Director’s Update Brief
Tuesday
26 May 2009 1100 EDT
Day 38
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
Novel Influenza A (H1N1) - 26 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 22 May 2009 0840 EDT
•
International Cases: 12,515 in 46 Countries
–
New countries with confirmed cases: Honduras, Iceland, Kuwait
•
Deployments: 24 deployed, 8 pending, 200 potential
Cases
Hosp
Deaths
6764
317
10
48
36
6
US TOTAL Cases
INCL DC
US TOTAL States
Affected INCL DC
Total Confimed and Probable
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 3
Epidemiology/Surveillance Number of Novel Influenza A (H1N1)
Cases Reported to CDC by State
As of
22 May 2009 0840 EDT
(n=6,764)
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
Novel Influenza A (H1N1) -
22 May 2009 0840 EDT
Confirmed and Probable Cases by Onset* and Report Date
0
100
200
300
400
500
600
700
800
900
28
-M
ar
30
-M
ar
1-A
pr
3-A
pr
5-A
pr
7-A
pr
9-A
pr
11
-A
pr
13
-A
pr
15
-A
pr
17
-A
pr
19
-A
pr
21
-A
pr
23
-A
pr
25
-A
pr
27
-A
pr
29
-A
pr
1-M
ay
3-Ma
y
5-M
ay
7-Ma
y
9-M
ay
11
-M
ay
13
-M
ay
15
-M
ay
17
-M
ay
19
-M
ay
21
-M
ay
Date
C
a
s
e
s
Onset Date (n=1,632)
Report Date (n=6,672)
*Information on onset date no longer presented after May 12 due to change to aggregate reporting
The large increase on 5/21
reflects a backlog of cases
from TX reported as of 8:00
5/21 and 18 hr reporting
period, vs 6.5 hrs for the
previous column.
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 5
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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
– No new influenza-associated pediatric deaths reported. 08-09 total = 61
•
ILINet (week ending 16 May)
– % of ILI outpatient visits è the national baseline; overall trend remains
stable
•
122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths remains within expected
– % deaths due to pneumonia and influenza are decreasing
•
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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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 6
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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
22 labs reporting
for current week
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 7
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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/
29
12/
13
12
/27 1/1
0
1/2
4
2/
7
2/
21
3/
7
3/
21
4/
4
4/1
8
5/
2
5/
16
Week Ending Date
P
e
rcen
t P
o
sitive
All Flu
Seasonal Flu
Novel Influenza A(H1N1)
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 8
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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 19, as of May 22, 2009 (n=950 weekly ILI reports received from 49 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) 9
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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
is
it
s
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
is
it
s
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
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 10
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 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, WI
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 11
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 26 May 2009
Current Influenza Surveillance – ILINet Regions VII-X
Region X - AK, ID, OR, WA
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) 13
BioSense
Percentage of Emergency Department Visits for Patient-reported ILI, Weekly
Trends, 10/07/2006 to 05/23/2009*: U.S.
* Note: Week ending 05/23/2009 includes data from 05/17/2009 to 05/21/2009 only
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 14
Percentage of BioSense Emergency Department Visits for Patient-reported ILI,
Weekly Trends by Federal Region,
10/04/2008 to 05/23/2009*: U.S.
* Note: Week ending 05/23/2009 includes data from 05/17/2009 to 05/21/2009 only
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 15
International
Novel Influenza A (H1N1) - 26 May 2009
•
WHO global case count: 12,515 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: 805 ( 86 in last 24 hours)
• Japan: 345 ( 24 in last 24 hours)
• Spain: 133 ( 7 in last 24 hours)
• UK: 122 ( 5 in last 24 hours)
– Cases in Kuwait are first to be reported in EMRO region; more
cases
*Note: WHO case counts are current as of 05/25/09, 11:00 pm EDT
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