US Updates • CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year, continued: • Under conditions of increased severity compared with spring 2009: • Active screening for fever and other symptoms each morning and throughout the day. • High-risk students and staff should stay home. • Students with ill household members should stay home. • Increase distance between people at school. • Extend the period for ill persons to stay home to at least 7 days, and no earlier than 24 hours after having no symptoms. • Consideration of 5 – 7 days of school dismissal (see Technical Report). • Involve stakeholders in decisions.

  26. US Updates • CDC Technical Report for State and Local Public Health Officials and School Administrators on CDC Guidance for School (K-12) Responses to Influenza during the 2009-2010 School Year, http://www.cdc.gov/h1n1flu/schools/technicalreport.htm • This report contains more detailed discussion of each of the recommendations made in the guidance document. • This Technical Report is attached to the update email. • an additional reference: Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. American Academy of Pediatrics, 195 pages, $45.

  27. US Updates • CDC Communication Toolkit for Schools (Grades K-12), http://www.cdc.gov/h1n1flu/schools/toolkit/pdf/schoolflutoolkit.pdf • This Toolkit is attached to the update email, and includes: • Questions and Answers (PDF Version ) about CDC’s Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year • 2 Fact Sheets to Inform Schools and Teachers • Action Steps for Schools to Prevent the Spread of Flu (PDF Version ) • Action Steps for Teachers to Prevent the Spread of Flu (PDF Version ) • 3 Fact Sheets to Inform Parents • Action Steps for Parents if School is Dismissed or Children are Sick and Must Stay Home (PDF Version ) • Action Steps for Parents to Protect Your Child and Family from the Flu this School Year (PDF Version ) • Action Steps for Parents of Children at High Risk for Flu Complications (PDF Version ) • Information on where to find Posters for Schools about Flu Prevention (PDF Version ) • 2 Template Letters (or E-mails) for Schools to Send to Parents • Steps the School is Taking During Current Flu Conditions (Word Version ) • Steps the School is Taking During More Severe Flu Conditions (Word Version )

  28. US Updates • Recent news headlines: • “New Mexico woman dies of swine flu” • “Swine flu claims 13th San Diego victim” • “Northern hemisphere braces for return of H1N1” • “Arkansas has first death due to H1N1 influenza” • “Kansas confirms first death of someone with swine flu” • “Swine flu death is first in Mississippi” • “Flu planners fear Ers flooded with the not-so-sick” • “51 US soldiers in Iraq diagnosed with swine flu” • “First H1N1 flu death reported in Montana” • “US discourages quick school closure” • “Florida A/H1N1 flu deaths double to 41 in 2 weeks”

  29. New Mexico updates • August 10: NM DOH has reported New Mexico’s first confirmed H1N1 death. A 45 year old female from Sierra County with end-stage liver disease had been hospitalized since January 25. She died over the August 8-9 weekend. • August 7: The US CDC awarded New Mexico $1.67M to help with H1N1 vaccination clinic preparation. • “The New Mexico Department of Health plans to use the funding to improve monitoring of influenza illness, enhance H1N1 investigations, expand laboratory resources and establish storage and shipping of vaccine and antiviral medications.” • “New Mexico expects to receive an additional $577,000 from the U.S. Health and Human Services Department that will primarily go to hospitals to help them prepare for a potential surge in demand for their services.” • NM DOH has updated its web page on “H1N1 Flu in New Mexico” - http://nmhealth.org/H1N1/index.shtml . It contains material for individuals and families; material for health professionals; media spots; HAN archives; FAQs, and links to additional information.

  30. UNM updates • SOM Incident Management Team met for briefing and to provide a strategic framework for autumn H1N1 preparedness and planning. • The UNM Pandemic Influenza Plan, UNM Pandemic Influenza Preparedness Implementation Plan, and UNM H1N1 FAQ documents have all been drafted or updated by Byron Piatt. • The Influenza COG is in communication with NM DOH about an autumn H1N1 planning meeting with city , county, and regional stakeholders. • H1N1 Autumn Planning briefing was presented to UNMH Management Coffee 8/6/09. • Pastor Hartenberger is working with religious groups on autumn preparedness. • President Schmidley’s 8/11/09 report to the Regents included an update on UNM H1N1 preparedness and planning. • Chief Guimond is educating the UNM Parents Association on autumn H1N1 preparedness. • Vaccination planning meeting 8/7/09 to discuss UNM scheduling, IT support, logistics and supplies.

  31. “Concerned about Swine Flu H1N1? Keep this personal kit at home for a quick test if you or someone close to you feel as though you are coming down with Flu like symptoms and want to be sure you simply have a cold or if you should get to the Doctors quick.”

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