Director’s Update Brief
Monday
25 May 2009 1100 EDT
Day 37
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)
•
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: 12,022 in 43 Countries
– New countries with confirmed cases: Russia
•
Deployments: 26 deployed, 8 pending, 202 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) - 25 May 2009 1100 EDT
Confirmed and Probable Cases by Onset* and Report Date
0
100
200
300
400
500
600
700
800
900
28
-Ma
r
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-M
ay
5-Ma
y
7-M
ay
9-Ma
y
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) - 25 May 2009 1100 EDT
•
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 6
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 25 May 2009 1100 EDT
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
rc
e
n
t
Po
s
it
iv
e
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 7
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 25 May 2009 1100 EDT
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
Pe
rc
e
n
t
Po
s
it
iv
e
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) - 25 May 2009 0100 EDT
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 9
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 25 May 2009 1100 EDT
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, WV
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) - 25 May 2009 1100 EDT
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) - 25 May 2009 1100 EDT
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) 13
BioSense
Percentage of Emergency Department (ED) Chief Complaint Visits for ILI and ED
Final Diagnosis Visits with ICD-9-CM codes for Influenza or ILI. U.S.
04/22/2009 to 05/21/2009
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 14
* Note: Week ending 05/23/2009 includes data from 05/17/2009 to 05/21/2009 only
BioSense
Percentage Emergency Department Visits for
Patient-reported ILI, Weekly Trends. U.S.
10/07/2006 to 05/23/2009*
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 15
BioSense Pharmacies
Percentage of Anti-infective Prescriptions for Antivirals, U.S.
04/22/2009 to 05/21/2009
:
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 16
International
Novel Influenza A (H1N1) - 25 May 2009
•
WHO global case count: 12,022 confirmed cases in 43 countries*
– New countries with confirmed cases: Russia
– Countries with highest confirmed case count after the US and
Mexico:
• Canada: 719 (=)
• Japan: 321 ( 27 in last 72 hours)
• Spain: 126 ( 13 in last 72 hours)
• UK: 117 ( 5 in last 72 hours)
*Note: WHO case counts are current as of 05/24/09, 10:00 pm EDT
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 17
Division of Global Migration and Quarantine
Novel Influenza A (H1N1) - 25 May 2009
School Dismissal, United States, 4/29 – 5/22, 2009
•
School Dismissal
– 78 schools closed due to H1N1 in 7 states (as of 12 noon, 22
May 2009):
• Increase from 60 schools on 21 May
• AZ, MA (12), MI, NJ, NY (47), TX, and WI.
– Closures impacted 49,893 (increase from 42,052 on 21 May)
– Closures appear to be in response to high absenteeism
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 18
Communications Summary
Novel Influenza A (H1N1) – 25 MAY 2009
H1N1 Communication Channel Activity
0
100
200
300
400
500
600
700
800
900
5/14
5/15
5/16
5/17
5/18
5/19
5/20
5/21
CDCINFO public
Print/Internet
National TV
Local TV
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 19
Communications Summary
Novel Influenza A (H1N1) – 25 MAY 2009
CDCINFO General Public Questions by Category
5/11-5/22
18.7%
15.4%
14.5%
8.9%
8.3%
8.2%
8.0%
6.6%
4.1%
3.1%
2.4% 1.8%
symptoms
travel
testing
transmission
mitigation
cases
prevention
treatment
general
severity
reporting
vaccines
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