Director’s Update Brief
Wednesday
27 May 2009 1100 EDT
Day 39
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)
27 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 27 May 2009 0100 EDT
•
International Cases: 12,954 confirmed cases in 46 countries
– New countries with confirmed cases: Honduras, Iceland, Kuwait
•
Deployments: 26 deployed, 5 pending, 200 potential
Cases
Hosp
Deaths*
7927
436
11
48
37
6
*
US TOTAL Cases
INCL DC
US TOTAL States
Affected INCL DC
One new death was reported in New York City
TTL Confirmed 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 27 May 2009 0100 EDT (n=7,927)
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
Confirmed and Probable Novel Influenza A (H1N1) Cases by Onset* and Report Date
by Week As of 27 May 2009 0100 EDT
*Information on onset date no longer presented after May 12 due to change to aggregate reporting
1
5
17
15
339
1057
198
0
0
0
0
5
19
915
2144
1879
1710
1163
0
500
1000
1500
2000
2500
3000
28
-M
ar
4-A
pr
11
-A
pr
18
-A
pr
25
-A
pr
2-M
ay
9-M
ay
16
-M
ay
23
-M
ay
30
-M
ay
Week Ending Date
C
a
s
e
s
Onset Date (n=1,632)
Report Date (n=7,835)
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 5
Epidemiology/Surveillance
Confirmed and Probable Novel Influenza A (H1N1) Cases by Age
As of 27 May 2009 0100 EDT
757
4,753
1,360
54
1,003
0
1000
2000
3000
4000
5000
C
o
n
fi
rm
e
d
a
n
d
P
ro
b
a
b
le
C
a
s
e
s
0-4 Yrs
5-24 Yrs 25-64 Yrs
≥65 Yrs Unknown
Age Groups
10%
60%
17%
1%
13%
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 6
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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
– One new influenza-associated pediatric death reported
• 11-year old female from Ohio
– 2008-09 season total = 62
•
ILINet (week ending 16 May)
– % of ILI outpatient visits è the national baseline
– % of outpatient visits for ILI increased
•
122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths remains within expected
– % deaths due to pneumonia and influenza is increased slightly
•
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) 7
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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
33%*
43%*
63%*
86%
*
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 8
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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
/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
P
e
rce
n
t
P
o
si
ti
ve
All Flu
Seasonal Flu
Novel Influenza A(H1N1)
Influenza % Positive
by Season (Week 19):
05-06: 7.80%
06-07: 4.98%
07-08: 2.15%
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 9
Epidemiology/Surveillance
BioSense - Percentage of Emergency Department Visits for
Patient-reported ILI, U.S., 10/07/2006 to 05/23/2009
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 10
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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 20, as of May 26, 2009 (n=485 weekly ILI reports received from 45 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) 11
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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
isi
ts
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
isi
ts
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
isi
ts
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) 12
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 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, W I
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) 13
Epidemiology/Surveillance
Novel Influenza A (H1N1) - 27 May 2009
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
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 14
International
Novel Influenza A (H1N1) - 27 May 2009
•
WHO global case count: 12,954 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: 921 ( 116 in last 24 hours)
• Japan: 350 ( 5 in last 24 hours)
• Spain: 136 ( 3 in last 24 hours)
• UK: 137 ( 15 in last 24 hours)
•
4 CDC deployed staff in Mexico
*Note: WHO case counts are current as of 05/26/09, 10:00 pm EDT
Division of Global Migration and Quarantine
Novel Influenza A (H1N1) - 27 May 2009
School Dismissal, United States, 4/29 – 5/26, 2009
•32 schools closed due to H1N1 in 3 states today: MA, NY, and TX, a 60% decrease from
last Friday with 78 school closures; The closures impacted 18,288 students & 1445 teachers
•61 schools reopened in AZ, MA, MI, NJ, NV, NY, & WI affecting approx. 37,888 students and
2793 teachers
Source: ED and CDC Confirmed School Closing Reports released each weekday at 2:00pm
18,288
49,893
42,052
25,854
17,663
11,794
4,838
55,765
169,000
245,449
329,834
468,282
369,237
197,985
118,033
61,697
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
4/28
4/29
4/30
5/1
5/4
5/5
5/6
5/7
5/8
5/11
5/15
5/18
5/19
5/20
5/21
5/22
5/26
Date
Number
Students Affected
32
Schools
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 16
Communications Summary
Novel Influenza A (H1N1) – 27 MAY 2009
National and local television
•
Case counts and death toll rising:
–
6700 U.S. cases;
–
12-14 deaths confirmed, 2 in NYC and 1 in Chicago (with underlying medical conditions)
•
27 NYC schools reopen – many parents children home
•
Promising developments regarding vaccine production
Print/Internet news
•
Flu scare reveals strapped local health agencies
•
Mexico, US, Canada announce swine flu deaths
Information Gaps in News Stories
•
No travel or public health guidance (exception NY media—people with chronic conditions)
Public Inquiries:
•
Symptoms?15%; Testing? 18%; Treatment? 12%; Transmission?12%
870,809
172
414
5/20-21
Wed-Thur
1,044,297
202
458
5/19-20
Tues-Wed
1,216,785
189
510
5/18-19 Mon-
Tue
423,954 (-51%)
Web
141 (-18%)
Internet/Print News
138 (-67%)
Public Inquiries
5/25-26
Mon-Tue
Channel Traffic
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