Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 1
Director’s Update Brief
Tuesday
19 May 2009 1100 EDT
Day 31
Day of Long Range Workforce Planning
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 2
Novel Influenza A (H1N1) Key Events
19 May 2009 1100 EDT
•
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)
– SLTT Declarations: 10
• CA, TX, WI, FL, NE, VA, MD, IA, OH, American Samoa
•
US Cases:
•
International Cases: 8,829 in 40 Countries
– New countries with confirmed cases: Chile
•
Deployments: 73 deployed, 5 pending, 207 potential (200 DGMQ)
•
DSNS: 13 million Antiviral Replenishment regimens placed
Cases
Hosp
Deaths
5469
229
6
48
35
3
Total States Affected
INCL DC
US TOTAL Cases INCL
DC
Total Confimed and Probable
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 3
200-400
51-200
1-50
0
>400
Epidemiology/Surveillance
Number of Novel Influenza A (H1N1) Cases Reported to CDC by State
19 May 2009 1100 EDT (n=5,469)
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 Date - 19 May 2009 1100 EDT
0
100
200
300
400
500
28-
M
ar
30-
Mar
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-
May
5-M
ay
7-
May
9-M
ay
11-
M
ay
13-
May
15-
M
ay
17-
May
19-
M
ay
D
Date
ss Onset
N
o
. o
f C
ases
Onset date (n=1,632)
Report date (n=5,364)
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 5
510
3,499
1,003
44
413
0
500
1,000
1,500
2,000
2,500
3,000
3,500
#
C
o
n
fi
rm
e
d
a
n
d
Pr
o
b
a
b
le
C
a
s
e
s
0-4 5--24
25--64
≥65
Unknown
Age (Years)
9%
64%
18%
1%
8%
Epidemiology/Surveillance
Total Confirmed and Probable Novel Influenza A (H1N1)
Cases (n=5,469) by Age - 19 May 2009 1100 EDT
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 6
Epidemiology/Surveillance
Current Influenza Surveillance - 19 May 2009 1100 EDT
•
WHO/NREVSS Collaborating Laboratories (graph)
– 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 were reported
– 2008-09 season total = 61
•
ILINet (graph)
– % ILI visits was below the national baseline
– % ILI visits remains constant
•
122 Cities Mortality Reporting System (graph)
– % pneumonia and influenza deaths remains stable
•
Geographic Spread of Influenza as Assessed by State and Territorial
Epidemiologists
– Widespread: 8 states; Regional: 14 states; Local: 15 states and DC;
Sporadic: 13 states
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 7
Epidemiology/Surveillance
U.S. WHO/NREVSS Collaborating Laboratories
Summary, 2008-09
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
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
0
4
8
12
16
20
24
28
32
36
40
Pe
rce
n
t
Po
si
ti
ve
A(H1N1-Sw ine)
A(Could not be subtyped)
A(H3)
A(H1)
A(Unsubtyped)
B
Percent Positive
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
2400
2600
2800
3000
3200
4/11
4/18
4/25
5/2*
5/9
5/16
5/23
5/30
Week ending
N
u
m
b
e
r
o
f
Is
o
la
te
s
0
2
4
6
8
10
12
14
16
18
20
22
P
e
rc
e
n
t
P
o
s
it
iv
e
*
Percentage of all positive
influenza specimens that are
Novel Influenza A(H1N1) or
Influenza A (unable to subtype)
for the week indicated
33%*
44%*
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 8
NOTE: Week ending dates vary by influenza season
*Preliminary ILI data for week 19, as of May 18, 2009 (n=367 weekly ILI reports received from 44 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.
Epidemiology/Surveillance
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
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
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.
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
2006-07
2007-08
2008-09
Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions I-III
19 May 2009 1100 EDT
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 10
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.
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
Vi
si
ts
fo
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
Vi
si
ts
fo
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
Vi
si
ts
fo
r
IL
I
2006-07
2007-08
2008-09
Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions IV-VI
19 May 2009 1100 EDT
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 11
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.
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
2006-07
2007-08
2008-09
Baseline
Epidemiology/Surveillance
Current Influenza Surveillance – ILINet Regions VII-X
19 May 2009 1100 EDT
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 12
Internal Use Only (FIUO)---For Official Use Only (FOUO)
NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 13
International
Novel Influenza A (H1N1) - 19 May 2009 1100 EDT
•
WHO global case count: 8,829 confirmed cases in 40 countries*
– New countries with confirmed cases:
Chile
• 2 women (25 & 32 years old), traveled to Dominican Republic with
transit through Panama
– Countries with highest confirmed case count after the US and
Mexico:
• Canada: 496 (=)
Spain: 103 (=)
• UK: 101 ( 19)
Panama: 54 (=)
•
Japan reports 26 new cases, most among high school students in
Kobe and Osaka
– Students from different towns competed in volleyball match
– Widespread infection reported in region, with probable cases
numbering 125+
– Schools in the region have been closed
*
WHO case counts are current as of May 18, 2009; 8:00 pm EDT
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NOT FOR FURTHER DISTRIBUTION
-Sensitive But Unclassified (SBU) 14
Communications Summary
Novel Influenza A (H1N1) - 19 May 2009 1100 EDT
Channel Traffic
•
Web Page Views: 547,371 (+7%)
•
Public Inquiries: 178 (-5%)
•
News Stories: Print/Internet: 212 (+86%)
•
Social Media: “Swine Flu” Twitters (12.6/min.), “H1N1” (3.9/min.)
Themes
•
Death of asst. principal - school closings in NYC
•
Outbreak is not “winding down”
–
Spreading rapidly throughout the world (“spreading like wildfire”)
–
Spreading faster than the seasonal virus
–
Japan swine flu cases surge, most are teenagers
•
WHO annual meeting to consider: 1) raising pandemic alert to level 6, and 2) vaccine production
questions
•
Potential for ebb during the summer and return of cases in the fall (”return with a vengeance”)
Emerging Themes
•
Adequate Supply of Swine Flu Vaccine Uncertain: “The current swine flu outbreak is raising
critical questions about the timing of bringing a new vaccine to market and the logistics of getting
it to the people who need it” (Atlanta Journal Constitution)
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