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IAC Express 2009 |
| Issue number 794: May 1, 2009 |
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Contents
of this Issue
Select a title to jump to the article. |
- CDC
continually posting new information regarding H1N1 influenza (swine flu)
- How to
keep up-to-date on H1N1 influenza (swine flu) news and recommendations
- MMWR
Dispatch reports on history of current swine-origin influenza A virus
outbreak
- MMWR
Dispatch reports on swine-origin influenza A virus infections in a New
York City school
- May 1
issue of MMWR includes four articles about H1N1 influenza
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| Abbreviations |
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AAFP, American Academy of Family Physicians; AAP,
American Academy of Pediatrics; ACIP, Advisory Committee on Immunization
Practices; AMA, American Medical Association; CDC, Centers for Disease
Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization
Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD,
National Center for Immunization and Respiratory Diseases; NIVS, National
Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD,
vaccine-preventable disease; WHO, World Health Organization. |
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Issue 794: May 1, 2009 |
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1. |
CDC continually posting new information regarding H1N1 influenza (swine flu)
The federal government is mounting a strong
response to the H1N1
influenza (swine flu) outbreak. CDC's goals during this public
health emergency are to reduce transmission and illness severity,
and provide information to assist healthcare providers, public
health officials, and the public in addressing the challenges
posed by this newly identified influenza virus. To this end,
CDC continues to update guidance continually.
CDC's H1N1 Flu web page titled Guidance for Professionals has
recently been updated with some interim guidance documents that
will be of particular interest to IAC Express readers. Following
are their titles and URLs:
Update on School (K-12) Dismissal and Childcare Facilities: Interim
CDC Guidance in Response to Human Infections with the 2009
Influenza A H1N1 Virus
http://www.cdc.gov/h1n1flu/K12_dismissal.htm
H1N1 Flu (Swine Flu) Infections Alert for Institutions of Higher
Education
http://www.cdc.gov/h1n1flu/college-alert.htm
Interim Guidance for Infection Control for Care of Patients with
Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in
a Healthcare Setting
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
Interim Guidance--HIV-Infected Adults and Adolescents:
Considerations for Clinicians Regarding Swine-Origin Influenza A
(H1N1) Virus
http://www.cdc.gov/h1n1flu/guidance_HIV.htm
Interim Guidance--Pregnant Women and H1N1 (Swine Influenza):
Considerations for Clinicians [updated since first release]
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm
CDC has also posted interim guidance on such topics as screening,
specimen collection, facemask and respirator use, travel, and
emergency personnel. To access the web page, which is constantly
evolving, go to: http://www.cdc.gov/swineflu/guidance
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2. |
How to keep up-to-date on H1N1 influenza (swine flu) news and recommendations
Need to keep up with the latest news and
recommendations regarding
the rapidly evolving H1N1 influenza outbreak? The following
resources can make your life easier.
(1) CDC's H1N1 Flu web section (http://www.cdc.gov/h1n1flu or
http://www.cdc.gov/swineflu) includes the latest statistics and
links to the interim guidance documents for healthcare
professionals (see IAC Express article #1 above), and a helpful
list of "What's New?" at
http://www.cdc.gov/h1n1flu/whatsnew.htm
H1N1 influenza information in Spanish from CDC is available at
http://www.cdc.gov/h1n1flu/espanol
CDC operates a hotline with English- and Spanish-language
operators. Health professionals and members of the public can call
(800) CDC-INFO [(800) 232-4636] 24 hours a day, 7 days a week.
CDC also offers the option to sign up for email updates, RRS
subscription, and Twitter feeds. Go to http://www.cdc.gov/h1n1flu
and click on your choice in the right column for more information.
(2) The U.S. Department of Health & Human Services website offers
webcasts on H1N1 influenza. Go to http://www.hhs.gov
(3) IAC has added a box to the top of its home page at
http://www.immunize.org that provides links to the most important
related CDC, HHS, and state web pages, as well as to recently
published articles on the subject. Look for the box titled "H1N1
Influenza (Swine Flu)."
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3. |
MMWR Dispatch reports on history of current swine-origin influenza A virus
outbreak
On April 30, CDC published "Outbreak of
Swine-Origin Influenza A
(H1N1) Virus Infection--Mexico, March-April 2009" as an electronic
MMWR Dispatch. The first paragraph and the editorial note are
reprinted below, excluding references.
In March and early April 2009, Mexico experienced outbreaks of
respiratory illness and increased reports of patients with
influenza-like illness (ILI) in several areas of the country. On
April 12, the General Directorate of Epidemiology (DGE) reported an
outbreak of ILI in a small community in the state of Veracruz to
the Pan American Health Organization (PAHO) in accordance with
International Health Regulations. On April 17, a case of atypical
pneumonia in Oaxaca State prompted enhanced surveillance throughout
Mexico. On April 23, several cases of severe respiratory illness
laboratory confirmed as swine-origin influenza A (H1N1) virus (S-OIV) infection were communicated to the PAHO. Sequence analysis
revealed that the patients were infected with the same S-OIV strain
detected in two children residing in California. This report
describes the initial and ongoing investigation of the S-OIV
outbreak in Mexico. . . .
Editorial Note:
Understanding the epidemiology and clinical profiles of recent
cases of S-OIV infection in Mexico can help inform regional,
national, and global control measures in response to the emergence
of S-OIV infection. Important areas for investigation worldwide
include evidence of person-to-person transmission, the geographic
distribution of disease, the clinical spectrum of disease, and the
effectiveness of mitigation strategies.
Previous instances of human-to-human transmission of other swine
viruses have been reported to result in small clusters of disease
and limited generations of disease transmission. Several findings
indicate that transmission in Mexico involves person-to-person
spread with multiple generations of transmission. Patients with
probable and laboratory-confirmed disease have presented over a
period of 4 weeks. Limited contact tracing of patients with
laboratory-confirmed disease also has identified secondary cases of
ILI.
The clinical spectrum of S-OIV illness is not yet well
characterized in Mexico. However, evidence suggests that S-OIV
transmission is widespread and that less severe (uncomplicated)
illness is common. Patients with confirmed disease have been
identified in several states, and suspected cases have been
identified in all states, which suggests that S-OIV transmission is
widespread. In addition, several countries are reporting S-OIV
infection among persons who have travel histories involving
different parts of Mexico in the 7 days before illness onset. To
date, case-finding in Mexico has focused on patients seeking care
in hospitals, and the selection of cases for laboratory testing has
focused on patients with more severe disease. Therefore, a large
number of undetected cases of illness might exist in persons
seeking care in primary-care settings or not seeking care at all.
Additional investigations are needed urgently to evaluate the full
clinical spectrum of disease in Mexico, the proportion of patients
who have severe illness, and the extent of disease transmission.
To expedite confirmation of disease in additional patients, the
World Health Organization (WHO) Influenza Collaborating Center in
Atlanta, Georgia, has placed the genetic sequence of S-OIV from
California in GenBank. Specific primers for S-OIV have been
developed and will be distributed through the WHO Global Influenza
Surveillance Network to reference laboratories throughout the
world. As of April 26, the National Laboratory for Public Health in
Mexico has capacity to perform PCR for S-OIV.
The epidemiologic characteristics of this outbreak underscore the
importance of monitoring the effectiveness of community mitigation
efforts, nonpharmaceutical interventions, and clinical management
practices in anticipation of a possible pandemic.
To access a web-text (HTML) version of the complete MMWR Dispatch,
which includes references, two tables, and a figure go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a2.htm
To access a ready-to-print (PDF) version of the MMWR Dispatch, go
to: http://www.cdc.gov/mmwr/pdf/wk/mm58d0430a2.pdf
To receive a FREE electronic subscription to MMWR (which includes
new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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4. |
MMWR Dispatch reports on swine-origin influenza A virus infections in a New
York City school
On April 30, CDC published "Swine-Origin
Influenza A (H1N1) Virus
Infections in a School--New York City, April 2009" as an electronic
MMWR Dispatch. The first paragraph is reprinted below, excluding
references.
On April 24, 2009, CDC reported eight confirmed cases of swine-origin influenza A (H1N1) virus (S-OIV) infection in Texas and
California. The strain identified in U.S. patients was confirmed by
CDC as genetically similar to viruses subsequently isolated from
patients in Mexico. Since April 24, the number of cases in the
United States and elsewhere has continued to rise. As of April 28,
approximately half (45) of all U.S. cases of S-OIV infection had
been confirmed among students and staff members at a New York City
(NYC) high school. This report describes the initial outbreak
investigation by the NYC Department of Health and Mental Hygiene
(DOHMH) and provides preliminary details about 44 of the 45
patients (the remaining patient resides outside of NYC and was not
included in the analysis). The preliminary findings from this
investigation indicate that symptoms in these patients appear to be
similar to those of seasonal influenza. DOHMH will continue
monitoring for changes in the epidemiology and/or clinical severity
of S-OIV infection. . . .
To access a web-text (HTML) version of the complete MMWR Dispatch,
including references and one figure, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a1.htm
To access a ready-to-print (PDF) version of the MMWR Dispatch, go
to: http://www.cdc.gov/mmwr/pdf/wk/mm58d0430.pdf
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5. |
May 1 issue of MMWR includes four articles about H1N1influenza
The May 1 issue of MMWR includes four articles
about H1N1
influenza, three of which have already been released as MMWR
Dispatches. As we have already covered some of this information in
IAC Express, the following provides full coverage of the two
articles not previously covered and titles and Web links for the
other two.
(1) CDC published "Update: Swine-Origin Influenza A (H1N1) Virus--United States and Other Countries" in the May 1 issue of MMWR. The
article is reprinted below in its entirety, excluding references.
Since April 21, 2009, CDC has been reporting cases of respiratory
infection with a swine-origin influenza A (H1N1) virus (S-OIV)
transmitted through human-to-human contact. In the United States,
as of April 29, a total of 91 confirmed cases had been reported,
including one death (in Texas). By state, the following numbers of
cases had been reported: New York (51); Texas (16); California
(14); Kansas, Massachusetts, and Michigan (two each); Arizona,
Indiana, Nevada, and Ohio (one each).
Outside of the United States, as of April 29, a total of 57
confirmed cases had been reported, including seven deaths (in
Mexico). By country, the following numbers of laboratory-confirmed
cases had been reported: Mexico (26); Canada (13); United Kingdom
(five); Spain (four); Germany and New Zealand (three each); Israel
(2); and Austria (one). Additional information is available at
http://www.cdc.gov/swineflu and
http://www.who.int/csr/don/2009_04_29/en/index.html
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a1.htm
(2) CDC published "Update: Swine Influenza A (H1N1) Infections--California and Texas, April 2009" in the May 1 issue of MMWR. This
information was previously released as an MMWR Dispatch on April
24. The first paragraph is reprinted below, excluding one
reference.
On April 21, 2009, CDC reported that two recent cases of febrile
respiratory illness in children in southern California had been
caused by infection with genetically similar swine influenza A
(H1N1) viruses. The viruses contained a unique combination of gene
segments that had not been reported previously among swine or human
influenza viruses in the United States or elsewhere. Neither child
had known contact with pigs, resulting in concern that human-to-human transmission might have occurred. The seasonal influenza
vaccine H1N1 strain is thought to be unlikely to provide
protection. This report updates the status of the ongoing
investigation and provides preliminary details about six additional
persons infected by the same strain of swine influenza A (H1N1)
virus identified in the previous cases, as of April 24. The six
additional cases were reported in San Diego County, California
(three cases), Imperial County, California (one case), and
Guadalupe County, Texas (two cases). CDC, the California Department
of Public Health, and the Texas Department of Health and Human
Services are conducting case investigations, monitoring for illness
in contacts of the eight patients, and enhancing surveillance to
determine the extent of spread of the virus. CDC continues to
recommend that any influenza A viruses that cannot be subtyped be
sent promptly for testing to CDC. In addition, swine influenza A
(H1N1) viruses of the same strain as those in the U.S. patients
have been confirmed by CDC among specimens from patients in Mexico.
Clinicians should consider swine influenza as well as seasonal
influenza virus infections in the differential diagnosis for
patients who have febrile respiratory illness and who 1) live in
San Diego and Imperial counties, California, or Guadalupe County,
Texas, or traveled to these counties or 2) who traveled recently to
Mexico or were in contact with persons who had febrile respiratory
illness and were in one of the three U.S. counties or Mexico during
the 7 days preceding their illness onset. . . .
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a7.htm
(3) CDC published "Update: Infections With a Swine-Origin Influenza
A (H1N1) Virus--United States and Other Countries, April 28, 2009"
in the May 1 issue of MMWR. This information was previously
released as an MMWR Dispatch on April 28, and was covered in the
April 29 issue of IAC Express.
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a5.htm
(4) CDC published "Update: Drug Susceptibility of Swine-Origin
Influenza A (H1N1) Viruses, April 2009" in the May 1 issue of MMWR.
This information was previously released as an MMWR Dispatch on
April 28, and was covered in the April 29 issue of IAC Express.
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a6.htm
To access a ready-to-print (PDF) version of the entire May 1 issue
of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf
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