Human Swine Influenza Investigation

ON THE INTERNET:

http://www.cdc.gov/h1n1flu/states.htm

SNIPPET - Quote:

http://www.cdc.gov/h1n1flu/update.htm#statetable

2009 H1N1 Flu: Situation Update
October 23, 2009, 5:30 PM ET

U.S. Situation Update
Weekly Flu Activity Estimates

U.S. Patient Visits Reported for Influenza-like Illness (ILI)

U.S. Influenza-like Illness (ILI) Reported by Regions

U.S. Influenza and Pneumonia-Associated Hospitalizations and Deaths from August 30 to October 17, 2009

International
Situation Update
Map of International
Activity Estimates
(Including 2009 H1N1 Flu)

Key Flu Indicators
October 23, 2009, 11:30 AM

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of October 11-17, 2009, a review of the key indictors found that influenza activity continued to increase in the United States from the previous week. Below is a summary of the most recent key indicators:

Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year. ILI activity now is higher than what is seen during the peak of many regular flu seasons.

Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.
The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for two weeks. In addition, 11 flu-related pediatric deaths were reported this week; 9 of these deaths were confirmed 2009 H1N1, and two were influenza A viruses, but were not subtyped. Since April 2009, CDC has received reports of 95 laboratory-confirmed pediatric 2009 H1N1 deaths and another 7 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined.

Forty-six states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.

Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

http://www.who.int
http://www.who.int/csr/disease/swineflu/en/index.html

Note: The following text is a quote:

http://www.who.int/csr/disease/swineflu/notes/h1n1_clinical_features_20091016/en/index.html

Global Alert and Response (GAR)
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WHO > Programmes and projects > Global Alert and Response (GAR) > Diseases covered by GAR > Pandemic (H1N1) 2009 > Briefing notes

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Clinical features of severe cases of pandemic influenza

Pandemic (H1N1) 2009 briefing note 13

16 OCTOBER 2009 | GENEVA — To gather information about the clinical features and management of pandemic influenza, WHO hosted a three-day meeting at the headquarters of the Pan American Health Organization in Washington, DC on 14–16 October. Findings and experiences were presented by around 100 clinicians, scientists, and public health professionals from the Americas, Europe, Asia, Africa, the Middle East and Oceania.

The meeting confirmed that the overwhelming majority of persons worldwide infected with the new H1N1 virus continue to experience uncomplicated influenza-like illness, with full recovery within a week, even without medical treatment.

Need for intensive care

However, concern is now focused on the clinical course and management of small subsets of patients who rapidly develop very severe progressive pneumonia. In these patients, severe pneumonia is often associated with failure of other organs, or marked worsening of underlying asthma or chronic obstructive airway disease.

Treatment of these patients is difficult and demanding, strongly suggesting that emergency rooms and intensive care units will experience the heaviest burden of patient care during the pandemic.

Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death. Secondary bacterial infections have been found in approximately 30% of fatal cases. Respiratory failure and refractory shock have been the most common causes of death.

Presentations during the meeting explored the pathology of severe disease in detail, with findings supported by work in experimental animals. These findings confirm the ability of the new H1N1 virus to directly cause severe pneumonia.

Clinical picture different from seasonal influenza

Participants who have managed such cases agreed that the clinical picture in severe cases is strikingly different from the disease pattern seen during epidemics of seasonal influenza. While people with certain underlying medical conditions, including pregnancy, are known to be at increased risk, many severe cases occur in previously healthy young people. In these patients, predisposing factors that increase the risk of severe illness are not presently understood, though research is under way.

In severe cases, patients generally begin to deteriorate around 3 to 5 days after symptom onset. Deterioration is rapid, with many patients progressing to respiratory failure within 24 hours, requiring immediate admission to an intensive care unit. Upon admission, most patients need immediate respiratory support with mechanical ventilation. However, some patients do not respond well to conventional ventilatory support, further complicating the treatment.

On the positive side, findings presented during the meeting add to a growing body of evidence that prompt treatment with the antiviral drugs, oseltamivir or zanamivir, reduces the severity of illness and improves the chances of survival. These findings strengthen previous WHO recommendations for early treatment with these drugs for patients who meet treatment criteria, even in the absence of a positive confirmatory test.

In addition to pneumonia directly caused by replication of the virus, evidence shows that pneumonia caused by co-infection with bacteria can also contribute to a severe, rapidly progressive illness. Bacteria frequently reported include Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistant strains in some cases. As these bacterial co-infections are more frequent than initially recognized, clinicians stressed the need to consider empiric antimicrobial therapy for community acquired pneumonia as an early treatment.

Groups at greatest risk

Participants agreed that the risk of severe or fatal illness is highest in three groups: pregnant women, especially during the third trimester of pregnancy, children younger than 2 years of age, and people with chronic lung disease, including asthma. Neurological disorders can increase the risk of severe disease in children.

Evidence presented during the meeting further shows that disadvantaged populations, such as minority groups and indigenous populations, are disproportionately affected by severe disease. Although the reasons for this heightened risk are not yet fully understood, theories being explored include the greater frequency of co-morbidities, such as diabetes and asthma, often seen in these groups, and lack of access to care.

Although the exact role of obesity is poorly understood at present, obesity and especially morbid obesity have been present in a large portion of severe and fatal cases. Obesity has not been recognized as a risk factor in either past pandemics or seasonal influenza.

WHO and its partners are providing technical guidance and practical support to help developing countries better detect and treat illness caused by the pandemic virus. Patient care advice that can be applied in resource-limited settings is being rapidly compiled.

http://www.defenselink.mil/home/features/2009/0509_h1n1/

Note: The following text is a quote:

http://www.defenselink.mil//news/newsarticle.aspx?id=56386

Obama Declares H1N1 Influenza National Emergency

By Army Sgt. 1st Class Michael J. Carden
American Forces Press Service
WASHINGTON, Oct. 26, 2009 – President Barack Obama signed a national emergency declaration on H1N1 influenza over the weekend to accommodate American health care facilities’ ability to address the pandemic.

“By rapidly identifying the virus, implementing public heath measures, providing guidance for health professionals and the general public, and developing an effective vaccine, we have take proactive steps to reduce the impact of the pandemic and protect the health of our citizens,” the president said in his proclamation Oct. 24.

Health and Human Services Secretary Kathleen Sebelius has twice declared a public health emergency due to the H1N1 strain. The first came July 24, and the most recent was Oct. 1.

“As a nation, we have prepared at all levels of government, and as individuals and communities, taking unprecedented steps to counter the emerging pandemic,” Obama said. “Nevertheless, the 2009 H1N1 pandemic continues to evolve. In recognition of the continuing progression of the pandemic, and in further preparation as a nation, we are taking additional steps to facilitate our response.”

The declaration grants authority to the Department of Health and Human Services to waive legal requirements and gives medical facilities the ability to set up alternate care sites, modify patient triage protocols, alter patient transfer procedures and other actions to employ disaster operations and relief, Pentagon spokeswoman Rene White said.

Temporary waivers are petitioned to HHS by the individual medical facilities under Section 1135 of the Social Security Act. Although the president declared the pandemic a national emergency, waivers still require specific requests to HHS, and some state laws may need to be addressed, according to a White House statement released yesterday.

“The H1N1 [pandemic] is moving rapidly,” White said. “By the time regions or health care systems recognize they are becoming overburdened, they need to implement disaster plans quickly. Adding a potential delay while waiting for a national emergency declaration is not in the best interest of the public, particularly if this step can be done proactively, as we are doing here.”

The most recent examples of a U.S. president granting the Section 1135 waivers was in the aftermath of Hurricane Katrina in 2005, Hurricanes Ike and Gustav in 2008, the North Dakota flooding in March and as a protocol for January’s presidential inauguration.

Although thousands of U.S. servicemembers were called to duty in these events, the Defense Department does not anticipate a major call up of forces due to the H1N1 , White said. However, the department is prepared to respond if needed.

“At this time, the Defense Department is evaluating the impacts the president’s declaration has on [Defense Department] H1N1 operations,” she said. “One of our first priorities right now continues to be vaccine availability and distribution – first protecting uniformed personnel, deployed [personnel], training sites, ships afloat and submarines, as well as our health care personnel.”

Related Sites:
Special Report: H1N1

Note: The following text is a quote:

http://www.whitehouse.gov/the-press-office/declaration-a-national-emergency-with-respect-2009-h1n1-influenza-pandemic-0

Home • Briefing Room • Presidential Actions • Proclamations

THE WHITE HOUSE
Office of the Press Secretary
___________________________________________________________________
For Immediate Release October 24, 2009

DECLARATION OF A NATIONAL EMERGENCY WITH RESPECT TO THE 2009 H1N1 INFLUENZA PANDEMIC
- - - - - - -

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
On April 26, 2009, the Secretary of Health and Human Services (the “Secretary”) first declared a public health emergency under section 319 of the Public Health Service Act,42 U.S.C. 247d, in response to the 2009 H1N1 influenza virus. The Secretary has renewed that declaration twice, on July 24,2009, and October 1, 2009. In addition, by rapidly identifying the virus, implementing public health measures, providing guidance for health professionals and the general public, and developing an effective vaccine, we have taken proactive steps to reduce the impact of the pandemic and protect the health of our citizens. As a Nation, we have prepared at all levels of government, and as individuals and communities, taking unprecedented steps to counter the emerging pandemic. Nevertheless, the 2009 H1N1 pandemic continues to evolve. The rates of illness continue to rise rapidly within many communities across the Nation, and the potential exists for the pandemic to overburden health care resources in some localities.Thus, in recognition of the continuing progression of the pandemic, and in further preparation as a Nation, we are taking additional steps to facilitate our response.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States,including sections 201 and 301 of the National Emergencies Act (50 U.S.C. 1601 et seq.) and consistent with section 1135 of the Social Security Act (SSA), as amended (42 U.S.C. 1320b-5), do hereby find and proclaim that, given that the rapid increase in illness across the Nation may overburden health care resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. health care facilities to implement emergency operations plans, the 2009 H1N1 influenza pandemic in the United States constitutes a national emergency. Accordingly, I hereby declare that the Secretary may exercise the authority under section 1135 of the SSA to temporarily waive or modify certain requirements of the Medicare, Medicaid, and State Children’s Health Insurance programs and of the Health Insurance Portability and Accountability Act Privacy Rule throughout the duration of the public health emergency declared in response to the 2009 H1N1 influenza pandemic. In exercising this authority, the Secretary shall provide certification and advance written notice to the Congress as required by section 1135(d) of the SSA (42 U.S.C. 1320b-5(d)).

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-third day of October, in the year of our Lord two thousand nine, and of the Independence of the United States of America the two hundred and thirty-fourth.

BARACK OBAMA
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blog:

http://www.americanthinker.com/2009/10/swine_flu_panic_in_perspective.html

“Swine Flu Panic in Perspective”
By Frank S. Rosenbloom, M.D.
(October 29, 2009)

SNIPPET: “I usually see about twenty patients in my office, and at least a few patients in the hospital, daily. Over the past several months, my patient load has increased by one third. Almost all of the increase is due to fears about H1N1 influenza.

Patients are coming to the office fearful of “Swine Flu,” with symptoms ranging from a slight sniffle to overt pneumonia. After seeing hundreds of cases of “flu” over the past several months and testing all of those who fit the clinical picture of influenza, I have confirmed only three genuine cases of H1N1. Two of these cases were in physicians and one was in a nurse.

All of the other cases turned out to be allergies, typical viral or bacterial infections, or the seasonal flu. Additionally, all three had mild illness and recovered with symptomatic treatment.”

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Peviously...

http://www.americanthinker.com/2009/05/swine_flu_in_perspective.html

May 02, 2009
“Swine Flu in Perspective”
By Frank S. Rosenbloom, M.D.

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