Director’s Update Brief

Thursday

21 May 2009 1100 EDT

Day 33

Day of Personal Protective Equipment (PPE)

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 Novel Influenza A (H1N1) Key Events
21 May 2009

• Novel Influenza A (H1N1) Declarations

– HHS: Downgraded to Phase 1 – Awareness (9 May 2009)
– WHO: Pandemic Phase 5 (29 Apr 1600 EDT)
– USG: Public Health Emergency declared (26 Apr 2009)
• US Cases:
Total Confimed and Probable
Cases Hosp Deaths**

US TOTAL Cases
INCL DC 5764 249 9

US TOTAL States
Affected INCL DC 48 35 6

• International Cases: 11,034 in 41 Countries, 85 total deaths

• WHO.int 21 May 2009 0655 EDT
• Deployments: 58 deployed, 4 pending, 205 potential

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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
Confirmed and Probable Cases by Onset* and Report Date
500

400

300
Cases

Onset Date (n=1,632)

Report Date (n=5,659)
200

100

0
28
30 ar

1- pr
3- a y
5- a y
7- a y
9- a y
11 a y
13 ay
15 ay
17 ay
19 ay
1- ar
3- r
5- r
7- r
9- r
11 r
13 pr
15 pr
17 pr
19 pr
21 pr
23 pr
25 pr
27 pr
29 pr

M
M
M
M
M
Ap
Ap
Ap
Ap
Ap
-M
-M

-M
-M
-M
-M
-M
-A
-A
-A
-A
-A
-A
-A
-A
-A
-A

ay
DDate
*Information on onset date no longer presented after May 12 due to change to aggregate reporting

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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
Confirmed and Probable Cases by Age (n=5,764)

4000 3,673

3500 64%
Confirmed and Probable Cases

3000

2500
2000
1500
1,045
1000 544 18%
457
500 9% 45 8%
1%
0
0-4 Yrs 5-24 Yrs 25-64 Yrs ≥65 Yrs Unknown
Age Groups

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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT

• WHO/NREVSS Collaborating Laboratories

– Seasonal influenza A (H1), A (H3), and B viruses co-circulated with novel
influenza A (H1N1) viruses

• Influenza-associated Pediatric Deaths

– No new influenza-associated pediatric deaths reported. 08-09 total = 61

• ILINet (week ending 16 May)

– % of ILI outpatient visits È the national baseline; overall trend remains stable
• 122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths remains within expected
– % deaths due to pneumonia and influenza are decreasing
• Geographic Spread of Influenza as Assessed by State and Territorial
Epidemiologists – state reporting:
– Widespread: 8 states Regional: 14 states + DC
– Local: 15 states Sporadic: 13 States

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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
U.S. WHO/NREVSS Collaborating Laboratories Summary, 2008-09

3500 A(H1N1-Sw ine) 50

A(Could not be subtyped)
43%* 46
A(H3)
3000 32%* 42
Number of Positive Specimens

A(H1) * Percentage of all positive

influenza specimens that are
A(Unknow n) Novel Influenza A(H1N1) or 38
2500 B Influenza A (unable to subtype)
34

Percent Positive
for the week indicated
Percent Positive
30
2000
26
22
1500
18
73%* 14
1000
10

500 6
17 labs
91%* reporting for 2
current week
0 -2
2/7

3/7

4/4

5/2

8/8
/18

/15

/29

/13

/27
/4

/1

2
1/1

1/2

2/2

3/2

4/1

5/1

5/3

6/1

6/2

7/1

7/2

8/2
10

11
10

11

11

12

12

Week ending
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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 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
7

5
% of Visits for ILI

0
/4 / 18 /1 / 15 / 29 / 13 / 27 10 24 2/
7 21 3/
7 21 4/
4 18 5/
2 16
10 10 11 11 11 12 12 1/ 1/ 2/ 3/ 4/ 5/
Week Ending Dates
2006-07† 2007-08† 2008-09 National Baseline
NOTE: Week ending dates vary by influenza season
*Preliminary ILI data for week 19, as of May 20, 2009 (n=867 weekly ILI reports received from 49 states)
† 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.
Data are provisional and will not be officially released by the CDC until 1100 EDT
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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
Current Influenza Surveillance – ILINet Regions I-III
Region I - CT, ME, MA, NH, RI, VT

% of Visits for ILI

3

2
/4

/1

10

24

21

21

18

16
2/

3/

4/

5/
/1

/1

/2

/1

/2
10

11

1/

1/

2/

3/

4/

5/
10

11

11

12

12
Week Ending Dates

2006-07 2007-08 2008-09 Baseline

Region II - NJ, NY Region III - DE, DC, MD, PA, VA, WV

6 8

6
4
% of Visits for ILI

% of Visits for ILI

3
2
2

0 0
4

6
18

15

29

13

27

/4

/1

10

24

21

21

18

16
8

2
/

/1

/1

/2

/1

/2
2/

3/

4/

5/

2/

3/

4/

5/
10

11

10

11
/

1/

1/

2/

3/

4/

5/

1/

1/

2/

3/

4/

5/
10

11

11

12

12

10

11

11

12

12

Week Ending Dates Week Ending Dates

NOTE: Scales differ between regions

NOTE: 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.
Data are provisional and will not be officially released by the CDC until 1100 EDT
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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
Current Influenza Surveillance – ILINet Regions IV-VI
Region IV - AL, FL, GA, KY, MS, NC, SC, TN

% of Visits for ILI

3

0
4

10

24

21

21

6
18

15

29

13

27

2
/

1
2/

3/

4/

5/
10

11
/

/
1/

1/

2/

3/

4/

5/
10

11

11

12

12
Week Ending Dates

2006-07 2007-08 2008-09 Baseline

Region V - IL, IN, MI, MN, OH, WI Region VI - AR, LA, NM, OK, TX

6 12

10

4 8
% of Visits for ILI

% of Visits for ILI

2 4

0 0
4

6
18

15

29

13

27

18

15

29

13

27
7

2
/

/
1

1
2/

3/

4/

5/

2/

3/

4/

5/
10

11

10

11
/

1/

1/

2/

3/

4/

5/

1/

1/

2/

3/

4/

5/
10

11

11

12

12

10

11

11

12

12

Week Ending Dates Week Ending Dates

NOTE: Scales differ between regions
NOTE: 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.
Data are provisional and will not be officially released by the CDC until 1100 EDT
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 Epidemiology/Surveillance
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT
Current Influenza Surveillance – ILINet Regions VII-X
Region VII - IA, KS, MO, NE Region VIII - CO, MT, ND, SD, UT, WY

8 5

4
6
% of Visits for ILI

% of Visits for ILI

3

2
1

0 0
4

6
8

7
7

2
/

/1

/1

/2

/1

/2

/1

/1

/2

/1

/2
1

1
2/

3/

4/

5/

2/

3/

4/

5/
10

11

10

11
1/

1/

2/

3/

4/

5/

1/

1/

2/

3/

4/

5/
10

11

11

12

12

10

11

11

12

12
Week Ending Dates Week Ending Dates

2006-07 2007-08 2008-09 Baseline

Region IX - AZ, CA, HI, NV Region X - AK, ID, OR, WA

8 10

8
6
% of Visits for ILI

% of Visits for ILI

2
2

0 0
4

10

24

21

21

18

16
18

15

29

13

27
4

2
8

/
/

/1

/1

/2

/1

/2

2/

3/

4/

5/
2/

3/

4/

5/

10

11
10

11

1/

1/

2/

3/

4/

5/
1/

1/

2/

3/

4/

5/

10

11

11

12

12
10

11

11

12

12

Week Ending Dates Week Ending Dates

NOTE: Scales differ between regions

NOTE: 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.

Data are provisional and will not be officially released by the CDC until 1100 EDT
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 BioSense
Percentage of Emergency Department Visits for Patient-reported ILI
Weekly Trends, 10/07/2006 to 05/16/2009: U.S.

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 BioSense
Percentage of Emergency Department Visits for Patient-reported ILI,
Weekly Trends by Federal Region, 10/07/2006 to 05/16/2009: U.S.

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 International
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT

• WHO global case count: 11,034 confirmed cases in 41 countries*

– Countries with highest confirmed case count after the US and
Mexico:
• Canada: 719 Japan: 259
• Spain: 111 UK: 109
• Increases in case counts expected in countries receiving CDC
PCR kits as testing capabilities are improved
*Note: WHO case counts are current as of 05/20/09, 8:00 pm EDT

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 Division of Global Migration and Quarantine
Novel Influenza A (H1N1) - 20 May 2009 1100 EDT
Students dismissed, United States, 4/29 – 5/20, 2009

500,000
468,282
Number of Students

400,000
369,237

329,834
300,000

245,449

200,000 197,985
169,000

118,033
100,000
55,765 61,697
25,854
17,663
4,838 11,794
0
0
4/29 4/30 5/1 5/4 5/5 5/6 5/7 5/8 5/11 5/12 5/15 5/18 5/19 5/20

Date

Source: ED and CDC Confirmed School Closing Reports released each weekday at 2:00pm.
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 Communications Summary
Novel Influenza A (H1N1) - 21 May 2009 1100 EDT

5/16-17 5/17-18 5/18-19 5/19-20

Channel Traffic
Sa-Sun Sun-Mon Mon-Tue Tue-Wed
41
Clinician Inquiry Calls 7 2 34
(+21%)

Local TV News 273 912 611 737 (+20%)

Web 512,254 547,371 1,216,785 1,044,297

(-14%)
National Themes
– H1N1 “attacks” young people more frequently; children w/chronic conditions
– UT and AZ report H1N1 deaths
– 26 NYC schools closed ~more expected;
– ERs crowed flu-like symptoms
• NYC television
– City gov. actions/response – efforts to calm fears
– Individuals having difficulty assessing symptoms – confusing messages

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