Saturday, October 24, 2009

Obama declares swine flu a national emergency

H1N1 matches seasonal flu peak months early: CDC

Friday, 23 Oct 2009 03:50pm EDT By Patricia Zengerle
WASHINGTON (Reuters) - U.S. President Barack Obama has declared 2009 H1N1 swine flu a national emergency, the White House said on Saturday.

The declaration will make it easier for U.S. medical facilities to handle a surge in flu patients by allowing the waiver of some requirements of Medicare, Medicaid and other federal health insurance programs as needed, the White House said in a statement.

The U.S. Centers for Disease Control and Prevention said on Friday that H1N1 swine flu has become widespread in 46 of the 50 U.S. states, a level comparable to the peak of ordinary flu seasons but far earlier and with more waves of infection expected.

Obama signed the statement on Friday night.

The White House statement said the declaration was intended to prepare the country in case of "a rapid increase in illness that may overburden health care resources." It was similar to disaster declarations issued before hurricanes hit coastal areas.

"It's important to note that this is a proactive measure -- not a response to a new development," an administration official said.

"H1N1 is moving rapidly, as expected. By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly," he said.

Seasonal flu normally peaks sometime between late November and early March.

Swine flu has hit young adults and children the hardest, while seasonal flu normally is more dangerous for people over age 65.

H1N1 has killed more than 1,000 Americans and put more than 20,000 in the hospital in the United States since it emerged earlier this year, the CDC said. But health officials are quick to note that the actual number of cases cannot be measured.

H1N1 swine flu had been declared a public health emergency earlier in the year.

The new declaration clears the way for waivers of federal requirements that, for example, could prevent hospitals from establishing off-site, alternate care facilities that could help them deal with emergency department demands, the White House said.

Oseltamivir-Resistant Influenza A Pandemic (H1N1) 2009 Virus, Hong Kong, China

[Comment: We had a case of a 16 year old out of China this past August, with Tamiflu Resistance. This is an ahead of print citation. I won't post the whole document, you can read it by clicking on the title. I've bolded the most important information]

DOI: 10.3201/eid1512.091057
Suggested citation for this article: Chen H, Cheung CL, Tai H, Zhao P, Chan JFW, Cheng VCC, et al. Oseltamivir-resistant influenza A pandemic (H1N1) 2009 virus, Hong Kong, China. Emerg Infect Dis. 2009 Dec; [Epub ahead of print]

Honglin Chen, Chung Lam Cheung, Hung Tai, Pengxi Zhao, Jasper F.W. Chan, Vincent C.C. Cheng, Kwok-Hung Chan, and Kwok-Yung Yuen
Author affiliation: The University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China

Resistance to oseltamivir was observed in influenza A pandemic (H1N1) 2009 virus isolated from an untreated person in Hong Kong, China. Investigations showed a resistant virus with the neuraminidase (NA) 274Y genotype in quasi-species from a nasopharyngeal aspirate. Monitoring for the naturally occurring NA 274Y mutation in this virus is necessary

The patient in this study was not treated with oseltamivir. Therefore it is unlikely that the 274Y mutation was drug-induced.

Detection of mixed populations of 274Y and 274H in the NPA specimen before antiviral treatment suggests that the mutation occurs naturally, either before or during infection.

Although no experimental data exist that show the growth properties of this resistant variant, examination of the quasi-species population in the cell culture–propagated virus isolate showed that the 274Y variant has become the dominant population. This finding implies that the 274Y mutation does not compromise replication of pandemic (H1N1) 2009 virus in vitro.

Obama declares swine flu a national emergency

41 minutes ago

WASHINGTON — President Barack Obama has declared the swine flu outbreak a national emergency.

The White House on Saturday said Obama signed a proclamation that would allow medical officials to bypass certain federal requirements. Officials described the move as similar to a declaration ahead of a hurricane making landfall.

Swine flu is more widespread now than it's ever been and has resulted in more than 1,000 U.S. deaths so far.

Health authorities say almost 100 children have died from the flu, known as H1N1, and 46 states now have widespread flu activity.

The White House said Obama signed the declaration on Friday evening.

Friday, October 23, 2009

CDC notes change in ethnic pattern of H1N1 impact

Oct 22, 2009 (CIDRAP News) – The Centers for Disease Control (CDC) has seen a change in the ethnic distribution of fatal pandemic H1N1 influenza cases, a CDC official reported at a meeting of its vaccine advisory committee today.

In an update on epidemiologic patterns in the pandemic H1N1 outbreak, Lyn Finelli, PhD, head of surveillance for the CDC's Influenza Division, told the Advisory Committee on Immunization Practices (ACIP) that the high-risk groups haven't changed since the spring wave.

However, the impact of the virus on racial groups has changed some since the first wave, she told the group, whose meeting was streamed over the Web. Hispanic people had a higher proportion of deaths in the spring, probably because they had connections to people traveling to and from Mexico, where the outbreak is thought to have started. While the number of deaths in Hispanic people has fallen, since September the rate has risen among African Americans, Finelli said. She said the CDC tracks trends through the Behavioral Risk Factor Surveillance System.

Finelli said CDC data show only two deaths in the Native American population, though some members of the committee said some people who work with tribes have received anecdotal reports of higher death rates in Native Americans, and they voiced concern that state surveillance systems may be undercounting deaths and severe illnesses among the tribes.

Finelli noted that not all tribes report flu data to states and that not all states collect data on tribes the same way. The Council of State and Territorial Epidemiologists recently had a conference call to discuss how to improve flu monitoring in native populations, she said.

Also at the meeting, Nancy Cox, MD, director of the CDC Influenza Division, told the committee that the CDC has analyzed 1,280 pandemic H1N1 isolates, 407 of them from other countries. So far it has conducted complete genetic sequencing of 76 isolates, most of them from severe or fatal cases.

She said though the virus continues to evolve and CDC scientists are detecting minor variations, there is no evidence of reassortment or mutation, which is reassuring, because it points to a close match between the circulating strains and the virus in the vaccine.

The World Health Organization has received reports of 38 oseltamivir-resistant pandemic H1N1 cases, only four of which had no history of exposure to the drug, Cox said. "Exposure to the drug is a primary factor to the resistance marker," she said, adding that researchers still don't know why oseltamivir use can sometimes lead to resistant pandemic H1N1 strains but doesn't seem to be a factor in the development of resistant seasonal H1N1 flu viruses.

A variant of the seasonal H3N2 strain that was circulating in South America this past spring, an A/Perth/16/2009-like virus, has been included in the 2010 Southern Hemisphere flu vaccine, Cox said. Laos and southern China have reported circulation of the H3N2 strain. However, she said the CDC has detected only H3N2 A/Brisbane/10/2007, a component of this season's Northern Hemisphere vaccine, in the few seasonal flu strains that it has isolated so far this fall.

Cox said it's difficult to predict how the US flu season will play out on the basis of the Southern Hemisphere's experience this year. The United States had a spring wave of pandemic H1N1, whereas the Southern Hemisphere's H1N1 epidemic hit during the normal flu season. She pointed out that a map of current virus activity in the United States shows a patchwork of hot spots with plenty of places that haven't been hit hard.

Officials can't predict if the season will peak early, but if it does, "that leaves plenty of time for seasonal strains to circulate if the viruses are successful and the population is susceptible," Cox said.

Wednesday, October 21, 2009

Florida Hospitals Might Deny Some Patients In Flu Pandemic

Source: by Sheri Fink, Pro Publica Posted on: 21st October 2009

Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases.

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with a poor prognosis from ventilators to treat those with better chances of survival. That decision would be made by each hospital.

The flu causes severe respiratory illnesses in a small proportion of cases, and people who need ventilators and are deprived of them could die without the breathing help the machines provide.

In June, Florida Surgeon General Ana M. Viamonte Ros sent the draft guidelines (PDF), which already had undergone a series of internal revisions, to 16 state medical organizations for comment.

But the state has not yet publicized the guidelines or solicited input from the general public.

The Health Department released a version of the draft plan at the request of ProPublica.

The document, drawn up by a team from across Florida that included Orange County Health Director Dr. Kevin Sherin, addresses one of the most delicate issues in medicine: what to do if the number of severely ill people needing ventilators and other treatment dramatically exceeds what is available.

The goal, the plan says, is to focus care on patients whose lives could be saved and who would be most likely to function better if they were given whatever resources were available. It says those decisions are not to be made based on patients’ perceived social worth or social role, but the plan calls for different rules for some populations.

The list of conditions that disqualify hospital admission would be applied to most people only in the two most severe levels of a pandemic. However, they would be applied in the first level of a pandemic for people transferred to hospitals from “other institutional facilities” such as nursing homes and mental-health centers.

A flood of patients

Florida’s planning effort reflects a growing acknowledgment that the nation’s hospitals would be unable to cope with the flood of patients that a severe influenza pandemic such as the one that gripped the United States in 1918 would unleash. That resource gap is in the spotlight now, as the country is battered by a second wave of pandemic H1N1 influenza, informally known as the swine flu.

“What we have seen are real stresses, particularly on the emergency departments,” Thomas Frieden, Centers for Disease Control and Prevention director, said in a news conference last week.

The H1N1 flu is much milder than the 1918 flu, but a small percentage of H1N1 patients, including some who have no risk factors and are young and healthy, develop severe breathing problems requiring mechanical ventilation and life support.

So far, intensive-care units have not been overwhelmed with people in need of breathing support.

“That’s something that we’re tracking closely,” Frieden said.

In Winnipeg, Manitoba, all regional critical-care beds were full at the peak of the outbreak last spring, and in Mexico, patients experienced long delays before being admitted to ICUs. Four died before being transferred from the emergency room.

Florida health officials think that the number of severely ill flu patients will likely remain at a manageable level, provided residents gets vaccinated, that they follow advice about not spreading germs and about when to stay home (see [2]) and the existing flu strain does not mutate into a more virulent form.

In the case of a much more severe scenario, Florida’s draft guidelines would call for hospitals to turn away anyone whose doctor has signed a “Do Not Resuscitate” order, which instructs rescuers not to revive a patient whose heartbeat or breathing stops. A recent report from a panel of national experts convened by the Institute of Medicine urged states not to use DNR orders for this purpose, because they reflect preferences and foresight about end-of-life planning “more than an accurate estimate of survival.”

The report also stressed that clinical scoring systems used to predict survival are imperfect and need more research.

The Florida plan calls for intensive-care patients and those using ventilators to be reassessed with a clinical scoring tool after 48 to 72 hours. Those whose prognoses have significantly worsened would be taken off the machines or discharged from critical care to make way for others who may have a better chance of survival. They would be given palliative care to keep them comfortable if needed.

Stretching resources

One goal of Florida’s plan is to “reduce or eliminate” the legal liability of health care workers who, in good faith, deny treatment or withdraw it from some patients in an emergency. The plan includes sample executive orders that the governor could issue to shield workers and authorize hospitals to implement the guidelines.

As to whether the governor would likely sign such an order, “it’s premature for us to say at this point,” Sterling Ivey, a spokesman for the governor’s office, said. He said it was likely the draft had not yet been sent to the governor, but that he would “look forward to reviewing the plan.”

The draft document also outlines how the health-care system should stretch critical resources, including oxygen, ventilators, medications, IV fluids and staffing, before moving to ration care. The guidelines suggest sterilizing and reusing some supplies, canceling surgeries and other procedures that are not absolutely necessary, and reassigning and training staff to perform critical tasks.

The general public’s responsibilities include treating certain sick family members at home and monitoring public-health messages.

State officials would not release the comments received from medical organizations so far. Health Department officials have yet to review those comments and a revised document, according to Viamonte Ros’ letter, “will be vetted through a series of workshops to receive a broader review” before being finalized.

Viamonte Ros will have final approval authority, and the plan will remain voluntary and subject to review and modification as necessary, according to Florida Department of Health information officer Doc Kokol.

However, staff at some county health departments appear unaware of the plans. Public-information officers working for the Seminole and Lake county health departments were unable to find health officials familiar with them. According to Kokol, a wider range of health departments will be contacted once the initial comments are incorporated.

Sherin, of Orange County, said his key concern is the availability of ventilators and critical-care beds in a pandemic.

“So far so good,” he said. “We haven’t had a lot of critically ill H1N1 patients that have required ventilation yet. But if you end up with a large number of very sick people, that would be the critical resource in the hospital.”

He added, “The public needs to lower expectations when we get to places of critical-resource shortages, and these guidelines would be helpful for hospitals, for EMS, for physicians, for emergency responders to be able to deal with the circumstances.”

Sherin said the draft still requires improvement and will benefit from a broad community process “where as many sets of eyes look at it as possible.”

The ‘greatest good’

Florida’s draft guidelines aim to provide the “greatest good for the greatest number” when doing the best for each patient is no longer possible.

That goal needs to be balanced with an effort to distribute scarce resources in the least discriminatory way, said professor Ken Goodman, director of University of Miami’s bioethics program, who was invited to comment on the draft.

“We want to make the most of our resources,” said Goodman, who also directs the Florida Bioethics Network. “Among the ways we can do that is to somehow take the evidence about what we think works and bolt it to the values that I think are uncontroversially shared: Namely, life is good, suffering is bad. And so how do we do it? It’s a very difficult problem to figure out how the world of science can help ensure that our strategies for allocating resources are fair and effective.”

The Florida Health Department’s original goal was to have a final draft of the plan ready by December. But with public-health workers scrambling to cope with other aspects of the H1N1 pandemic, that is now unlikely, state officials said.

Even so, the draft plan likely would shape the state’s response to a sudden, extreme surge in patients requiring hospital treatment.

“We’d certainly start the discussion with this document,” said Rhonda White, director of the Florida Health Department’s Office of Public Health Preparedness.

Gut-wrenching choices

Florida plans to accept public input after the guidelines are revised by health officials.

“The exact plan for engaging the public is still being discussed,” Kokol wrote in an e-mail, “but it will likely include regional meetings for public input as well as electronic receipt of comments.”

When Utah tested a similar plan against reality in a drill in late August, the results revealed the difficulties Florida clinicians and patients are likely to encounter if its plan is needed.

Utah family physician Pete DeWeerd had to tell the mother of a mock patient that her 7-year-old daughter, who had cerebral palsy and was suffering from the flu, would be turned away from the hospital and likely die.

“I don’t like to tell you this,” he said he told her. “It feels unfair, but our list is our list is our list.”

He added, “It was awful. You get a huge lump in your throat.”

Infectious-disease physician Tom Kurrus, medical director of St. Mark’s Hospital in Salt Lake City, called it “emotionally draining” when mock patients and family members yelled, screamed and took issue with who was denied treatment.

Kurrus said that although the exercise was covered widely in Utah’s media, the public isn’t aware of what the triage protocols contain.

“Even with the scenarios played out and the discussions entertained, they still don’t understand,” he said. “It’s, ‘Why can’t I get into the hospital? Why can’t Grandma get put on a respirator?’”

Goodman, the ethicist, said a frank discussion about the value-laden decisions surrounding who gets treatment in disasters is crucial. “This should be an ongoing process that includes new evidence as it becomes available and that includes, in an open society, the participation of citizens.”

Swine Flu Care May Swamp Health System, Senator Says (Update1)

By Pat Wechsler

Oct. 21 (Bloomberg) -- Swine flu “may be getting ahead of the public health system” because it is spreading so rapidly, causing illness and death, U.S. Senator Joe Lieberman told public health officials today.

Lieberman, an independent legislator from Connecticut, and Senator Susan Collins, a Maine Republican, said at a hearing in Washington that they weren’t sure the U.S. was ready to fight the disease, as H1N1 vaccine production has slowed with 25 percent less supply of the H1N1 vaccine at the end of October than health officials expected.

Hospital emergency rooms may not be prepared and there may also be a shortage of the pediatric version of the antiviral drug Tamiflu made by Roche Holding AG, Collins said at the hearing of the Senate Committee on Homeland Security and Governmental Affairs. The committee is investigating whether the U.S. can cope with the H1N1 flu, which has already killed almost 300 people in 28 states, according to U.S. Centers for Disease Control and Prevention, based in Atlanta.

“The flu is moving very rapidly and while it seems to be affecting most people mildly, it is still affecting a minority very severely,” said Lieberman, the committee’s chairman. Public health officials may not be prepared to “adequately treat” victims at the peak of the U.S. outbreak, he said.

‘Surge of People’

Connecticut may see more than one million people contract H1N1 flu, with 17,300 hospitalizations, Lieberman said, quoting a study by the Washington-based nonpartisan Trust for America’s Health. That number is “150 percent” of the state’s hospital- bed capacity, Lieberman said.

“I want to stress my concern that hospitals and public health departments won’t have the capacity to care for the surge of people who may need hospitalization,” he said.

Maine also may not be prepared, with insufficient vaccine to cover the populations considered most at risk, such as children and pregnant women, Collins said.

She noted an outbreak at Bates College in Lewiston, Maine, where the number of students with swine flu jumped from six to 245 in a week.

Health and Human Services Secretary Kathleen Sebelius said that while there are vaccine delays, the “good news” is that people over the age of 10 years will need only one dose and that the immune response is being detected in eight to 10 days rather than two weeks.

“This disease only surfaced in April and we already have a robust vaccine available,” Sebelius told the committee.

Senate Investigation

The Senate committee is investigating whether the U.S. is prepared to adequately handle the H1N1 flu, which has already killed almost 300 people in 28 states, according to U.S. Centers for Disease Control. As many as 5,000 have been hospitalized, with 53 percent of the patients under the age of 25, the CDC reported.

Sebelius said delays in vaccine shipments are occurring because of “glitches on the production lines.”

The U.S. has placed orders with at least four companies including Novartis AG in Basel, Switzerland; Sanofi-Aventis SA in Paris; AstraZeneca Plc in London, and CSL Ltd. in Melbourne.

“The fill and finish were not working as expected,” she said, referring to packaging of the vaccine. Sebelius said those problems have been addressed and the supply should increase “exponentially,” beginning next month.

Enough Vaccine Coming

“There will be enough vaccine for every American who wants to be vaccinated,” Sebelius said at the hearing.

The U.S. is too dependent on vaccine production in other countries as well as out-of-date technology, Sebelius said.

“We are committed to moving to cell-based technology,” she said. Vaccines are made now using eggs cultured with viruses. “We need something appropriate for the 21st century,” she said.

To help with the most severely ill flu victims, who sometimes don’t respond to antiviral medications or are too sick to take pills or use an inhaler, Sebelius told the committee that the U.S. Food and Drug Administration will push out intravenous medication that may prove to be more effective on an “emergency use authorization” rather than waiting for the testing to be completed.

“This is among the highest priorities with the FDA and CDC,” she said. Sebelius said approval is “imminent” and may be days away.

IV Medicine

Biocryst Pharmaceuticals Inc. is one of the companies testing an IV formulation of peramivir. While the drug performed no better than a placebo against seasonal influenza in a human medical trial, a CDC laboratory found it may work against swine flu, the Birmingham, Alabama company has said.

The antiviral drugs already in use include Roche’s Tamiflu pills and Glaxo’s Relenza, which is inhaled.

Homeland Security Secretary Janet Napolitano told the committee that the government was starting undercover operations to root out sellers of phony treatments for the flu.

To contact the reporters on this story: Pat Wechsler in New York at

Last Updated: October 21, 2009 14:13 EDT

Tuesday, October 20, 2009

Turkeys catch swine flu at Ontario farm

October 20, 2009
Theresa Boyle

The Ontario government is investigating an outbreak of H1N1 influenza at a turkey farm.

The birds have been infected by the H1N1 virus but there has been no transmission to humans, a source confirms.

Cooking destroys the virus, so no one is at risk from consuming turkey, the source says.

The Chief Veterinarian for Ontario, Dr. Deb Stark, and Chief Medical Officer of Health, Dr. Arlene King, are holding a news conference on the issue at 2 pm Tuesday.

hat-tip Ironorehopper

CDC Health Alert Network (HAN) Info Service Message: Recommendations for Early Empiric Antiviral Treatment in Persons with Suspected Influenza who are

Distributed via Health Alert Network
October 19, 2009, 13:51 EDT

Summary Recommendations: When treatment of influenza is indicated in a patient with suspected influenza, health care providers should initiate empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation of influenza to begin treatment with antiviral drugs is not necessary. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative rapid influenza test result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests for 2009 H1N1 virus can range from 10% to 70%, indicating that false negative results occur frequently.


The 2009 pandemic H1N1 influenza virus continues to be the dominant influenza virus in circulation in the U.S. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. Several recent reports have indicated two problems related to antiviral treatment: (1) some patients with suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, were not treated at all with antiviral medications because of a negative rapid influenza diagnostic test result and (2) initiation of treatment was delayed for some patients with suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, because clinicians were waiting for results of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay.

Who is prioritized for treatment with influenza antiviral drugs?

Most healthy persons (i.e., those without a condition which puts them at higher risk for complications) who develop an illness consistent with uncomplicated influenza do not need to be treated with antiviral medications and will recover without complications. However, clinical judgment should be the ultimate guide in making antiviral treatment decisions for ill persons who are not at higher risk for complications from influenza.

Early empiric treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization. Prompt empiric outpatient antiviral therapy is also recommended for persons with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration regardless of previous health or age.

Early empiric treatment should be considered for persons with suspected or confirmed influenza who are at higher risk for complications, even if not hospitalized, including:

o Children younger than 2 years old

o Adults 65 years and older

o Pregnant women

o Persons with the following conditions:

· Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus);

· Disorders that that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)

· Immunosuppression, including that caused by medications or by HIV;

· Persons younger than 19 years of age who are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome.

When should health care providers start treatment with antiviral drugs?

Once the decision to administer antiviral treatment is made, oseltamivir or zanamivir should be initiated as soon as possible. Evidence for benefit from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization, even for patients whose treatment was started more than 48 hours after illness onset.

When treatment is indicated, health care providers should not wait for laboratory confirmation of influenza to begin oseltamivir or zanamivir treatment of patients with suspected 2009 pandemic H1N1 influenza virus infection. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests to detect 2009 H1N1 virus in respiratory specimens ranges from 10% to 70%, and therefore false negative results occur frequently. Similarly, false negative results can also occur with immunoflorescence assays.

What actions should health care providers take when waiting for influenza test results?

Health care providers should empirically treat persons with suspected influenza illness who are at increased risk for complications if clinically indicated while influenza test results are pending. Antiviral treatment is most effective when administered as early as possible in the course of illness. The rRT-PCR tests are the most sensitive and specific influenza diagnostic tests, but they may not be readily available, obtaining test results may take one to several days, and test performance depends on the individual rRT-PCR assay. Antiviral treatment should not be delayed until rRT-PCR test results are available.

For More Information

Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season:

Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season:

ECDC DAILY UPDATE Pandemic (H1N1) 2009 Update 20 October 2009, 09:00 hours CEST


Updates from U.S.A. and Canada
United States
Update Data as of 16 October 2009, for week ending 10 October 2009 (Week 40)

Virology: 100% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses. 99.6% of all specimens were type A and 0.4% were type B. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Since September 1, 2009, four infections with oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States, and a total of 13 cases have been identified in the U.S. since April 2009 (10 viruses identified by CDC and three viruses identified by additional laboratories).

The 13 cases represent an increase of one case over the previous week. All tested viruses retain their sensitivity to the neuraminidase inhibitor zanamivir. Eleven patients (including nine of the viruses detected at CDC and two viruses identified by the additional laboratories) had documented exposure to oseltamivir treatment or chemoprophylaxis, and the remaining two patients are under investigation to determine exposure to oseltamivir.

Since the emergence of the 2009 influenza A (H1N1), all isolates tested have been resistant to the adamantanes (amantadine and rimantadine). Currently, adamantane antiviral susceptibility testing has been suspended at CDC to allow a focus on neuraminidase inhibitors. Because of the low level of circulation of seasonal influenza A (H1N1), A (H3N2), and influenza B viruses, no samples collected since September 1, 2009 were available for antiviral resistance testing.

Mortality Surveillance:
Pneumonia and Influenza Hospitalization and Deaths: From 30 August – 10 October 2009, 4,958 laboratory-confirmed influenza associated hospitalizations, 292 laboratory-confirmed influenza associated deaths, 15,696 pneumonia and influenza syndrome-based hospitalizations, and 2,029 pneumonia and influenza syndrome-based deaths, were reported to CDC.

Pneumonia and Influenza (P&I) Mortality Surveillance:
During week 40, 6.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.5% for week 40.

Influenza-associated Pediatric Deaths: Influenza-Associated Pediatric Mortality:
Eleven influenza-associated pediatric deaths were reported to CDC during week 40. Ten of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype is undetermined. These deaths occurred between 30 August and 10 October 2009. Since 30 August 2009, CDC has received 43 reports of influenza-associated pediatric deaths that occurred during the current influenza season. (A total of 86 deaths in children associated with 2009 H1N1 virus have been reported to CDC.) Among the 43 deaths in children, 28 children had specimens collected for bacterial culture from normally sterile sites and seven (25.0%) of the 28 were positive; Staphylococcus aureus was identified in five (71.4%) of the seven children.

Also called: Staph

Staph is short for Staphylococcus, a type of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced “staff infections”), including

  • Skin infections
  • Pneumonia
  • Food poisoning
  • Toxic shock syndrome
  • Blood poisoning (bacteremia)

Skin infections are the most common. They can look like pimples or boils. They may be red, swollen and painful, and sometimes have pus or other drainage. They can turn into impetigo, which turns into a crust on the skin, or cellulitis, a swollen, red area of skin that feels hot.

Anyone can get a staph skin infection. You are more likely to get one if you have a cut or scratch, or have contact with a person or surface that has staph bacteria. The best way to prevent staph is to keep hands and wounds clean. Most staph skin infections are easily treated with antibiotics or by draining the infection. Some staph bacteria are resistant to certain antibiotics, making infections harder to treat.

Monday, October 19, 2009

Nevada: More Than 2,000 Stand in Line for H1N1 Vaccine

Monday, October 19, 2009

More than 2,600 people stood in line — sometimes longer than two hours — to be among the first in southern Nevada to get the injectable swine flu vaccine.

Gwen Osburn, community health nurse at the Southern Nevada Health District, said more than 300 people were vaccinated in the first hour after opening on Saturday.

The health district has received more than 48,000 doses of the H1N1 vaccine, including an initial delivery of 20,000 FluMist doses, which are administered through the nose.

About 11,000 doses have been distributed to doctors' offices in Clark County that serve at-risk populations.

USDA Confirms H1N1 in Minnesota Pigs

Monday, October 19, 2009

The U.S. Department of Agriculture says at least one pig from the Minnesota State Fair has tested positive for the H1N1 virus, the first case of a pig contracting the virus in the United States.

Agriculture Secretary Tom Vilsack said in a statement Monday that USDA officials have begun to reach out to international organizations and are emphasizing that H1N1, also known as swine flu, cannot be contracted by eating pork products.

The USDA's National Veterinary Services Laboratories confirmed the presence of H1N1 after an initial test suggested that as many as three pigs may have had the virus.

USDA officials say the infection of a so-called show pig doesn't indicate an infection of commercial herds because show pigs are in separate segments of the swine industry.

U.S. Department of Education Issues Guidance On Swine Flu

October 19, 2009

The US Department of Education has issued guidance that discusses waivers from federal education requirements that may provide state or local educational institutions with the operational flexibility necessary to efficiently close schools and otherwise respond to the administrative challenges presented by a potential H1N1 outbreak such as: prolonged school closures, excessive absenteeism, or other disruptions in the regular delivery of educational services to students for a prolonged period of time.

The document, which is quite lengthly, contains advisory information on six sections: Elementary and Secondary education issues, adult education and career and technology issues, Federal Student Aid and other postsecondary education issues, grant administration requirements, Family Educational Rights and Privacy Act (FERPA) issues, and distribution of flu vaccines at school facilities. The document also addresses concerns for IEPs and Special Education student services which may be disrupted.

The Guidance is available here.

Mitchell H. Rubinstein