Director’s Update Brief
Wednesday
27 May 2009 1100 EDT
Day 39
The Week of CDC Workforce
Director’s Update Brief
Wednesday
27 May 2009 1100 EDT
Day 39
The Week of CDC Workforce
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 2
Key Events
US Novel Influenza A (H1N1)
27 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:
As of 27 May 2009 0100 EDT
•
International Cases: 12,954 confirmed cases in 46 countries
– New countries with confirmed cases: Honduras, Iceland, Kuwait
•
Deployments: 26 deployed, 5 pending, 200 potential
Cases
Hosp
Deaths*
7927
436
11
48
37
6
*
US TOTAL Cases
INCL DC
US TOTAL States
Affected INCL DC
One new death was reported in New York City
TTL Confirmed and Probable
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-Sensitive But Unclassified (SBU) 3
Epidemiology/Surveillance
Number of Novel Influenza A (H1N1) Cases Reported to CDC by State
As of 27 May 2009 0100 EDT (n=7,927)
200-400
51-200
1-50
0
>400
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 4
Epidemiology/Surveillance
Confirmed and Probable Novel Influenza A (H1N1) Cases by Onset* and Report Date
by Week As of 27 May 2009 0100 EDT
*Information on onset date no longer presented after May 12 due to change to aggregate reporting
1
5
17
15
339
1057
198
0
0
0
0
5
19
915
2144
1879
1710
1163
0
500
1000
1500
2000
2500
3000
28
-M
ar
4-A
pr
11
-A
pr
18
-A
pr
25
-A
pr
2-M
ay
9-M
ay
16
-M
ay
23
-M
ay
30
-M
ay
Week Ending Date
C
a
s
e
s
Onset Date (n=1,632)
Report Date (n=7,835)
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 5
Epidemiology/Surveillance
Confirmed and Probable Novel Influenza A (H1N1) Cases by Age
As of 27 May 2009 0100 EDT
757
4,753
1,360
54
1,003
0
1000
2000
3000
4000
5000
C
o
n
fi
rm
e
d
a
n
d
P
ro
b
a
b
le
C
a
s
e
s
0-4 Yrs
5-24 Yrs 25-64 Yrs
≥65 Yrs Unknown
Age Groups
10%
60%
17%
1%
13%
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 6
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
•
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
– One new influenza-associated pediatric death reported
• 11-year old female from Ohio
– 2008-09 season total = 62
•
ILINet (week ending 16 May)
– % of ILI outpatient visits è the national baseline
– % of outpatient visits for ILI increased
•
122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths remains within expected
– % deaths due to pneumonia and influenza is increased slightly
•
Geographic Spread of Influenza as Assessed by State and Territorial
Epidemiologists – state reporting
:
– Widespread: 5 states
Regional: 13 states
– Local: 15 states + DC
Sporadic: 16 states
None: 1 state
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-Sensitive But Unclassified (SBU) 7
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
U.S. WHO/NREVSS Collaborating Laboratories Summary, 2008-09
0
500
1000
1500
2000
2500
3000
3500
1
0
/4
1
0
/1
8
1
1
/1
1
1
/1
5
1
1
/2
9
1
2
/1
3
1
2
/2
7
1
/1
0
1
/2
4
2
/7
2
/2
1
3
/7
3
/2
1
4
/4
4
/1
8
5
/2
5
/1
6
5
/3
0
6
/1
3
6
/2
7
7
/1
1
7
/2
5
8
/8
8
/2
2
Week ending
N
u
m
b
e
r
o
f
Po
si
ti
ve
Sp
e
ci
m
e
n
s
-2
2
6
10
14
18
22
26
30
34
38
42
46
50
Pe
rce
n
t
P
o
si
ti
ve
A(H1N1-Sw ine)
A(Could not be subtyped)
A(H3)
A(H1)
A(Unknow n)
B
Percent Positive
* Percentage of all
positive influenza
specimens that are
Novel Influenza
A(H1N1) or Influenza
A (unable to subtype)
for the week indicated
33%*
43%*
63%*
86%
*
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 8
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
Percent of Specimens Positive for Influenza Reported by WHO and NREVSS
Labs: Novel Influenza A(H1N1) vs. Seasonal Influenza, by Week
0
5
10
15
20
25
30
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Date
P
e
rce
n
t
P
o
si
ti
ve
All Flu
Seasonal Flu
Novel Influenza A(H1N1)
Influenza % Positive
by Season (Week 19):
05-06: 7.80%
06-07: 4.98%
07-08: 2.15%
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-Sensitive But Unclassified (SBU) 9
Epidemiology/Surveillance
BioSense - Percentage of Emergency Department Visits for
Patient-reported ILI, U.S., 10/07/2006 to 05/23/2009
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 10
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
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
NOTE: Week ending dates vary by influenza season
*Preliminary ILI data for week 20, as of May 26, 2009 (n=485 weekly ILI reports received from 45 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.
0
1
2
3
4
5
6
7
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
2006-07†
2007-08†
2008-09
National Baseline
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 11
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
Current Influenza Surveillance – ILINet Regions I-III
Region II - NJ, NY
0
2
4
6
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
isi
ts
f
o
r
IL
I
Region III - DE, DC, MD, PA, VA, W V
0
1
2
3
4
5
6
7
8
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
isi
ts
f
o
r
IL
I
Region I - CT, ME, MA, NH, RI, VT
0
1
2
3
4
5
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
isi
ts
f
o
r
IL
I
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.
2006-07
2007-08
2008-09
Baseline
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 12
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
Current Influenza Surveillance – ILINet Regions IV-VI
Region IV - AL, FL, GA, KY, MS, NC, SC, TN
0
1
2
3
4
5
6
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
Region V - IL, IN, MI, MN, OH, W I
0
2
4
6
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
Region VI - AR, LA, NM, OK, TX
0
2
4
6
8
10
12
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
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.
2006-07
2007-08
2008-09
Baseline
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 13
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
Current Influenza Surveillance – ILINet Regions VII-X
Region X - AK, ID, OR, W A
0
2
4
6
8
10
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
Region IX - AZ, CA, HI, NV
0
2
4
6
8
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
Region VIII - CO, MT, ND, SD, UT, W Y
0
1
2
3
4
5
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
Region VII - IA, KS, MO, NE
0
2
4
6
8
10
/4
10
/1
8
11
/1
11
/1
5
11
/2
9
12
/1
3
12
/2
7
1/
10
1/
24
2/
7
2/
21
3/
7
3/
21
4/
4
4/
18
5/
2
5/
16
Week Ending Dates
%
o
f
V
is
it
s
f
o
r
IL
I
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.
2006-07
2007-08
2008-09
Baseline
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 14
International
Novel Influenza A (H1N1) - 27 May 2009
•
WHO global case count: 12,954 confirmed cases in 46 countries*
– New countries with confirmed cases: Honduras, Iceland, Kuwait
– Countries with highest confirmed case count after the US and
Mexico:
• Canada: 921 ( 116 in last 24 hours)
• Japan: 350 ( 5 in last 24 hours)
• Spain: 136 ( 3 in last 24 hours)
• UK: 137 ( 15 in last 24 hours)
•
4 CDC deployed staff in Mexico
*Note: WHO case counts are current as of 05/26/09, 10:00 pm EDT
Division of Global Migration and Quarantine
Novel Influenza A (H1N1) - 27 May 2009
School Dismissal, United States, 4/29 – 5/26, 2009
•32 schools closed due to H1N1 in 3 states today: MA, NY, and TX, a 60% decrease from
last Friday with 78 school closures; The closures impacted 18,288 students & 1445 teachers
•61 schools reopened in AZ, MA, MI, NJ, NV, NY, & WI affecting approx. 37,888 students and
2793 teachers
Source: ED and CDC Confirmed School Closing Reports released each weekday at 2:00pm
18,288
49,893
42,052
25,854
17,663
11,794
4,838
55,765
169,000
245,449
329,834
468,282
369,237
197,985
118,033
61,697
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
4/28
4/29
4/30
5/1
5/4
5/5
5/6
5/7
5/8
5/11
5/15
5/18
5/19
5/20
5/21
5/22
5/26
Date
Number
Students Affected
32
Schools
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-Sensitive But Unclassified (SBU) 16
Communications Summary
Novel Influenza A (H1N1) – 27 MAY 2009
National and local television
•
Case counts and death toll rising:
–
6700 U.S. cases;
–
12-14 deaths confirmed, 2 in NYC and 1 in Chicago (with underlying medical conditions)
•
27 NYC schools reopen – many parents children home
•
Promising developments regarding vaccine production
Print/Internet news
•
Flu scare reveals strapped local health agencies
•
Mexico, US, Canada announce swine flu deaths
Information Gaps in News Stories
•
No travel or public health guidance (exception NY media—people with chronic conditions)
Public Inquiries:
•
Symptoms?15%; Testing? 18%; Treatment? 12%; Transmission?12%
870,809
172
414
5/20-21
Wed-Thur
1,044,297
202
458
5/19-20
Tues-Wed
1,216,785
189
510
5/18-19 Mon-
Tue
423,954 (-51%)
Web
141 (-18%)
Internet/Print News
138 (-67%)
Public Inquiries
5/25-26
Mon-Tue
Channel Traffic