37
Director’s Update Brief novel 2009-H1N1 FRIDAY 14 AUG 2009 0815 EDT Day 119 Week of Workforce Augmentation
Director’s Update Brief novel 2009-H1N1
FRIDAY14 AUG 2009 0815 EDT
Day 119Week of Workforce Augmentation
2
Key Events
novel 2009-H1N1
14 AUG 2009
– Key events:
– novel 2009-H1N1 Declarations
• WHO: Pandemic Phase 6 (11 JUN 2009 1600 EDT)
• Outbreaks in at least one country in > two WHO regions
• USG: Public Health Emergency declared (26 Apr 2009)
• Renewed by HHS Secretary Kathleen Sebelius
• HHS: Downgraded to Phase 1 – Awareness (9 May 2009)
– US Cases (as of 13 Aug 2009; next update 21 August 2009)
– No longer reporting total cases.
HOSP DEATHS
7,511 477
51 39SLTTs
AFFECTED
US TOTALS
CASES
3
Vaccine
Distribution
novel 2009-H1N1 – 14 AUG 2009
• Centralized distribution by contractor receiving vaccine from 5
manufacturers and ancillary supplies from up to 4 manufacturers and
shipping to sites (up to 80,000), under direction of state health departments
• System similar to VFC
• Vaccine record cards provided by CDC and included in the ancillary supply
kit
• VIS posted on the CDC website
4
Vaccine
Upcoming Events
novel 2009-H1N1 – 14 AUG 2009
• ~August 18
– Posting of ACIP recommendations
– Family of related communication products and information, such as
• Additional description of program
• School-located vaccination guidance
• Provider information on enrollment
• Adverse Events drill: CDC, FDA, HHS—mid-Sept
5
International
Southern Hemisphere Summary
novel 2009-H1N1 – 14 AUG 2009
• Novel influenza A (H1N1) is now the predominate influenza subtype in
circulation
– 66% of influenza viruses in the Northern Hemisphere
– 89% of influenza viruses in the Southern Hemisphere
• Epidemiology and clinical characteristics in Southern Hemisphere are
similar to United States experience in spring
• No changes in the virus
6
Epidemiology/Surveillance
Hospitalizations by Report Date
2009-H1N1 – (as of)13 AUG 2009 (n=7,511) (Weekly*)
2 2 150 65 83 114
336 374
591 605
842
598
469
663
216
503
992 1,005
0
200
400
600
800
1000
1200
11-A
pr18-
Apr25
-Apr
2-May
9-M
ay16-
May
23-M
ay30-
May
6-Ju
n
13-J
un20
-Jun
27-J
un
4-Jul
11-J
ul18
-Jul
25-J
ul30-
Jul
6-Aug
13-A
ug
Week Ending Date
Ho
sp
ita
liza
tio
ns
es
7
Epidemiology/Surveillance
Hospitalization Rate per 100,000 Population by Age Group (n=7,090*)
2009-H1N1 – 14 AUG 2009
6.1
2.9
1.8 1.9
2.8
0
1
2
3
4
5
6
7
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs
Age Group
Hospitalizations p
er 1
00,0
00 P
opula
tion in
Age G
roup
n=1288
n=2366
n= 1915
n= 436
n=1085
*Hospitalizations with unknown ages are not included (n=421)
*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
8
Epidemiology/Surveillance
Deaths by Report Date
2009-H1N1 – (as of)13 AUG 2009 (n=477) (Weekly*)
41
1 17 5
1218
42
83
51
394340 41
52
10
10
20
30
40
50
60
70
80
90
100
2-M
ay9-
May
16-M
ay23
-May
30-M
ay
6-Ju
n13
-Jun
20-J
un27
-Jun
4-Ju
l11
-Jul
18-J
ul25
-Jul
30-J
ul6-
Aug
13-A
ug
Week Ending Date
De
ath
ss
9
Epidemiology/Surveillance
Death Rate per 100,000 Population by Age Group (n=460*)
2009-H1N1 – 14 AUG 2009
0.05
0.08
0.19
0.24
0.12
0
0.05
0.1
0.15
0.2
0.25
0.3
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs
Age Group
Death
s p
er 100,0
00 P
opula
tion in A
ge G
roup
n=10
n=67
n= 203
n= 45
n=135
*Deaths with unknown ages are not included (n=17)
*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
10
Epidemiology/Surveillance
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
novel 2009-H1N1 – 14 AUG 2009
0
1
2
3
4
5
6
7
10/4
10/1
811
/1
11/15
11/29
12/1
3
12/27
1/10
1/24 2/
72/
21 3/7
3/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
2006-07† 2007-08† 2008-09 National Baseline
11
2006-07 2007-08 2008-09 Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions IV-VI
novel 2009-H1N1 – 14 AUG 2009
Region IV - AL, FL, GA, KY, MS, NC, SC, TN
0
1
2
3
4
5
6
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
Region V - IL, IN, MI, MN, OH, WI
0
2
4
6
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
Region VI - AR, LA, NM, OK, TX
0
2
4
6
8
10
12
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
12
Epidemiology and Surveillance
Influenza Like Illness Activity – Florida Week 31
2009-H1N1 – 14 AUG 2009
Supporting Documentation
14
Epidemiology/Surveillance
Hospitalizations by Age Group
2009-H1N1 – 13 AUG 2009 (n=7,511)
1,288
2,366
1,915
1,085
436 421
0
500
1000
1500
2000
2500
Ho
sp
italiz
atio
ns (
n)
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs Unknown
Age Groups
32%
6% 6%
17%
25%
14%
Percentages Represent Proportion of Total Hospitalizations
15
Epidemiology/Surveillance
Deaths by Age Group
2009-H1N1 – 14 AUG 2009 (n=477)
10
67
203
135
45
170
50
100
150
200
250
Mortalitite
s
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs Unknown
Age Groups
2%
14%
9%
4%
43%
28%
16
Epidemiology/Surveillance
Hospitalization Rate per 100,000 Population by Age Group and Selected Sites
2009-H1N1 – 13 AUG 2009
0
5
10
15
20
25
30
US IL MN NJ NY UTHo
sp
italiz
atio
ns
pe
r 1
00
,00
0 p
op
in S
tate
an
d A
ge
Gro
up
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs
0
5
10
15
20
25
30
35
40
NYC
*Denominator: U.S. Census population estimates for July 2008 for all states, 2007 American Community Survey for NYC
Hospitalizations with unknown ages are not included
17
Epidemiology/Surveillance
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 Three Seasons, By Age
novel 2009-H1N1 – 14 AUG 2009
0
2
4
6
8
10
12
10/8
/05
12/3
/05
1/28
/06
3/25
/06
5/20
/06
7/15
/06
9/9/
06
11/4
/06
12/3
0/06
2/24
/07
4/21
/07
6/16
/07
8/11
/07
10/6
/07
12/1
/07
1/26
/08
3/22
/08
5/17
/08
7/12
/08
9/6/
08
11/1
/08
12/2
7/08
2/21
/09
4/18
/09
6/13
/09
Week
% o
f V
isit
s f
or
ILI
% ILI 0-4 % ILI 5-24 % ILI 25-64 % ILI 65 and Older
18
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
19
Epidemiology/Surveillance
Surveillance Systems Summary
novel 2009-H1N1 – 14 AUG 2009
• WHO/NREVSS Collaborating Laboratories
– Seasonal A (H1), A (H3), and B viruses co-circulated with Novel H1N1 viruses
– % of specimens testing positive for influenza decreased
• ILINet (week ending 08 August)
– % of ILI outpatient visits is below the national baseline
– Overall, the % of outpatient visits for ILI decreased slightly
• 122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths was below the epidemic threshold
– % deaths due to pneumonia and influenza decreased slightly
• Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists – state reporting:
– Widespread: PR + 4 states Regional: 10 states
– Local: DC + 10 states Sporadic: 26 states
20
Epidemiology/Surveillance
U.S. WHO/NREVSS Collaborating Laboratories, National Summary, 2008-09
novel 2009-H1N1 – 14 AUG 2009
0
500
1000
1500
2000
2500
3000
3500
4000
4500
500010
/410
/18
11/1
11/1
511
/29
12/1
312
/27
1/10
1/24 2/7
2/21 3/7
3/21 4/4
4/18 5/2
5/16
5/30
6/13
6/27
7/11
7/25 8/8
8/22
Week ending
Num
ber
of P
ositi
ve S
pecim
ens
0
4
8
12
16
20
24
28
32
36
40
44
48
52
56
60
64
68
72
Perc
ent P
ositi
ve
A(Novel H1N1)
A(Unable to Subtype)A(H3)
A(H1) A(Subtyping not performed)
BPercent Positive
* Percentage of all positive influenza
specimens that are
Influenza A (Pandemic H1N1) or Influenza A
(unable to subtype) for the week indicated
37%*
54%*
68%*
73%*
82%*
81%*
86%*
78%*
74%*
73%*
74%*
73%*
73%*
74%*
73%*
77%*
73%*
66%*
21
Epidemiology/Surveillance
Percent of Specimens Positive for Influenza Reported by WHO and NREVSS Labs:
Influenza A (Novel H1N1) vs. Seasonal Influenza, by Week
novel 2009-H1N1 – 14 AUG 2009
0
5
10
15
20
25
30
35
40
45
50
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21
3/7
3/21 4/
44/
185/
25/
165/
306/
136/
277/
117/
25 8/8
8/22
Week Ending Date
Perc
en
t P
osit
ive
All Flu Seasonal Flu Influenza A (Novel H1N1)
Influenza % Positive by Season (for Week 31 – ending 8/08/09):
05-06: 2.12%06-07: 1.97%07-08: 0.62%
22
Epidemiology/Surveillance
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
novel 2009-H1N1 – 14 AUG 2009
0
1
2
3
4
5
6
7
10/4
10/1
811
/1
11/15
11/29
12/1
3
12/27
1/10
1/24 2/
72/
21 3/7
3/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
2006-07† 2007-08† 2008-09 National Baseline
23
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions I-III
novel 2009-H1N1 – 11 AUG 2009
2006-07 2007-08 2008-09 Baseline
Region II - NJ, NY
0
2
4
6
8
10/4
10/1
811
/1
11/15
11/29
12/13
12/27
1/10
1/24 2/
72/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
Region III - DE, DC, MD, PA, VA, WV
0
1
2
3
4
5
6
7
8
10/4
10/1
811
/1
11/15
11/2
9
12/1
3
12/27
1/10
1/24 2/
72/
21 3/7
3/21 4/
44/
18 5/2
5/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
Region I - CT, ME, MA, NH, RI, VT
0
1
2
3
4
5
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
24
2006-07 2007-08 2008-09 Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions IV-VI
novel 2009-H1N1 – 14 AUG 2009
Region IV - AL, FL, GA, KY, MS, NC, SC, TN
0
1
2
3
4
5
6
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
Region V - IL, IN, MI, MN, OH, WI
0
2
4
6
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
Region VI - AR, LA, NM, OK, TX
0
2
4
6
8
10
12
10/4
10/1
811
/1
11/1
5
11/2
9
12/1
3
12/2
71/
101/
24 2/7
2/21 3/
73/
21 4/4
4/18 5/
25/
165/
306/
136/
277/
117/
25 8/8
Week Ending Dates
% o
f V
isits for IL
I
25
2006-07 2007-08 2008-09 Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions VII-X
novel 2009-H1N1 – 14 AUG 2009
Region X - AK, ID, OR, WA
0
2
4
6
8
10
10/4
10/18
11/1
11/15
11/29
12/13
12/27
1/10
1/24 2/
72/21 3/
73/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
Region IX - AZ, CA, HI, NV
0
2
4
6
8
10/4
10/18
11/1
11/15
11/29
12/13
12/27
1/10
1/24 2/
72/21 3/
73/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
Region VIII - CO, MT, ND, SD, UT, WY
0
1
2
3
4
5
10/4
10/18
11/1
11/15
11/29
12/13
12/27
1/10
1/24 2/
72/21 3/
73/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
Region VII - IA, KS, MO, NE
0
2
4
6
8
10/4
10/18
11/1
11/15
11/29
12/13
12/27
1/10
1/24 2/
72/21 3/
73/21 4/
44/18 5/
25/16
5/30
6/13
6/27
7/11
7/25 8/
8
Week Ending Dates
% o
f V
isits for IL
I
26
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
27
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
28
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
29
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
30
Epidemiology/Surveillance
novel 2009-H1N1 – 14 AUG 2009
31
Epidemiology/Surveillance
Percentage of Visits Due to ILI Reported to ILINet*, by day**
novel 2009-H1N1 – 11 AUG 2009
*Average of 169 providers reporting per day
**Weekend and holiday data excluded
0
0.5
1
1.5
2
2.5
3
3.5
4
4/28 5/
15/
45/
75/
105/
135/
165/
195/
225/
255/
285/
31 6/3
6/6
6/96/
126/
156/
186/
216/
246/
276/
30 7/3
7/6
7/97/
127/
157/
187/
217/
247/
277/
30 8/2
8/5
8/88/
11
Date
% I
LI
%ILI Three Day Moving Average
32
Epidemiology/Surveillance
Pneumonia and Influenza Mortality for 122 U.S. Cities
Week Ending 08/08/2009
novel 2009-H1N1 – 14 AUG 2009
4
6
8
10
12
31 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30
Weeks
% o
f A
ll D
ea
ths D
ue
to
P&
I
Epidemic Threshold
Seasonal Baseline
2007 200820062005 2009
33
Epidemiology/Surveillance
Percentage of Deaths Due to Pneumonia and Influenza
Reported by 122 Cities* Mortality Reporting System, by day**
novel 2009-H1N1 – 14 AUG 2009
*Average of 51 cities reporting per day
**Weekend & Holiday data excluded
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
11.00%
4/29 5/
35/
75/
115/
155/
195/
235/
275/
31 6/4
6/8
6/12
6/16
6/20
6/24
6/28 7/
27/
67/
107/
147/
187/
227/
267/
30 8/3
8/7
8/11
Date
% P
&I
% P&I Three Day Moving Average
34
Epidemiology/Surveillance
Weekly Influenza Activity Reported by SLTT’s
novel 2009-H1N1 – 14 AUG 2009
35
Community Measures Task Force (CMTF)
novel 2009-H1N1 – 14 AUG 2009
• Surveillance
– No H1N1-related school dismissals were detected in USA on
August 13
• Guidance
– Business Sector Guidance
– College/University Guidance
– Childcare Guidance
36
Joint Information Center (JIC)
novel 2009-H1N1 – 14 AUG 2009
Figure 1: Distribution of News Topics (N=2638)
8/6 - 8/12
Containment &
Mitigation
6.7%
Outbreaks
19.7%Treatment
25.0%
Preparedness &
Response
40.8%
Basic Science
1.5%Legislation
0.4%
Socioeconomics
5.9%
Fig. 4: Total Number of News Stories Per Week
2638
9541337
1383 1869
1352
0
500
1000
1500
2000
2500
3000
7/2 - 7/8 7/9 - 7/15 7/16 - 7/22 7/23 - 7/29 7/30 - 8/5 8/6 - 8/12
Week
No. of S
tori
es
37
Joint Information Center (JIC)
Public Inquires Since School Guidance
novel 2009-H1N1 – 14 AUG 2009
Additional Clarification
• New guidance different from previous?
• Difference between school dismissal
and school closure?
• What are fever-reducing medications?
• How will communities know if the flu is
more severe and they need to take
additional steps?
• Should members of families with sick
students stay home too?
• Why should we be concerned about
spread of flu in schools?
Answered in guidance
• Exclusion period?
• What are the different types of
dismissals?
Other applications
• How does guidance apply to my child
at boarding school?
• To my child in college?
How do I follow the guidelines?
• We just received an email that there
has been people that tested positive
for the h1n1. One of them is in our
football program. I need to sanitize
and clean are football mats and other
equipment what is the best way to
clean them?
• When should I stop giving fever
reducing medications to my child?
• What are cleansers that can be used
to clean/disinfect surfaces on a bus?
