FCBOE -- H1N1 Background & Lastest Updates

H1N1 Background & Lastest Updates

Follow us on:

Share

Information provide by the Floyd County Health Departnment and the CDC

There are no probable or confirmed novel H1N1 cases in the 10-county Northwest Georgia Public Health district

Here's what we know so far about the severity issue: The Pandemic of 2009 could be mild. Or it could be catastrophic. Or somewhere in the middle. We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

Background: Our thinking about pandemics has been conditioned by H5N1, the bird flu virus that has killed more than half the people that we know have been infected. We have become accustomed to assuming that any pandemic would be a catastrophic pandemic. 1918 genuinely was catastrophic, even though its case fatality rate was only 2 - 3%. Seasonal flu has a case fatality rate of 0.01% to 0.02%. Preliminary findings by the WHO estimate the case-fatality rate for novel H1N1 in a range from 0.3% to 1.4%, with 0.4% the most likely value, so it appears right now that novel H1N1 is slightly deadlier than seasonal flu. Of course, the case-fatality rate for novel H1N1 is likely to change: either drop as estimated non-hospitalized cases are included in the counts and the true extent of its spread becomes known or increase as its genetic components evolve. The other two twentieth century pandemics, 1957 and 1968, were mild, not catastrophic -- they killed roughly one percent of the people they infected; for most non-professionals they were non-events. The Pandemic of 2009 could be just as mild.

Or it could be catastrophic. Or somewhere in the middle. We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

So the key question is what to say to the public when a pandemic may well be imminent, but may still fizzle or stay poised at the brink or turn out anticlimactically mild -- or, to further complicate our risk communications, disappear for the summer and come roaring back with a vengeance next fall.

Here's the crucial question we can't answer yet: Will novel H1N1 swine flu become more virulent (stronger) or less so (weaker)? Swine flu has demonstrated that: 1) it is transmissible from person to person; and 2) it is a new (novel strain) and not blocked by most peoples' immune systems worldwide. Swine flu is now out in the world, undergoing incessant cycles of reproduction, mutation, and (still unpredictable) selection. This process could lead to changes in virulence (down or up). Increases in virulence set us up for a severe pandemic. What will happen? We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

We are all (experts and officials and citizens alike) desperate to know the answer to this question, on which everything else depends. And yet we need to move forward, to make our preparations, without that all-important answer. We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

The worst case scenario is almost unimaginably bad: a highly contagious H1N1 that more deadly than it is right now. On the opposite extreme, the pandemic could turn out really mild and anti-climactic, leaving people to wonder what all the fuss was about.

Or, of course, it could turn out somewhere in the middle. Or the pandemic virus might start out mild and become highly virulent the second time it rolls around the world - or vice versa. We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

What should we be watching for this summer? Influenza is a seasonal disease. Summer in the Earth's northern Hemisphere is winter in its southern hemisphere and vice versa. In the United States, we are moving into summer. But below the equator, they are moving into winter. Public health officials will be keeping a very careful watch on the southern hemisphere. Is this the making of the perfect storm: new Swine flu in circulation and winter conditions promoting its circulation? We just don't know right now and wish we did. We have to plan for the worst and hope for the best.

The latest CDC update:
updated: May 22, 2009->

Surveillance & Reporting

Note the key points will not include updated case counts.
The list of states with the numbers of people who are confirmed cases of novel H1N1 infection will be available online and updated Monday - Friday at approximately 11 a.m. at http://www.cdc.gov/h1n1flu/. (Most states do not report over the weekend.)
CDC is reporting 3,352 laboratory confirmed human infections with novel H1N1 flu in 44 states and the District of Columbia (D.C.) in the United States.
An additional 604 probable cases have been reported nationwide. (CDC will not be reporting probable cases at the state level.)
This is a total of 3,956 confirmed and probable cases in 46 states and the District of Columbia in the United States.
Three deaths in the U.S. have been confirmed from this outbreak to date.
Novel influenza A (H1N1) activity is now being detected in two of CDC's routine influenza surveillance systems as reported in the May 8, 2009 FluView.
FluView is a weekly report that tracks U.S. influenza activity through multiple systems across five categories.
CDC will report individual cases for as long as possible, and then will transition to using the seasonal surveillance system to track the progress of the novel H1N1 outbreak.
Routine seasonal surveillance does not count individual cases, but instead monitors activity levels and virus characteristics through a nationwide surveillance system.
The Epidemiology and Prevention Branch in the Influenza Division at CDC collects, compiles and analyzes information on influenza activity year round in the United States and produces a weekly report published each Friday called "FluView" (normally from October through mid-May).
In light of the current outbreak, weekly publication of FluView will continue over the spring and summer.
The U.S. influenza surveillance system is a collaborative effort between CDC and its many partners in state and local health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics and emergency departments.
Information in five categories is collected from nine different data sources that allow CDC to:
- Find out when and where influenza activity is occurring
- Track influenza-related illness
- Determine what influenza viruses are circulating
- Detect changes in influenza viruses
- Measure the impact influenza is having on deaths in the United States
- More information about CDC' s influenza surveillance systems can be found at http://www.cdc.gov/flu/weekly/fluactivity.htm

Outbreak Summary

Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009.
The virus is infecting people and is spreading from person-to-person, and has sparked a growing outbreak of illness in the United States with an increasing number of cases being reported internationally as well.
This virus is spreading from person-to-person without regard for borders, race or ethnicity.
CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks because the population has little to no immunity against it.
The number of countries reporting cases of this virus is growing.
Refer to the WHO website at http://www.who.int/en/for updated country counts.
According to WHO, there is no evidence of sustained person-to-person transmission beyond two generations outside of North America.
This kind of sustained transmission in other parts of the world would need to occur in order for WHO to raise the pandemic alert phase to level 6.
Should WHO raise the pandemic alert level to phase 6, this would have little impact on the United States.
The United States is already engaged in implementing its pandemic response plan.
Influenza is always serious - each year in the United States, seasonal influenza results, on average, in an estimated 36,000 deaths and more than 200,000 hospitalizations from flu-related causes.
It's uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses.
Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result.
In addition, currently there is no vaccine to protect against this novel H1N1 virus as we have for seasonal influenza.
This outbreak certainly poses the potential to be at least as serious as seasonal flu, if not more so, especially given the fact that there currently is no vaccine against this virus and there is no immunity against this virus in the population.
The Southern Hemisphere is just going into their flu season and how this virus behaves in terms of illness severity, high risk groups and overall burden of disease might give us some clues about what we can expect for the Northern.

Response:

The Federal Government is mounting an aggressive response to this outbreak.
CDC's goals during this public health emergency are to reduce illness and death, and to provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.
CDC continues to update guidance continuously as more information becomes available.
For example, CDC has issued updated interim guidance for clinicians on the use of influenza antiviral medications. CDC recommends that use of antiviral medications be prioritized for hospitalized patients and sick patients who are at high risk of serious seasonal flu-related complications.
Visit http://www.cdc.gov/h1n1flu/guidance/ for the most updated guidance
Deployment of 25 percent of the SNS supplies has been completed to all 62 state or project areas.
There are currently 115 CDC staff persons deployed in the field to support the outbreak response.
CDC is taking early steps in the vaccine manufacturing process, working closely with manufacturing and the rest of the government. (More vaccine information below.)
CDC-developed and is distributing PCR diagnostic test kits to detect this virus domestically and internationally.
All 50 states, the District of Columbia and Puerto Rico have received test kits.
This will increase testing capacity, which likely will result in a rapid jump in the number of confirmed cases once states start doing their own testing.
This will be an artifact of testing, but will actually present a more accurate picture of the true scope of novel H1N1 disease in the United States.
Yesterday, May 12, CDC issued an MMWR Report entitled "Novel Influenza A (H1N1) Infections in Three Pregnant Women - United States, April-May 2009"
As of May 10, a total of 20 cases of novel influenza A (H1N1) virus have been reported among pregnant women in the United States from 12 states; 15 of these cases are confirmed (with one death) and 5 of these cases are "probable."
This MMWR report provides preliminary details on three cases of novel influenza A (H1N1) virus infection in pregnant women. Additional information on these cases and other pregnant women with this infection is being compiled by CDC based on reports from state health departments. (More information on pregnancy and influenza below.)
The MMWR report is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0512a1.htm?s_cid=mm58d0512a1_e
Much of CDC's guidance is informed by studies and past experience with seasonal (human) influenza and past influenza pandemics.
Like seasonal flu, some people may be at greater risk of serious complications related to novel H1N1 infection and illness.
People who are at high risk of serious seasonal flu-related complications include pregnant women, children younger than 5 years old, people with chronic medical conditions, and people 65 years and older.
CDC believes this information from seasonal flu applies to the novel H1N1 (swine flu) viruses as well, but studies on this virus are ongoing to learn more about its characteristics and to learn what groups are at highest risk.
This is a rapidly evolving situation and guidance should be considered interim and will be updated frequently as more information becomes available.
Visit the CDC website at http://www.cdc.gov/h1n1flu/ for more information or call 1-800-CDC-INFO.
Everyday, we learn more about this virus and what we learn will continue to inform the actions that we take in response.

Pregnancy

Pregnant women are at high risk for serious complications from seasonal flu and have been disproportionately affected in influenza pandemics.
Pregnancy weakens a woman's immune system and places her at increased risk for serious flu-related complications. The greatest risks for pregnant women can be pneumonia or dehydration. There can also be risks to their unborn babies including pre-term labor.
For novel influenza A (H1N1), CDC has determined that the benefits of treatment or chemoprophylaxis with zanamivir or oseltamivir "likely outweigh the theoretical risks of antiviral use."
Therefore, CDC is recommending that if a clinician suspects that a pregnant woman is infected with this virus, she should receive antiviral treatment without confirmatory testing.
Thus CDC recommends that antiviral use recommendations be applied to pregnant women as it is applied to other groups of persons at high risk of influenza-related complications.
This is a more forward-leaning approach than what is taken with seasonal flu because the burden of illness on pregnant women of the novel H1N1 virus is unknown and we know from the past that influenza can be a serious disease in pregnant women.
We are taking steps to protect pregnant women and others who may be at high risk of serious flu-related complications by pushing out our recommendations on how to aggressively treat novel H1N1 influenza.
On our website, we have posted:

Pregnant Women and Novel H1N1 Considerations for Clinicians.
What Pregnant Women Should Know
Breastfeeding Your Baby: What Parents Should Know
Info for Pregnant Women in Education, Child Care, and Health Care

In addition, we are reaching out through partners to get the word out to these groups that they should take precautions; be aware of warning signs; and seek medical care sooner rather than later.

Novel H1N1 Flu Virus

The hallmark of influenza viruses is their ability to undergo constant and dramatic change.
Many different animals and, of course, humans get infected with influenza viruses, but the viruses generally stick with one species or another.
However, sometimes flu viruses jump from one species to another, and sometimes, viruses from different species can infect the same host and result in a new combination of virus genes.
This last scenario is what happened and resulted in the novel H1N1 flu virus.
This is a very unusual virus. This particular genetic combination of influenza virus segments has not been recognized before in the U.S. or elsewhere.
Testing of a number of the virus samples submitted to CDC show that they are very similar, which means that they likely originated from the same source.
It's too soon to predict what will happen or how the virus might change.
Regular seasonal influenza activity continues in the United States at this time.
There are seasonal influenza A H1, influenza A H3 and type B viruses circulating and causing illness in the United States - these are viruses that regularly circulate among humans - in addition to the novel influenza A H1N1 virus.
There is the possibility of reassortment (swapping virus genes) between this novel influenza A (H1N1) virus and circulating seasonal influenza viruses.
Such a reassortant virus could be resistant to the antiviral drug oseltamivir because most of currently circulating seasonal H1 viruses are resistant to oseltamivir. (They are sensitive to zanamivir and the adamantane drugs amantadine and rimantidine.)
That is one reason why it's important to continue to watch the novel H1N1 virus and human seasonal viruses carefully over the coming weeks and months and to continue to be prepared and proactive.
In addition, as always, we must continue to look for emergence of other flu viruses with pandemic potential.
It is important that we continue to watch this virus carefully to look for changes that may occur.
The Southern Hemisphere is just going into their flu season and how this virus behaves will give us some clues about what we can expect for the Northern Hemisphere.

Vaccine

Vaccines are a very important part of a response to influenza, including novel influenza that may become pandemic.
CDC has isolated the novel H1N1 flu virus and is working to make a candidate vaccine virus that can be provided to industry so that manufacturers can scale up for production of a vaccine, if necessary.
There are many steps involved with producing a vaccine, and we are committed to going forward with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to see about developing full scale vaccine production.
If things go well, and we achieve full scale production, it will be several months until the vaccine will be available.
So a vaccine is an important tool for the future.
Seasonal Flu Vaccine. Production of the seasonal flu vaccine for next season is nearly complete and will be completed. Seasonal flu is responsible for causing an estimated 36,000 flu-related deaths and 200,000 flu-related hospitalizations in the U.S. each year. Seasonal flu vaccine is always a public health priority.

Public/Personal Responsibility:

You have a role in protecting yourself and your family.
Stay informed. Health officials will provide additional information as it becomes available. Visit www.cdc.gov
Everyone should take everyday steps to protect your health and lessen the spread of this new virus:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.

Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
Children, especially younger children, might potentially be contagious for longer periods. CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.
Follow local public health advice regarding school closures, avoiding crowds and other social distancing measures based on illness in specific communities.
We do have antiviral medications in our arsenal against flu.
The priority use for influenza antiviral drugs during this outbreak is to treat severe influenza illness (including those who are hospitalized or ill people who are considered at high risk of serious influenza-related complications