World Health Organization Pandemic H1N1 Update from the USPACOM/COE Pandemic Influenza Workshop, February 2010.
Response to H1N1
•Strategic National Stockpile
•Distributed 25% pro rata supply
•Enhanced Surveillance Initiated
•PCR panH1N1 kits for testing
•Development at CDC, EUA at FDA, manufacture at ATCC, and ready to ship in ~ 2.5 weeks
1. Current stocks of disposable N-95 respirators will not be sufficient to meet demands within the health care community.
a. Increased number of sick individuals;
b. Decreased stores and available stock-on-hand;
c. Limited production with dependence on international production facilities;
d. Production and delivery may be impacted by staff and employee absenteeism;
e. The pandemic may result in the prolonged requirement for respiratory protection.
• As of 16 October, the number of Influenza-Like Illness (ILI) deaths in the U.S. was 537 this week compared to 405 deaths reported last week. (Source: HHS/CDC)
• As of 16 October, the most significant impacts of A(H1N1) remain increased ILI outpatient visits and influenza associated pediatric deaths. (Source: HHS/CDC)
• CDC provided updated interim guidance on the use of face masks and N95 respirators for decreasing exposure to A(H1N1). (Source: HHS/CDC)
2009 H1N1 Influenza
As of October 2, 2009:
–World Health Organization (WHO) regions have reported over 343,298 laboratory-confirmed cases
–At least 4,108 deaths
–The laboratory-confirmed cases represent a substantial underestimation of total cases
So far this year, there have been nine deaths related to H1N1 influenza in the state. The other H1N1-related deaths are as follows: A 45-year-old female from Sierra County with end stage liver disease, a 52-year-old female from Bernalillo County with chronic pulmonary disease, a 48-year-old female from McKinley County with asthma and diabetes, a 21-year-old female from Los Alamos County without chronic medical conditions, a 58-year-old male from Bernalillo County with chronic conditions that put him at risk for serious complications from the flu, a 28-year-old male from Lea County died Sept. 23 after being hospitalized in El Paso, Texas.
The Los Angeles County Department of Public Health (LACPDH) encourages schools, residents, community organizations and businesses to develop plans and policies in the event of a public health emergency, such as a pandemic or other large-scale disease outbreak. Preparedness is one of the best prevention techniques available. Many of the planning procedures and precautionary measures suggested are important to practice in everyday life—not only in the event of a public health emergency.
Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal is not approved for use in children <24 months of age. In a clinical trial with FluMist, among children 6-23 months of age, wheezing requiring bronchodilator therapy or with significant respiratory symptoms occurred in 5.9% of FluMist recipients compared to 3.8% of active control (injectable influenza vaccine made by Sanofi Pasteur Inc.) recipients (Relative Risk 1.5, 95% CI: 1.2, 2.1). Wheezing was not increased in children ≥24 months of age. Hypersensitivity, including anaphylactic reaction, has been reported during post-marketing experience with FluMist.
Anaphylaxis has been reported after administration of FLUVIRIN. Although FLUVIRIN and Influenza A (H1N1) 2009 Monovalent Vaccine contain only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have severe egg allergy. Allergic reactions include hives, angioedema, allergic asthma, and systemic anaphylaxis. The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated.
Anaphylaxis has been reported after administration of influenza vaccines. Although Influenza A (H1N1) 2009 Monovalent Vaccine contains only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have severe egg allergy. Allergic reactions include hives, angioedema, allergic asthma, and systemic anaphylaxis. The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated. Neurological disorders temporally associated with influenza vaccination such as encephalopathy, optic neuritis/neuropathy, partial facial paralysis, and brachial plexus neuropathy have been reported.
Because postmarketing reporting of adverse reactions is voluntary and from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to vaccine exposure. The adverse reactions described have been included in this section because they: 1) represent reactions that are known to occur following immunizations generally or influenza immunizations specifically; 2) are potentially serious; or 3) have been reported frequently.
* Disease likely persists through summer in US, possible surge in late August when school returns
* Monitor closely for genetic and antigenic virus changes
* Expected higher attack rate (20-30%) than in spring (6-15%), notably affecting younger individuals
* Vaccine availability possibly mid October, Federal funds for distribution and administration are available
* Healthcare facility support in part from HPP grants
* SNS Antiviral stocks likely to be distributed
* Drifted H3N2 may co-circulate with novel H1N1
• Oseltamivir (Tamiflu) and Zanamivir (Relenza)
• Randomized clinical trials (RCT): Reduced duration of influenza by 1-1.5 days when administered in 48 hours
• Pooled RCT analysis: Reduced lower respiratory tract complications, pneumonia, and hospitalization
• Observational studies*: Oseltamivir reduced mortality among hospitalized adults with lab-confirmed seasonal influenza A virus infections
• Media are reporting concerns about the imminent arrival of almost 1,000 organ recipients on the Gold Coast for the World Transplant Games. The Local Organising Committee Chairman is said to be negotiating with a health provider to set up a flu clinic at the Games. [couriermail.com.au, 4/8/09]
• Queensland Health has had extensive correspondence with the United Kingdom Organising Committee for the Transplant Games regarding the event. The Organising Committee concluded it would continue with the Games as planned.
Townsville HSD reported a youth at Cleveland Detention Centre was displaying influenza like symptoms. The inmate was swabbed, isolated and commenced on Tamiflu, with ten further courses of Tamiflu supplied to the Centre’s nurse. Two further suspected cases have been swabbed, administered Tamiflu and isolated. On Tnesday, 04 Angnst 2009, Townsville HSD reported two positive cases of Pandemic (HlNl) 2009 at the facility.
This Pandemic Influenza Preparedness and Response Plan is a guide on how to prepare, detect, and respond to an influenza pandemic in the state of Nevada. This plan is written in accordance with guidelines set forth by the Centers for Disease Control and Prevention (CDC) and describes the emergency management concepts and structure under which the Nevada State Health Division (NSHD) may operate.
This report is based on the most recent and accurate available information at the time of preparation. Given the rapidly changing nature of the incident, readers should be aware of the potential requirement for later confirmation or clarification.
* WHO: Pandemic Phase 6 (11 JUN 2009 1600 EDT)
* Outbreaks in at least one country in > two WHO regions
* USG: Public Health Emergency declared (26 Apr 2009)
* Renewed by HHS Secretary Kathleen Sebelius
* HHS: Downgraded to Phase 1 – Awareness (9 May 2009)
It is the policy of the United States to safeguard the health and well-being of the American people during the 2009-H1N1 influenza pandemic by: (1) taking action to slow the spread of disease, mitigate illness, and prevent death, and (2) sustaining critical infrastructure and minimizing the impact of the pandemic on the economy and functioning of society.
– Antigenic characteristics
– Transmission characteristics
– Severity of disease
– Antiviral resistance
– Intensity (surge) in US cases
On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus.
• January 2007 –“Novel influenza A” made a Nationally Notifiable Disease but CSTE –part of pandemic preparedness efforts
• RT-PCR for influenza capabilities developed by public health labs in U.S.
• Increasing numbers of swine influenza infections in humans being detected from improved surveillance
• Increasing efforts at states, CDC, and USDA to investigate human cases of swine influenza
On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway. More than 70 countries are now reporting cases of human infection with novel H1N1 flu.
As you may be aware, the Centers for Disease Control (CDC) has announced that the Swine flu’s recent outbreak in Mexico has spread to the United States. It should be emphasized that as of yet, no one has died here in the U.S. from this current flu outbreak and only minimal hospitalization has been required from the case discovered here in the U.S.
The outbreak is affecting adults and spreading through human-to-human transmissions, which is atypical as influenza typically targets young children and elderly individuals, and human contraction of swine influenza is normally associated with close contact with pigs.