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Vaccines and Related Biological Products Advisory Committee Meeting July 23, 2009 Novel influenza A (H1N1) Epidemiology

Vaccines and Related Biological Products Advisory Committee Meeting July 23, 2009 Novel influenza A (H1N1) Epidemiology Update . Anthony Fiore, MD, MPH Influenza Division National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention.

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Vaccines and Related Biological Products Advisory Committee Meeting July 23, 2009 Novel influenza A (H1N1) Epidemiology

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  1. Vaccines and Related Biological Products Advisory Committee MeetingJuly 23, 2009Novel influenza A (H1N1)Epidemiology Update Anthony Fiore, MD, MPH Influenza Division National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention

  2. Epidemiology/Surveillance Novel H1N1 – 16 JUL 2009 EDT Percentage 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 †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.

  3. Epidemiology/Surveillance Novel H1N1 – 16 JUL 2009Current Influenza Surveillance – ILINet Regions I-III 2006-07 2007-08 2008-09 Baseline

  4. Case Counts (July 16, 2009) • US case counts* • 40,617 laboratory-confirmed cases • 4,795 hospitalizations • 262 deaths • Case characteristics • 50% male • Median age • all cases: 12 years • hospitalized cases: 20 years • deceased cases: 37 years • Counts of confirmed cases affected by guidance to focus testing on persons at risk for complications or hospitalized • Aggregate confirmed case reporting began early June; age groups same as for seasonal influenza syndromic surveillance systems * Most states only testing hospitalized cases. Counts updated weekly

  5. Epidemiology/Surveillance Pandemic H1N1 Cases Rate per 100,000 Population by Age GroupAs of 16 JULY 2009 (n=33,112*) n=4098 n=6713 n=1984 n=439 *Excludes 7,505 cases with missing ages. Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: http://www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File24.csv

  6. Epidemiology/Surveillance Pandemic H1N1 Hospitalization Rate per 100,000 Population by Age Group (n=4,395*) *Hospitalizations with unknown ages are not included (n=300) *Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: http://www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File24.csv

  7. EIP Influenza Laboratory-Confirmed Cumulative Hospitalization Rates, Spring/Summer 2009 *This value represents an age group-specific average influenza rate from October 1 to April 30 from the 2005-06, 2006-07, and 2007-08 influenza seasons.**Note: The scales for the 0-23 month and the ≥65 year age groups differ from other age groups.

  8. Rate per 10,000 population

  9. Rate per 10,000 population

  10. Epidemiology/Surveillance Distribution by Age Group of Influenza Hospitalized Cases Emerging Infections Program - Pandemic H1N1 -14 JUL 2009 *April 12 – June 30

  11. Epidemiology/SurveillancePandemic H1N1 Deaths by Age Group16 JULY 2009 (n=262) 39% 25%

  12. Epidemiology/Surveillance Pandemic H1N1 Case Fatality Ratio by Age Group 16 JULY 2009 (n=262)

  13. Summary of key epidemiologic findings • Distribution of cases/hospitalizations/deaths • Highest incidence lab confirmed infections in school age children • Highest hospitalization rates among 0-4 year olds • Hospitalization rates for Apr-Jul 2009 approach cumulative rates for seasonal influenza among school age children and 18-49 year old adults • Fewest cases but highest case-fatality ratio in older adults • Distribution of cases by age group is markedly different compared to seasonal influenza • Higher proportion of hospitalized cases in children and young adults • Few cases in older adults • Similar to seasonal influenza many have underlying medical conditions (~70% among cases hospitalized during April-May) • 30% previously healthy

  14. Future plans for case-countingWHO and United States • WHO Briefing Note, July 16, 2009 • Countries already experiencing community-wide transmission • can shift focus of surveillance activities to reporting established indicators for monitoring of seasonal influenza activity • are not required to submit regular reports of individual laboratory-confirmed cases and deaths to WHO • Newly affected countries • report the first confirmed cases • provide weekly aggregated case numbers and descriptive epidemiology of early cases • United States • Plan for aggregate confirmed case counting to cease • Focus on monitoring hospitalized and deceased cases • Continued monitoring: • Syndromic surveillance (e.g., ILINet, Biosense) • Population-based surveillance platforms (e.g., Emerging Infections Program, Vaccine Safety Datalink surveillance sites) • Viral surveillance

  15. Reported Cumulative Cases by Country novel 2009-H1N1 – 21 JUL 2009

  16. Reports from Australia • 3,912 conf cases nationwide (13 July) • Incidence increasing in most of Australia but declining in Victoria • 268 (6.9%) hospitalized • 25 (0.6%) ICU • 5 deaths (0.1%) Victoria state, Australia (Melbourne area) July 12, 2009 Source: Victoria Infectious Diseases Reference Laboratory (figure); Kaufman et al. MJA 13 July 2009 (case counts). http://www.vidrl.org.au/surveillance/flu%20reports/flurpt09/pdf_files/flu0911.pdf

  17. Activity in the Americas, 17 July 2009 Influenza A(H1N1) confirmed cases (Source: PAHO)

  18. International Pandemic H1N1 – 17 JUL 2009Southern Hemisphere Summary • To date any evidence of … • Change in epidemiology? • Different age distribution of cases or severe cases from US? No • Different profile of pre-existing conditions from US? No • Change in timing? • Earlier start to influenza season following nH1N1 introduction? Mixed evidence • Change in health care impact? • Increase in hospitalizations following nH1N1 introduction? Limited evidence • Increase in proportion of hospitalized cases in ICU? Limited evidence • Change in transmission? • HH and community attack rates > seasonal influenza? ?

  19. Advisory Committee on Immunization Practices Update • July 29, 2009 special public meeting (Atlanta) • Meeting goals • Review epidemiology and virology • Use scientific data to provide guidance on which groups should be the focus of vaccination efforts • Provide recommendations on which groups should be prioritized for vaccination first if vaccine is produced and distributed in phases (considerations include epidemiologic data and implementation issues) • Provide recommendations that would allow the overall vaccination program (seasonal and pandemic) to be most successful

  20. Advisory Committee on Immunization Practices Update • Meeting presentations • Epidemiology • Virology • Implementation • Communications strategy • Vaccine availability, formulations and timelines • Influenza vaccine workgroup discussion summary • Outcome: ACIP recommendations for use of novel influenza A H1N1 vaccines • Age and/or risk groups • Prioritization • Need? • Strategy • Interim recommendations on web • MMWR publication later in summer

  21. Acknowledgements • Influenza Division • Joe Bresee (Chief, Epidemiology and Prevention Branch • Lyn Finelli (Team Lead, Surveillance and Outbreak Investigations) • Seema Jain • Sonja Olsen • Josh Mott • Many others…. • Hundreds of Federal personnel involved in novel H1N1 pandemic response • State and Local Health Departments

  22. Pandemic H1N1 Cases by StateRate / 100,000 State Population As of 16 JUL 2009

  23. South America Situation Report (July 21, 2009) • Peru • Community attack rate similar to US (5-10%) • Argentina • Higher observed case fatality proportion influenced by early testing practices focusing on identification of severe cases • Assessment of multiple hospitals in Buenos Aires, Tucuman, and other areas during July suggest that while ICUs have been full, the facilities have not needed to make use of overflow facilities • CDC staff continue to participate as part of a team that is investigating severe cases, enhancing nationwide surveillance, and establishing population-based surveillance at three sites. • Chile • CDC field staff continue to work to enhance national surveillance and establish population-based surveillance in San Felipe

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