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Immunization Action Coalition
IAC Express 2009
Issue number 794: May 1, 2009
Please click here to subscribe to IAC Express as well as other FREE IAC periodicals.
Contents of this Issue
Select a title to jump to the article.
  1. CDC continually posting new information regarding H1N1 influenza (swine flu)
  2. How to keep up-to-date on H1N1 influenza (swine flu) news and recommendations
  3. MMWR Dispatch reports on history of current swine-origin influenza A virus outbreak
  4. MMWR Dispatch reports on swine-origin influenza A virus infections in a New York City school
  5. May 1 issue of MMWR includes four articles about H1N1 influenza
 
Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
  
Issue 794: May 1, 2009
1.  CDC continually posting new information regarding H1N1 influenza (swine flu)

The federal government is mounting a strong response to the H1N1 influenza (swine flu) outbreak. CDC's goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist healthcare providers, public health officials, and the public in addressing the challenges posed by this newly identified influenza virus. To this end, CDC continues to update guidance continually.

CDC's H1N1 Flu web page titled Guidance for Professionals has recently been updated with some interim guidance documents that will be of particular interest to IAC Express readers. Following are their titles and URLs:

Update on School (K-12) Dismissal and Childcare Facilities: Interim CDC Guidance in Response to Human Infections with the 2009 Influenza A H1N1 Virus
http://www.cdc.gov/h1n1flu/K12_dismissal.htm

H1N1 Flu (Swine Flu) Infections Alert for Institutions of Higher Education
http://www.cdc.gov/h1n1flu/college-alert.htm

Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

Interim Guidance--HIV-Infected Adults and Adolescents: Considerations for Clinicians Regarding Swine-Origin Influenza A (H1N1) Virus
http://www.cdc.gov/h1n1flu/guidance_HIV.htm

Interim Guidance--Pregnant Women and H1N1 (Swine Influenza): Considerations for Clinicians [updated since first release]
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

CDC has also posted interim guidance on such topics as screening, specimen collection, facemask and respirator use, travel, and emergency personnel. To access the web page, which is constantly evolving, go to: http://www.cdc.gov/swineflu/guidance

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2 How to keep up-to-date on H1N1 influenza (swine flu) news and recommendations

Need to keep up with the latest news and recommendations regarding the rapidly evolving H1N1 influenza outbreak? The following resources can make your life easier.

(1) CDC's H1N1 Flu web section (http://www.cdc.gov/h1n1flu or http://www.cdc.gov/swineflu) includes the latest statistics and links to the interim guidance documents for healthcare professionals (see IAC Express article #1 above), and a helpful list of "What's New?" at
http://www.cdc.gov/h1n1flu/whatsnew.htm

H1N1 influenza information in Spanish from CDC is available at
http://www.cdc.gov/h1n1flu/espanol

CDC operates a hotline with English- and Spanish-language operators. Health professionals and members of the public can call (800) CDC-INFO [(800) 232-4636] 24 hours a day, 7 days a week.

CDC also offers the option to sign up for email updates, RRS subscription, and Twitter feeds. Go to http://www.cdc.gov/h1n1flu and click on your choice in the right column for more information.

(2) The U.S. Department of Health & Human Services website offers webcasts on H1N1 influenza. Go to http://www.hhs.gov

(3) IAC has added a box to the top of its home page at http://www.immunize.org that provides links to the most important related CDC, HHS, and state web pages, as well as to recently published articles on the subject. Look for the box titled "H1N1 Influenza (Swine Flu)."

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3 MMWR Dispatch reports on history of current swine-origin influenza A virus outbreak

On April 30, CDC published "Outbreak of Swine-Origin Influenza A (H1N1) Virus Infection--Mexico, March-April 2009" as an electronic MMWR Dispatch. The first paragraph and the editorial note are reprinted below, excluding references.


In March and early April 2009, Mexico experienced outbreaks of respiratory illness and increased reports of patients with influenza-like illness (ILI) in several areas of the country. On April 12, the General Directorate of Epidemiology (DGE) reported an outbreak of ILI in a small community in the state of Veracruz to the Pan American Health Organization (PAHO) in accordance with International Health Regulations. On April 17, a case of atypical pneumonia in Oaxaca State prompted enhanced surveillance throughout Mexico. On April 23, several cases of severe respiratory illness laboratory confirmed as swine-origin influenza A (H1N1) virus (S-OIV) infection were communicated to the PAHO. Sequence analysis revealed that the patients were infected with the same S-OIV strain detected in two children residing in California. This report describes the initial and ongoing investigation of the S-OIV outbreak in Mexico. . . .

Editorial Note:
Understanding the epidemiology and clinical profiles of recent cases of S-OIV infection in Mexico can help inform regional, national, and global control measures in response to the emergence of S-OIV infection. Important areas for investigation worldwide include evidence of person-to-person transmission, the geographic distribution of disease, the clinical spectrum of disease, and the effectiveness of mitigation strategies.

Previous instances of human-to-human transmission of other swine viruses have been reported to result in small clusters of disease and limited generations of disease transmission. Several findings indicate that transmission in Mexico involves person-to-person spread with multiple generations of transmission. Patients with probable and laboratory-confirmed disease have presented over a period of 4 weeks. Limited contact tracing of patients with laboratory-confirmed disease also has identified secondary cases of ILI.

The clinical spectrum of S-OIV illness is not yet well characterized in Mexico. However, evidence suggests that S-OIV transmission is widespread and that less severe (uncomplicated) illness is common. Patients with confirmed disease have been identified in several states, and suspected cases have been identified in all states, which suggests that S-OIV transmission is widespread. In addition, several countries are reporting S-OIV infection among persons who have travel histories involving different parts of Mexico in the 7 days before illness onset. To date, case-finding in Mexico has focused on patients seeking care in hospitals, and the selection of cases for laboratory testing has focused on patients with more severe disease. Therefore, a large number of undetected cases of illness might exist in persons seeking care in primary-care settings or not seeking care at all. Additional investigations are needed urgently to evaluate the full clinical spectrum of disease in Mexico, the proportion of patients who have severe illness, and the extent of disease transmission.

To expedite confirmation of disease in additional patients, the World Health Organization (WHO) Influenza Collaborating Center in Atlanta, Georgia, has placed the genetic sequence of S-OIV from California in GenBank. Specific primers for S-OIV have been developed and will be distributed through the WHO Global Influenza Surveillance Network to reference laboratories throughout the world. As of April 26, the National Laboratory for Public Health in Mexico has capacity to perform PCR for S-OIV.

The epidemiologic characteristics of this outbreak underscore the importance of monitoring the effectiveness of community mitigation efforts, nonpharmaceutical interventions, and clinical management practices in anticipation of a possible pandemic.


To access a web-text (HTML) version of the complete MMWR Dispatch, which includes references, two tables, and a figure go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a2.htm

To access a ready-to-print (PDF) version of the MMWR Dispatch, go to: http://www.cdc.gov/mmwr/pdf/wk/mm58d0430a2.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

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4 MMWR Dispatch reports on swine-origin influenza A virus infections in a New York City school

On April 30, CDC published "Swine-Origin Influenza A (H1N1) Virus Infections in a School--New York City, April 2009" as an electronic MMWR Dispatch. The first paragraph is reprinted below, excluding references.


On April 24, 2009, CDC reported eight confirmed cases of swine-origin influenza A (H1N1) virus (S-OIV) infection in Texas and California. The strain identified in U.S. patients was confirmed by CDC as genetically similar to viruses subsequently isolated from patients in Mexico. Since April 24, the number of cases in the United States and elsewhere has continued to rise. As of April 28, approximately half (45) of all U.S. cases of S-OIV infection had been confirmed among students and staff members at a New York City (NYC) high school. This report describes the initial outbreak investigation by the NYC Department of Health and Mental Hygiene (DOHMH) and provides preliminary details about 44 of the 45 patients (the remaining patient resides outside of NYC and was not included in the analysis). The preliminary findings from this investigation indicate that symptoms in these patients appear to be similar to those of seasonal influenza. DOHMH will continue monitoring for changes in the epidemiology and/or clinical severity of S-OIV infection. . . .


To access a web-text (HTML) version of the complete MMWR Dispatch, including references and one figure, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0430a1.htm

To access a ready-to-print (PDF) version of the MMWR Dispatch, go to: http://www.cdc.gov/mmwr/pdf/wk/mm58d0430.pdf

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5 May 1 issue of MMWR includes four articles about H1N1influenza

The May 1 issue of MMWR includes four articles about H1N1 influenza, three of which have already been released as MMWR Dispatches. As we have already covered some of this information in IAC Express, the following provides full coverage of the two articles not previously covered and titles and Web links for the other two.

(1) CDC published "Update: Swine-Origin Influenza A (H1N1) Virus--United States and Other Countries" in the May 1 issue of MMWR. The article is reprinted below in its entirety, excluding references.


Since April 21, 2009, CDC has been reporting cases of respiratory infection with a swine-origin influenza A (H1N1) virus (S-OIV) transmitted through human-to-human contact. In the United States, as of April 29, a total of 91 confirmed cases had been reported, including one death (in Texas). By state, the following numbers of cases had been reported: New York (51); Texas (16); California (14); Kansas, Massachusetts, and Michigan (two each); Arizona, Indiana, Nevada, and Ohio (one each).

Outside of the United States, as of April 29, a total of 57 confirmed cases had been reported, including seven deaths (in Mexico). By country, the following numbers of laboratory-confirmed cases had been reported: Mexico (26); Canada (13); United Kingdom (five); Spain (four); Germany and New Zealand (three each); Israel (2); and Austria (one). Additional information is available at http://www.cdc.gov/swineflu and http://www.who.int/csr/don/2009_04_29/en/index.html


To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a1.htm


(2) CDC published "Update: Swine Influenza A (H1N1) Infections--California and Texas, April 2009" in the May 1 issue of MMWR. This information was previously released as an MMWR Dispatch on April 24. The first paragraph is reprinted below, excluding one reference.


On April 21, 2009, CDC reported that two recent cases of febrile respiratory illness in children in southern California had been caused by infection with genetically similar swine influenza A (H1N1) viruses. The viruses contained a unique combination of gene segments that had not been reported previously among swine or human influenza viruses in the United States or elsewhere. Neither child had known contact with pigs, resulting in concern that human-to-human transmission might have occurred. The seasonal influenza vaccine H1N1 strain is thought to be unlikely to provide protection. This report updates the status of the ongoing investigation and provides preliminary details about six additional persons infected by the same strain of swine influenza A (H1N1) virus identified in the previous cases, as of April 24. The six additional cases were reported in San Diego County, California (three cases), Imperial County, California (one case), and Guadalupe County, Texas (two cases). CDC, the California Department of Public Health, and the Texas Department of Health and Human Services are conducting case investigations, monitoring for illness in contacts of the eight patients, and enhancing surveillance to determine the extent of spread of the virus. CDC continues to recommend that any influenza A viruses that cannot be subtyped be sent promptly for testing to CDC. In addition, swine influenza A (H1N1) viruses of the same strain as those in the U.S. patients have been confirmed by CDC among specimens from patients in Mexico. Clinicians should consider swine influenza as well as seasonal influenza virus infections in the differential diagnosis for patients who have febrile respiratory illness and who 1) live in San Diego and Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during  the 7 days preceding their illness onset. . . .


To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a7.htm


(3) CDC published "Update: Infections With a Swine-Origin Influenza A (H1N1) Virus--United States and Other Countries, April 28, 2009" in the May 1 issue of MMWR. This information was previously released as an MMWR Dispatch on April 28, and was covered in the April 29 issue of IAC Express.

To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a5.htm


(4) CDC published "Update: Drug Susceptibility of Swine-Origin Influenza A (H1N1) Viruses, April 2009" in the May 1 issue of MMWR. This information was previously released as an MMWR Dispatch on April 28, and was covered in the April 29 issue of IAC Express.

To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a6.htm

To access a ready-to-print (PDF) version of the entire May 1 issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5816.pdf

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