CDC Telebriefing on Investigation of Human Cases of H1N1 Flu
June 4, 2009, 12 noon ET
Audio recording (MP3)
Operator: Please continue holding for the CDC media conference. I would like to remind you that your lines are in listen only mode. I will turn the meeting over to Joe Quimby.
Joe Quimby: Good afternoon to everybody. I’m Joe Quimby from the Division of Media Relations here at the CDC. Thank you all for joining us. With us today to provide opening remarks, take questions and answers, is Dr. Anne Schuchat, the director of National Center for Immunization and Respiratory Diseases. Doctor?
Anne Schuchat: Good afternoon, everyone, and thanks for joining us. Today I’ll give a brief update on the situation here in the U.S., but I want to, in addition, mention a couple other things – an MMWR that's out just today on the Mexico situation, I’ll mention a report that was just issued by the trust for America’s health. A little bit on vaccine development, and just some background about the WHO and its approaches to pandemic phases. In terms of the case situation, we do continue to see more cases in places around the country. Activity seems to be declining in the nation as a whole, but there are some areas where illness is ongoing. We do have cases confirmed from all 50 states. The global situation is increasing with the WHO officially reporting 19,273 cases in 66 countries. Of course, you know the southern hemisphere is going into its flu season and so cases are increasing in some countries there. In the U.S., so as of our official counts for the day, are 11,468 probable and confirmed cases, with 770 hospitalizations or 6.7% [Editor's Note: This is a correction] of our cases. We have 19 fatalities that have been reported to us. As we've been mentioning, these case counts are really what we think of as a minimal estimate, a burden we think that disease is much more common than that, but these are a way that we track some of the patterns. When we look more closely at our cases and hospitalizations, we are continuing to see this focus on younger people. 60% of the cases and 42% of hospitalizations have occurred in people between the ages of 5 and 24 years. hospitalization rates, that is cases per population, are highest in people 5 to 24 and next highest in children under 5. This is quite different than what we see with seasonal influenza where the highest hospitalization rates are in the elderly. We have very low rates of hospitalization in cases in people 65 and over. We tested isolates from a wide geographic area, America, New Zealand, and other areas and we're not seeing variation in the genetic testing we do here.
There's an MMWR report that was issued today. This is a really nice summary by colleagues from Mexico, the Pan American Health Organization and both Canadians and Americans that were part of this response team describing the outbreak in Mexico. And there are a number of epidemiologic features summarized in the article that turn out to be consistent with what we are seeing here in the united states and what has been observed in other countries. Key features that are similar are this off-season transmission of the influenza strain. In cases predominating in children, young and middle aged adults with this sparing of the elderly that we've been noting here in the U.S. and certainly that was a feature of the Mexican report, of the evidence from Mexico suggests that the outbreak there likely peaked nationally in late April. There are decrease necessary case counts from the country as a whole, although some localizes transmission is continuing to occur. So the Mexico report is a helpful summary of the country that really first had the largest problem noted and, you know, with a helpful summary of the circumstances there to put this into context. I want to next mention that the trust for America’s health has issued a report describing lessons learned so far in responding to the H1N1 outbreak. You know we are only several weeks into this response and I think it's very helpful that Trust for America’s Health has already done an extensive review and tried to identify what has worked and what -- where the gaps are. This is the kind of review that we really encourage organizations and communities to do to think about where the gaps are and what we need to do to strengthen those gaps. As we've been saying, this is not over. The novel H1N1 virus is in many parts of the country and, of course, now increasing in some parts of the southern hemisphere and we are very busy in learning all we can about what has happened so far, reaching out to the southern hemisphere partners to work with them on understanding the course of illness there and then, of course, making extensive preparations for response in the fall, potential vaccination, laboratory and epidemiologic needs and really an extensive preparedness planning. So Trust for America’s Health has a number of findings that they think people should think about in terms of lessons learned and gaps that might be built.
We've been talking about vaccine development and planning for vaccinations. Remember that we've taken the first steps of developing a candidate vaccine virus. CDC has provided that virus to a number of laboratories and manufacturers in other countries that serve manufacturers there, really a virus that can then be used to produce pilot lots of vaccines that can then go into testing to see whether a vaccine would produce in response clinical protection and could be safe. So the first steps that candidate virus vaccines -- or candidate vaccine virus strain, sharing and go ahead for the clinical lot development is ongoing as well as the U.S. government committing to purchase a bulk ingredient that could be stockpiled for future vaccines. That decision about whether or not to use a vaccine and how to use it if you're not going to use it has not been made and won't be made until more information is available about patterns of disease and about how a vaccine performs in this clinical testing. So those are intensive efforts over the summer. In the meantime, efforts have begun to plan for immunization, even if we don't have to go there, we really need to start the planning now. That's how vaccinations might go forward. There's been some mention in the news and through the world health organization about the WHO phases and whether it might be appropriate at some point to go from phase 5, which is where we are currently, to phase six. And so I want to provide a little bit of background about that type of decision making. Designation of phase six would indicate that a global pandemic is under way. It would suggest that the virus has spread widely. It would not suggest that this virus is more severe than we've been describing. The phasing at WHO is an indicator of spread and not of severity. So the WHO's decision, should they make a decision in the future to raise the pandemic alert level would be a reflection of epidemiologic changes in other parts of the world, not here in the Americas where we also -- where we already have had extensive community spreads. But it would be an indicator of the patterns of disease that are being observed or confirmed in other regions. And it's really would have less implications here in the U.S. where we've already been having an active intensive response. It still is uncertain at this time how serious or severe this novel H1N1 virus will be in terms of how many people infected will -- there will ultimately be, how severe complications or deaths would stack up. So again, this phase six would be a transition to a more extensive spread, but not to a change in severity.
As we've been saying all along, we're taking this very seriously here. We know that the state and local health departments and the clinicians have been taking it seriously and we also applaud the American public that has been taking this seriously examine doing their part to keep their families and communities protected. It's a good time for people to be thinking through plans going forward, how to cope with illness that might come back in your communities in the fall. And so these planning efforts aren't just important at the government or institutional level, but also in the homes. It's also a good reminder that we're officially entering hurricane season and that's another thing that is good to be prepared for.
So I want to close at this point and just stress that this is a novel virus, this H1N1 virus. The world has several weeks' experience now. We really aren't even looking at a three-month experience yet with this particular virus and we need to remain humble and learn as we go. Of course, here at CDC, we're committed to share what we learn as we learn it. So let's now go to the phone for questions.
Operator: Thank you. our first question is from Fergus Walsh, CDC. your line is open.
Fergus Walsh: Hi. Thank you for taking my question. Could you tell me where you stand at the moment with the level of hospitalizations? Is that enough in itself if we get a pandemic and indeed an epidemic in the united states for you to think that it would be worth shifting from seasonal flu vaccine production to a pandemic H1N1 strip?
Anne Schuchat: You know, the seasonal influenza viruses are estimated to cause 200,000 hospitalizations every year in the united states. And we estimate about 36,000 deaths in the U.S. each year from seasonal flu. Now, most of those deaths and most of those hospitalizations are in people over 65. So the epidemiology of this particular virus does not seem to be causing a lot of problems in the elderly, who are more likely to die when they get infected with influenza. 2.5% of the cases we're counting have required hospitalizations and some of those hospitalizations have been severe. So, you know, it would require intensive care unit and mechanical ventilation and such. We're really at too soon of a stage to say how extensive a problem we might have with hospitalizations or severe illness in the fall should this virus continue to persist in our communities and go through a full season. I can say that there is no intention here in the united states to pull back from seasonal influenza vaccination. Manufacturers have been producing -- you know, going through the steps to produce vaccines and the timing of recognition of this virus here in the U.S. was such that the decision to take the early steps towards vaccine development did not interfere with producing a vaccine for the northern hemisphere or for here in the U.S. We are, of course, in this phase of considering whether we may need to vaccinate against this novel H1N1 virus. As I’ve said, we want to learn from the experience of the southern hemisphere, learn all we can about how much disease and problem is caused here in the U.S. and learn whether a vaccine even could be produced that would be safe and protective. Next question, please.
Operator: The next is from Mike Stobbe. Your line is open, from AP.
Mike Stobbe: Hi. Thanks for taking the question. Hey, doctor, you mentioned before that you're going to be watching the southern hemisphere. And you mentioned earlier in this call that as you've testified around the world there's not much variation. But the flu is starting to occur in the southern hemisphere. Could you tell us more about how it's unraveling there? Is it -- what percentage of the cases are the swine flu, what percentage are seasonal and is it a bad flu season in the southern hemisphere so far or how is it going?
Anne Schuchat: You know, we have information from a few places that have reported their experience. And important to say is that it's early in the southern hemisphere. It's the beginning of their flu season. Australia actively tracks influenza. They're one of the four WHO international collaborating centers for influenza. And in Australia, they tell us that their season peaks in July and august. They are seeing cases of this novel h1n1 virus. They're seeing cases of other viruses, as well. But it's too soon to say whether this is dominating or not and it's very, very early before we would know whether -- with the extent of illness that they'll have. But I would just give that as one example where there's been long-term influenza tracking and active health care response and good information sharing across country. Next question.
Joe Quimby: Operator, next question, please.
Daniel Denoon, WebMD: The next is from Daniel Denoon from WebMD. Your line is open.
Daniel Denoon: Thank you, doctor. During the phah report today raised specter that even if the flu this fall is very much the same as we've seen over the summer, the heightened flu activity we would expect may cause -- may overwhelm some hospitals in local communities. Can you talk about preparedness of local communities and how CDC is going to be preparing possibly for the kind of surges, the kind of worried well that we saw in new York that overwhelmed infectious disease wards and made it difficult to get people into ICU.
Anne Schuchat: You know, partnership between the medical providers, the public health sector, business and the private sector and then, of course, the public is vital to preparedness for influenza surges or for other kinds of catastrophes. And so I think there is a lot that we can do this summer to better prepare communities and the health system to be able to handle increases in influenza that might be greater than expected for the season. So there is an active effort working between some of the public health organizations, the association of state and territorial health officers, the national association of county health officials and CDC as well as with some of the medical provider groups to work together on this community preparedness to say what did work, what didn't work, where can we address some gaps. I would say that we are working actively on strategies like what kinds of laboratory sampling should be done so that the laboratories can keep up with the information needs but also with the critical other things that they need to do. We're also working on the clinical front in terms of what kinds of treatment would be needed, what kinds of testing is important for individuals versus for understanding the patterns. Certainly the department of education and schools all over the country are looking at lessons learned from those kinds of school dismissals that we saw and strengthening school preparedness. Schools need to be prepared for infectious disease problems and for other problems that they see, whether they're natural disasters or some of the violence that we've seen in schools. So dusting off those plans, getting the pandemic plans that people have within their communities or organizations or also their emergency management plans. for family webs of course, there's a lot you can do with having a communication plan. Certainly as hurricane season goes forward, we urge people to remember the steps that they can have to be prepared for some of the services they rely on go out. So this is a very good time for us to make sure that we're as sure as ready going forward. I think that some of the steps that we've learned from our exercises in the past or how important it is for people to know where to get information or for the partners who respond to these kinds of emergencies to know each other and to know who is doing what and sort out the rules and responsibilities. So those are the kinds of planning and coordination efforts that can happen within communities and a lot that we can do to make sure that the federal, state and local levels are well coordinated together that we can be working with one enterprise and really sharing the responsibilities of the response together.
Joe Quimby: Next question, please.
Operator: The next is from Kate Traynor, AJHP. Your line is open.
Kate Traynor: Hi. Thank you for taking my question. I saw an estimate of the world health organization recently that the bulk of the seasonal influenza vaccine for the northern hemisphere will be finished up at the end of July. So I’m wondering if you can comment on that particular estimate. And also, if that's the case, is CDC going to take some kind of official push for organizations to start their seasonal influenza vaccine campaigns early to sort of clear the decks in case you need to start vaccinating against the new virus?
Anne Schuchat: You know, the estimates for manufacturing are always challenging. We always want vaccines to come out on schedule and just very difficult season to season, manufacturer to manufacturer to predict precisely when we'll have product and exactly how much we'll have. When you look over the past five to ten-year seasons of influenza, we've had very different timing of availability. Of course, these investments and expanding manufacturing are giving us a much morrow bust manufacturing base. I think it's really too soon for me to be certain whether vaccine supplies will be available during the summer months or not. That said, I would say that we are working with our local and state immunization partners and the preparedness community as well as across the federal government to talk about immunization planning, both for seasonal influenza and potentially for a vaccine that would be developed against this novel h1n1 virus. And so the concept of how would vaccination with two different kinds of influenza vaccines work in terms of where would it be given, the timing, the logistics and so forth been so I do think that these are important discussions to have, understanding that we can only -- we cannot predict perfectly the timing of when seasonal flu vaccine would be available. We also cannot -- we also cannot -- have not yesterday made a decision to immunize against the seasonal flu. Next question, please.
Operator: Next from Madison Park CNN. Your line is open.
Madison Park: Thank you. I wanted to go back to the issue of preparedness and the trust for America’s health report. And see, outbreak of the avian flu a few years ago helped the CDC in terms of preparing for an outbreak of the H1N1 virus?
Anne Schuchat: I’m sorry, I missed the last part of your question. Something got blurred there. Can you tell that again.
Madison Park: Since the outbreak of the avian flu helped the CDC in terms of preparing for an outbreak of the H1N1 virus? Yes, absolutely. The H1N1 virus that continues to circulate in parts of the world and that had been a particular problem in bird populations and then in people particularly in a few Asian countries, really was a wake-up call for the world that serious infection threats like influenza are out there and we have a lot of work to do. So there have been a lot of investments that have greatly helped strengthen our preparedness. Some of those investments were to carry out practices to practice how we would behave at an epidemic, exercises here at the federal level in U.S., exercises at state and local levels and exercises in many countries around the world. I would say those exercises helped immensely in going through steps that would be important, whether they were scientific steps like how to track disease or communication steps like figuring out how to explain what's going on with people, also practicing how we would ship antivirus medicines out to the states. These things were worked out well in advance. The other investments related to the H1N1 virus that were particularly helpful were investments related to diagnostic tests. It's actually through supporting new diagnostic tests that we first recognize this novel virus here in the U.S. with a test kit that was being tested to see whether we get better at recognizing this virus, new, unusual viruses. And then, of course, another test approached and the CDC had worked on and gotten FDA approval was ready right in time and is was -- we were able to ship test kits to all of the public health laboratories in the U.S. and then to labs around the world within a record time so that they would be able to specifically diagnose this problem. So there's been a lot of chaos from worrying about the bird flu and I think we're grateful that people around government and in the private sector have been taking this so seriously. A lot of research, a lot of modeling, a lot of lessons learned looking back to the 1918 virus as well as the bird flu virus that put us in a better depth -- put us in better shape to be prepared right now. That said, we have a lot more work to do and as that trust for America’s health report suggested, gaps remain. So this is an area that we're working very hard at right now to make sure we're as well prepared as we can be here in the U.S. for the fall.
Joe Quimby: Thank you. Next question.
Operator: Thank you again. If you'd like to ask a question, press star 1. The next is from John Cohen, "Science" magazine. Your line is open.
John Cohen: Thanks for taking my question. I want to return to something that I asked you earlier and I don't think I was clear in what I asked. I’m curious about the vaccine for the other 280 million Americans and when the decision will be made whether to make it or not. Not whether to use it, but whether to make it and how could it possibly be ready in the fall, given the timeline?
Anne Schuchat: Oh, thank you. I’m sorry. I didn't understand that part of your question. So far, the decision that has been made is to produce vaccines for clinical lots that will go into these clinical studies of safety and effectiveness. Safety and immune response. And then a second decision was made to pro cure bulk ingredients for potential production that could be used for stockpiled vaccines. Additional decisions would be made later in the summer, so the decisions that have been made were appropriate given what we know about a novel virus. Those are the kind of things that we did for the H5N1 virus and there were steps that needed to be taken because of some outside deadlines that were out there. We have time before additional steps on production would need to be made and so I think we will be sharing information about future decisions when those -- you know, when things are a little more timely. I also want to mention that, you know, CDC's role in this is really developing that candidate vaccine virus strain that's handed off for manufacturing. The decisions about procurement are ones made at Health and Human Services under really the leadership of BARTA within the assistant secretary for preparedness and response. We have a coordinated federal government approach to these discussions, but they would be in the lead of that type of decision making.
Joe Quimby: Thank you. We have time, operator, for two more questions.
Operator: Next is from Erin Sykes, NBC News.
Erin Sykes: Good morning. I’m wondering, schools are closing for the summer, so are you anticipating a drop in cases or possibly a new emergence as children go off to camp or on vacation?
Anne Schuchat: You know, there have been outbreaks of influenza at summer camps and there have been times when influenza viruses persist in the summer here in the U.S. so we'll be monitoring for clusters and for unusual influenza occurrence in the summer and using the surveillance systems that we traditionally use to track influenza like illness or virus circulation. So we are wondering whether there will be a change or not. Usually when schools dismiss, summer has arrived and whether it's the school system or the seasonal changes, influenza usually goes into a low point during the summer here in the U.S. so we're keeping an open mind about what will happen and we are alert to the idea that there have been outbreaks in camps of such. We've provided some information, communication and guidance to summer camps so that they'll know, you know, the basics of looking for the virus and how to handle children that are ill. But we really -- we have -- and so I would say that we are going to be actively looking this summer.
Joe Quimby: Our final question, please.
Operator: That is from Mike Stobbe from associated press. Your line is open.
Mike Stobbe: Hi. Thanks for letting me go again. Doctor, I think there's an assumption that we likely have a round of seasonal flu vaccinations maybe in the early fall and what remains to be seen is whether there would be a decision about a second round of vaccinations against the novel virus. But did you say a minute ago that we have not yet made a decision to immunize against the seasonal flu?
Anne Schuchat: No, no, thank you for getting me to clarify. We recommend seasonal influenza vaccines for many people, you know, most of -- we have new recommendations for all children between the ages of 6 months and 18 years. Certainly seniors, adults with medical conditions and people who were household contacts of those at high risk are all recommended to receive influenza vaccine. We recommend it for pregnant women and seasonal influenza vaccine for anyone who wants to reduce their risk of getting influenza. so we definitely -- I did not mean to say we have changed that recommendation at all. the decision that we haven't made is about whether an immunization program against novel H1N1 virus ought to be taken. That's a decision that we will make, depending on the epidemiologic and virologic characteristics that we see with this new virus and based on the performance of the tests that are studied in people over the summer months. So that decision would be something made early in the fall once information from the clinical trials is available, together, of course, with the information on the epidemiology of disease. So we continue to recommend seasonal flu vaccines for many people and we think that's a good idea. We haven't yet made a decision about whether an immunization program against this new strain will be needed. on the other hand, we're actively planning, how would we do an immunization program for this novel strain if that decision is made. We can't wait until that decision is made to start our planning, Just like we couldn't wait to plan for a pandemic until there was a pandemic. We actually have been exercising for a pandemic response for many years now.
Joe Quimby: Mike, thank you very much. Ladies and gentlemen across the country and the world, thank you all very much for joining us. Dr. Schuchat, thank you very much. This now concludes our press briefing.
END
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Thursday, June 11, 2009
What To Do If You Get The Swine Flu
What to Do If You Get Flu-Like Symptoms
May 7, 2009 7:15 PM ET
NOTE: On May 22, 2009, CDC issued updated Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission. This new guidance should be considered the most up-to-date and supersede previously issued guidance.
Content related to masks and respirators on this web page will be used.
Symptoms
Avoid Contact With Others
Treatment is Available for Those Who Are Seriously Ill
Emergency Warning Signs
Protect Yourself and your family
Background
The novel H1N1 flu virus is causing illness in infected persons in the United States and countries around the world. CDC expects that illnesses may continue for some time. As a result, you or people around you may become ill. If so, you need to recognize the symptoms and know what to do.
Symptoms
The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this new H1N1 virus also have reported diarrhea and vomiting. The high risk groups for novel H1N1 flu are not known at this time but it’s possible that they may be the same as for seasonal influenza. People at higher risk of serious complications from seasonal flu include people age 65 years and older, children younger than 5 years old, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and people who are immunosuppressed (e.g., taking immunosuppressive medications, infected with HIV).
Avoid Contact With Others
If you are sick, you may be ill for a week or longer. You should stay home and avoid contact with other persons, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general you should avoid contact with other people as much as possible to keep from spreading your illness. At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.
Treatment is Available for Those Who Are Seriously III
It is expected that most people will recover without needing medical care.
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes wide spread, there will be little need to continue testing people, so your health care provider may decide not to test for the flu virus.
Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including H1N1 flu virus. These medications must be prescribed by a health care professional.
There are two influenza antiviral medications that are recommended for use against H1N1 flu. The drugs that are used for treating H1N1 flu are called oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®). As the H1N1 flu spreads, these antiviral drugs may become in short supply. Therefore, the drugs will be given first to those people who have been hospitalized or are at high risk of complications. The drugs work best if given within 2 days of becoming ill, but may be given later if illness is severe or for those at a high risk for complications.
Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs. For more information about Reye’s syndrome, visit the National Institute of Health website.
Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.
Emergency Warning Signs
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish or gray skin color
Not drinking enough fluids
Severe or persistent vomiting
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms improve but then return with fever and worse cough
Protect Yourself, Your Family, and Community
Stay informed. Health officials will provide additional information as it becomes available. Visit the CDC H1N1 Flu website.
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Keep away from other household members as much as possible. This is to keep you from infecting others and spreading the virus further.
Learn more about how to take care of someone who is ill in "Taking Care of a Sick Person in Your Home"
Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.
If you don’t have one yet, consider developing a family emergency plan as a precaution. This should include storing a supply of extra food, medicines, and other essential supplies. Further information can be found in the "Flu Planning Checklist."
May 7, 2009 7:15 PM ET
NOTE: On May 22, 2009, CDC issued updated Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission. This new guidance should be considered the most up-to-date and supersede previously issued guidance.
Content related to masks and respirators on this web page will be used.
Symptoms
Avoid Contact With Others
Treatment is Available for Those Who Are Seriously Ill
Emergency Warning Signs
Protect Yourself and your family
Background
The novel H1N1 flu virus is causing illness in infected persons in the United States and countries around the world. CDC expects that illnesses may continue for some time. As a result, you or people around you may become ill. If so, you need to recognize the symptoms and know what to do.
Symptoms
The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this new H1N1 virus also have reported diarrhea and vomiting. The high risk groups for novel H1N1 flu are not known at this time but it’s possible that they may be the same as for seasonal influenza. People at higher risk of serious complications from seasonal flu include people age 65 years and older, children younger than 5 years old, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and people who are immunosuppressed (e.g., taking immunosuppressive medications, infected with HIV).
Avoid Contact With Others
If you are sick, you may be ill for a week or longer. You should stay home and avoid contact with other persons, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general you should avoid contact with other people as much as possible to keep from spreading your illness. At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.
Treatment is Available for Those Who Are Seriously III
It is expected that most people will recover without needing medical care.
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes wide spread, there will be little need to continue testing people, so your health care provider may decide not to test for the flu virus.
Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including H1N1 flu virus. These medications must be prescribed by a health care professional.
There are two influenza antiviral medications that are recommended for use against H1N1 flu. The drugs that are used for treating H1N1 flu are called oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®). As the H1N1 flu spreads, these antiviral drugs may become in short supply. Therefore, the drugs will be given first to those people who have been hospitalized or are at high risk of complications. The drugs work best if given within 2 days of becoming ill, but may be given later if illness is severe or for those at a high risk for complications.
Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs. For more information about Reye’s syndrome, visit the National Institute of Health website.
Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.
Emergency Warning Signs
If you become ill and experience any of the following warning signs, seek emergency medical care.
In children emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish or gray skin color
Not drinking enough fluids
Severe or persistent vomiting
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Confusion
Severe or persistent vomiting
Flu-like symptoms improve but then return with fever and worse cough
Protect Yourself, Your Family, and Community
Stay informed. Health officials will provide additional information as it becomes available. Visit the CDC H1N1 Flu website.
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Keep away from other household members as much as possible. This is to keep you from infecting others and spreading the virus further.
Learn more about how to take care of someone who is ill in "Taking Care of a Sick Person in Your Home"
Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.
If you don’t have one yet, consider developing a family emergency plan as a precaution. This should include storing a supply of extra food, medicines, and other essential supplies. Further information can be found in the "Flu Planning Checklist."
U.S Swine Flu Cases Reproted
Table. U.S. Human Cases of H1N1 Flu Infection
Web page updated June 5, 2009,
11:00 AM ET (Updated each Friday)
Data reported to CDC by June 4, 2009, 5:00 PM ET States and Territories* Confirmed and Probable Cases Deaths
States
Alabama 94 cases 0 deaths
Alaska 3cases 0 deaths
Arkansas 9cases 0 deaths
Arizona 547 cases 4 deaths
California 973 cases 0 deaths
Colorado 75 cases 0 deaths
Connecticut 395 cases 1 death
Delaware 142 cases 0 deaths
Florida 247 cases 0 deaths
Georgia 33 cases 0 deaths
Hawaii 115 cases 0 deaths
Idaho 16 cases 0 deaths
Illinois 1357 cases 5
Indiana 173 cases 0 deaths
Iowa 92 cases 0 deaths
Kansas 92 0 deaths
Kentucky 96 0 deaths
Louisiana 134 cases 0 deaths
Maine 17 0 deaths
Maryland 89 0 deaths
Massachusetts 787 0 deaths
Michigan 298 cases 1 death
Minnesota 82 0 deaths
Mississippi 40 cases 0 deaths
Missouri 46 cases 1 death
Montana 15 cases 0 deaths
Nebraska 60 cases 0 deaths
Nevada 128 cases 0 deaths
New Hampshire 64 cases 0 deaths
New Jersey 148 cases 0 deaths
New Mexico 108 cases 0 deaths
New York 858 cases 8 deaths
North Carolina 30 cases 0 deaths
North Dakota 23 cases 0 deaths
Ohio 35 cases 0 deaths
Oklahoma 93 cases 0 deaths
Oregon 167 cases 0 deaths
Pennsylvania 299 cases 0 deaths
Rhode Island 18 cases 0 deaths
South Carolina 60 0 deaths
South Dakota 10 cases 0 deaths
Tennessee 104 cases 0 deaths
Texas 1670 cases 3 deaths
Utah 461 cases 2 deaths
Vermont 9 cases 0 deaths
Virginia 55 cases 1 death
Washington 577 cases 1 death
Washington, D.C. 24 cases 0 deaths
West Virginia 6 cases 0 deaths
Wisconsin 2217 cases 0 deaths
Wyoming 25 cases 0 deaths
Territories
Puerto Rico 1 case 0 deaths
TOTAL*(52) 13,217 cases 27 deaths
*includes the District of Columbia and Puerto Rico
International Human Cases of H1N1 Flu Infection
See: World Health Organization.
Source CDC Website
Web page updated June 5, 2009,
11:00 AM ET (Updated each Friday)
Data reported to CDC by June 4, 2009, 5:00 PM ET States and Territories* Confirmed and Probable Cases Deaths
States
Alabama 94 cases 0 deaths
Alaska 3cases 0 deaths
Arkansas 9cases 0 deaths
Arizona 547 cases 4 deaths
California 973 cases 0 deaths
Colorado 75 cases 0 deaths
Connecticut 395 cases 1 death
Delaware 142 cases 0 deaths
Florida 247 cases 0 deaths
Georgia 33 cases 0 deaths
Hawaii 115 cases 0 deaths
Idaho 16 cases 0 deaths
Illinois 1357 cases 5
Indiana 173 cases 0 deaths
Iowa 92 cases 0 deaths
Kansas 92 0 deaths
Kentucky 96 0 deaths
Louisiana 134 cases 0 deaths
Maine 17 0 deaths
Maryland 89 0 deaths
Massachusetts 787 0 deaths
Michigan 298 cases 1 death
Minnesota 82 0 deaths
Mississippi 40 cases 0 deaths
Missouri 46 cases 1 death
Montana 15 cases 0 deaths
Nebraska 60 cases 0 deaths
Nevada 128 cases 0 deaths
New Hampshire 64 cases 0 deaths
New Jersey 148 cases 0 deaths
New Mexico 108 cases 0 deaths
New York 858 cases 8 deaths
North Carolina 30 cases 0 deaths
North Dakota 23 cases 0 deaths
Ohio 35 cases 0 deaths
Oklahoma 93 cases 0 deaths
Oregon 167 cases 0 deaths
Pennsylvania 299 cases 0 deaths
Rhode Island 18 cases 0 deaths
South Carolina 60 0 deaths
South Dakota 10 cases 0 deaths
Tennessee 104 cases 0 deaths
Texas 1670 cases 3 deaths
Utah 461 cases 2 deaths
Vermont 9 cases 0 deaths
Virginia 55 cases 1 death
Washington 577 cases 1 death
Washington, D.C. 24 cases 0 deaths
West Virginia 6 cases 0 deaths
Wisconsin 2217 cases 0 deaths
Wyoming 25 cases 0 deaths
Territories
Puerto Rico 1 case 0 deaths
TOTAL*(52) 13,217 cases 27 deaths
*includes the District of Columbia and Puerto Rico
International Human Cases of H1N1 Flu Infection
See: World Health Organization.
Source CDC Website
Swine Flu -New Virus Emerges
Updated June 5, 2009, 11:00 AM ET
A New Virus Emerges
Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in Mexico and the United States in March and April, 2009. The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency.
It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.
Since the outbreak began in the United States, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
It’s uncertain at this time how serious or severe this novel H1N1 virus will be in terms of how many people infected will develop serious complications or die or how this new virus may affect the U.S. during its upcoming influenza season in the fall and winter. Because this is a new virus, most people will have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus.
At this time, most people who have become ill with novel H1N1 in the United States have recovered without requiring medical treatment and have experienced typical flu symptoms.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics.
CDC Response
CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.
CDC is issuing updated interim guidance daily in response to the rapidly evolving situation.
Clinician Guidance
CDC has issued interim guidance for clinicians on identifying and caring for patients with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat severe influenza illness, including people who are hospitalized or sick people who are considered at high risk of serious influenza-related complications.
Public Guidance
CDC has provided guidance for the public on what to do if they become sick with flu-like symptoms, including infection with novel H1N1. CDC also has issued instructions on taking care of a sick person at home and the use of facemasks and respirators to reduce novel influenza A (H1N1) transmission. Novel H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea. Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing. People who are sick should stay home and avoid contact with others in order to limit further spread of the disease.
Testing
CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and the District of Columbia and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus.
Vaccine
The U.S. Government is aggressively taking early steps in the process to manufacture a novel H1N1 vaccine, working closely with manufacturing. CDC has isolated the new H1N1 virus, made a candidate vaccine virus that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary. Making vaccine is a multi-step process requiring several months to complete.
Strategic National Stockpile
CDC has deployed 25 percent of the supplies in the Strategic National Stockpile (SNS) to all states in the continental United States and U.S. territories. This included antiviral drugs, personal protective equipment, and respiratory protection devices. These supplies and medicines will help states and U.S. territories respond to novel H1N1 virus.
Surveillance
Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. While our influenza surveillance systems indicate that overall influenza activity is decreasing in the United States, novel H1N1 outbreaks are ongoing in different parts of the U.S., in some cases with intense activity. Most of the influenza viruses being detected now are novel H1N1 viruses.
Shared Responsibility
Individuals have an important role in protecting themselves and their families.
Stay informed. Health officials will provide additional information as it becomes available.
Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
A New Virus Emerges
Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in Mexico and the United States in March and April, 2009. The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. The second patient was confirmed on April 17, 2009. It was quickly determined that the virus was spreading from person-to-person. On April 22, CDC activated its Emergency Operations Center to better coordinate the public health response. On April 26, 2009, the United States Government declared a public health emergency.
It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.
Since the outbreak began in the United States, an increasing number of U.S. states have reported cases of novel H1N1 influenza with associated hospitalizations and deaths. By June 3, 2009, all 50 states in the United States and the District of Columbia and Puerto Rico were reporting cases of novel H1N1 infection. While nationwide U.S. influenza surveillance systems indicate that overall influenza activity is decreasing in the country at this time, novel H1N1 outbreaks are ongoing in parts of the U.S., in some cases with intense activity.
It’s uncertain at this time how serious or severe this novel H1N1 virus will be in terms of how many people infected will develop serious complications or die or how this new virus may affect the U.S. during its upcoming influenza season in the fall and winter. Because this is a new virus, most people will have little or no immunity against it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus.
At this time, most people who have become ill with novel H1N1 in the United States have recovered without requiring medical treatment and have experienced typical flu symptoms.
CDC is continuing to watch the situation carefully, to support the public health response and to gather information about this virus and its characteristics.
CDC Response
CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.
CDC is issuing updated interim guidance daily in response to the rapidly evolving situation.
Clinician Guidance
CDC has issued interim guidance for clinicians on identifying and caring for patients with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat severe influenza illness, including people who are hospitalized or sick people who are considered at high risk of serious influenza-related complications.
Public Guidance
CDC has provided guidance for the public on what to do if they become sick with flu-like symptoms, including infection with novel H1N1. CDC also has issued instructions on taking care of a sick person at home and the use of facemasks and respirators to reduce novel influenza A (H1N1) transmission. Novel H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea. Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing. People who are sick should stay home and avoid contact with others in order to limit further spread of the disease.
Testing
CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and the District of Columbia and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus.
Vaccine
The U.S. Government is aggressively taking early steps in the process to manufacture a novel H1N1 vaccine, working closely with manufacturing. CDC has isolated the new H1N1 virus, made a candidate vaccine virus that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary. Making vaccine is a multi-step process requiring several months to complete.
Strategic National Stockpile
CDC has deployed 25 percent of the supplies in the Strategic National Stockpile (SNS) to all states in the continental United States and U.S. territories. This included antiviral drugs, personal protective equipment, and respiratory protection devices. These supplies and medicines will help states and U.S. territories respond to novel H1N1 virus.
Surveillance
Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. While our influenza surveillance systems indicate that overall influenza activity is decreasing in the United States, novel H1N1 outbreaks are ongoing in different parts of the U.S., in some cases with intense activity. Most of the influenza viruses being detected now are novel H1N1 viruses.
Shared Responsibility
Individuals have an important role in protecting themselves and their families.
Stay informed. Health officials will provide additional information as it becomes available.
Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
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