November 6, 2009,
U.S. Situation Update
Centers for Disease Control
Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView.* During the week of October 25-31, 2009, a review of the key indicators found that influenza activity remained high in the United States. Below is a summary of the most recent key indicators:
* Visits to doctors for influenza-like illness (ILI) nationally decreased very slightly this week over last week after four consecutive weeks of sharp increases. While ILI declined slightly, visits to doctors for influenza-like illness remain at much higher levels than what is expected for this time of the year and parts of the country continue to see sharp increases in activity. It’s possible that nationwide ILI could rise again. ILI continues to be higher than what is seen during the peak of most regular flu seasons.
* Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year. Hospitalization rates continue to be highest is younger populations with the highest hospitalization rate reported in children 0-4 years old.
* The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report continues to increase and has been higher for five weeks now than what is expected at this time of year. In addition, 18 flu-related pediatric deaths were reported this week; 15 of these deaths were confirmed 2009 H1N1, and three were influenza A viruses, but were not sub-typed. Since April 2009, CDC has received reports of 129 laboratory-confirmed pediatric 2009 H1N1 deaths and another 15 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined. (Editor's Note: It is reasonable to assume that the total number of Pediatric deaths due to Swine Flu [to date] is 144)
* Forty-eight states are reporting widespread influenza activity at this time; a decline of one state over last week. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity at this time of year are unprecedented during seasonal flu.
* Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs Oseltamivir and Zanamivir with rare exception
Saturday, November 7, 2009
Thursday, November 5, 2009
2009 H1N1 Flu ("Swine Flu") and You
Centers for Disease Control and Prevention
November 3, 2009 11:45 AM ET
In The News
2009 H1N1 Hospitalizations in People with Asthma
What does CDC know about hospitalizations among people with asthma who get 2009 H1N1 flu? (November 3, 2009)
People with asthma are at higher risk for serious complications from influenza (flu), including 2009 H1N1 flu. This can place people with asthma at higher risk of hospitalization when they have 2009 H1N1 flu. CDC monitors 2009-H1N1 related hospitalizations, including among people with asthma, through the Emerging Infections Program (EIP).
What is the Emerging Infections Program (EIP)? (November 3, 2009)
The EIP Influenza Project conducts surveillance for laboratory-confirmed influenza (flu) related hospitalizations in children (persons younger than 18 years) and adults in 62 counties covering 13 metropolitan areas of 10 states (for more information see the overview of influenza surveillance in the United States). Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test* conducted as a part of routine patient care. EIP estimated hospitalization rates are reported every week during the flu season.
*Tests used by EIP to confirm influenza infection include viral culture, direct/indirect fluorescent antibody assay (DFA/IFA), real-time reverse transcriptase polymerase chain reaction (rRT-PCR), or a commercial rapid antigen test.
What percentage of people hospitalized with 2009 H1N1 flu have asthma? (November 3, 2009)
According to Emerging Infections Program (EIP) data collected from April 15 through October 27, 2009, 32% of people hospitalized with 2009 H1N1 had asthma. Among adults hospitalized with 2009 H1N1, 30% had asthma, whereas 35% of hospitalized children with 2009 H1N1 had asthma.
What percentage of people hospitalized with asthma and 2009 H1N1 are admitted to an Intensive Care Unit (ICU)? (November 3, 2009)
According to Emerging Infections Program (EIP) data collected from April 15 - October 27, 2009, 21% of hospitalized adults with asthma and a 2009 H1N1 infection and 18% of hospitalized children with asthma and a 2009 H1N1 infection were admitted to an ICU. No significant differences in the number of ICU admissions were noted between 2009 H1N1 infected people hospitalized with or without asthma.
What percentage of hospitalizations for 2009 H1N1 flu occur in different age groups in the United States? October 20
The percentage of hospitalizations for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 4,958 laboratory-confirmed 2009 H1N1 hospitalizations to CDC. The percentage of 2009 H1N1 related hospitalizations that occurred among those 0 to 4 years old was 19%; among those 5 years to 18 years was 25%; among people 19 years to 24 years was 9%; among those 25 years to 49 years was 24%; among people 50 to 64 years was 15%; and among people 65 years and older was 7%. For a graphical representation of this data, please see the chart below.
What percentage of deaths for 2009 H1N1 flu occur in different age groups in the United States? October 20
The percentage of deaths for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 292 laboratory-confirmed 2009 H1N1 deaths to CDC. The percentage of 2009 H1N1 related deaths that occurred among people 0 years to 4 years was 3%; among those 5 years to 18 years was 14%; among people 19 to 24 years was 7%; among people 25 to 49 years was 33%; among people 50-64 years was 32%; and among people 65 years and older was 12%. For a graphical representation of this data, please see the chart below.
2009 H1N1 Flu
What is 2009 H1N1 (swine flu)?
2009 H1N1 (sometimes called “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization External Web Site Icon (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a "quadruple reassortment" virus.
2009 H1N1 Flu in Humans
Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with 2009 H1N1 are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.
Is 2009 H1N1 virus contagious?
The 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
Photo of nurse and child
What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.
How severe is illness associated with 2009 H1N1 flu virus?
Illness with 2009 H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
Young children are also at high risk of serious complications from 2009 H1N1, just as they are from seasonal flu. And while people 65 and older are the least likely to be infected with 2009 H1N1 flu, if they get sick, they are also at “high risk” of developing serious complications from their illness. See People at High Risk of Developing Flu-Related Complications for more information about who is more likely to get flu complications that result in being hospitalized and occasionally result in death.
CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.
How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are relatively fewer cases and deaths reported in people 65 years and older, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.
How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.
Prevention & Treatment
What can I do to protect myself from getting sick? Oct 8
This season, there is a seasonal flu vaccine to protect against seasonal flu viruses and a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”). A flu vaccine is the first and most important step in protecting against flu infection. For information about the 2009 H1N1 vaccines, visit H1N1 Flu Vaccination Resources. For information about seasonal influenza vaccines, visit Preventing Seasonal Flu With Vaccination.
There are also everyday actions that can help prevent the spread of germs that cause respiratory illnesses like the flu.
Take these everyday steps to protect your health:
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. If soap and water are not available, use an alcohol-based hand rub.*
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Other important actions that you can take are:
* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
* Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.
What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.
If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.
What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
What should I do if I get sick?
For information about what to do if you get sick with flu-like symptoms this season, see What To Do If You Get Sick: 2009 H1N1 and Seasonal Flu. A downloadable flyer Adobe PDF file containing this information also is available HERE...
What are “emergency warning signs” that should signal anyone to seek medical care urgently?
In children:
* Fast breathing or trouble breathing
* Bluish skin color
* Not drinking enough fluids
* 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
* Fever with a rash
In adults:
* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
Are there medicines to treat 2009 H1N1 infection?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.
CDC does not recommend "swine flu parties" as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.
CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.
Contamination & Cleaning
How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.
*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Exposures Not Thought to Spread 2009 H1N1 Flu
Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.
Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.
November 3, 2009 11:45 AM ET
In The News
2009 H1N1 Hospitalizations in People with Asthma
What does CDC know about hospitalizations among people with asthma who get 2009 H1N1 flu? (November 3, 2009)
People with asthma are at higher risk for serious complications from influenza (flu), including 2009 H1N1 flu. This can place people with asthma at higher risk of hospitalization when they have 2009 H1N1 flu. CDC monitors 2009-H1N1 related hospitalizations, including among people with asthma, through the Emerging Infections Program (EIP).
What is the Emerging Infections Program (EIP)? (November 3, 2009)
The EIP Influenza Project conducts surveillance for laboratory-confirmed influenza (flu) related hospitalizations in children (persons younger than 18 years) and adults in 62 counties covering 13 metropolitan areas of 10 states (for more information see the overview of influenza surveillance in the United States). Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test* conducted as a part of routine patient care. EIP estimated hospitalization rates are reported every week during the flu season.
*Tests used by EIP to confirm influenza infection include viral culture, direct/indirect fluorescent antibody assay (DFA/IFA), real-time reverse transcriptase polymerase chain reaction (rRT-PCR), or a commercial rapid antigen test.
What percentage of people hospitalized with 2009 H1N1 flu have asthma? (November 3, 2009)
According to Emerging Infections Program (EIP) data collected from April 15 through October 27, 2009, 32% of people hospitalized with 2009 H1N1 had asthma. Among adults hospitalized with 2009 H1N1, 30% had asthma, whereas 35% of hospitalized children with 2009 H1N1 had asthma.
What percentage of people hospitalized with asthma and 2009 H1N1 are admitted to an Intensive Care Unit (ICU)? (November 3, 2009)
According to Emerging Infections Program (EIP) data collected from April 15 - October 27, 2009, 21% of hospitalized adults with asthma and a 2009 H1N1 infection and 18% of hospitalized children with asthma and a 2009 H1N1 infection were admitted to an ICU. No significant differences in the number of ICU admissions were noted between 2009 H1N1 infected people hospitalized with or without asthma.
What percentage of hospitalizations for 2009 H1N1 flu occur in different age groups in the United States? October 20
The percentage of hospitalizations for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 4,958 laboratory-confirmed 2009 H1N1 hospitalizations to CDC. The percentage of 2009 H1N1 related hospitalizations that occurred among those 0 to 4 years old was 19%; among those 5 years to 18 years was 25%; among people 19 years to 24 years was 9%; among those 25 years to 49 years was 24%; among people 50 to 64 years was 15%; and among people 65 years and older was 7%. For a graphical representation of this data, please see the chart below.
What percentage of deaths for 2009 H1N1 flu occur in different age groups in the United States? October 20
The percentage of deaths for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 292 laboratory-confirmed 2009 H1N1 deaths to CDC. The percentage of 2009 H1N1 related deaths that occurred among people 0 years to 4 years was 3%; among those 5 years to 18 years was 14%; among people 19 to 24 years was 7%; among people 25 to 49 years was 33%; among people 50-64 years was 32%; and among people 65 years and older was 12%. For a graphical representation of this data, please see the chart below.
2009 H1N1 Flu
What is 2009 H1N1 (swine flu)?
2009 H1N1 (sometimes called “swine flu”) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization External Web Site Icon (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.
Why is 2009 H1N1 virus sometimes called “swine flu”?
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a "quadruple reassortment" virus.
2009 H1N1 Flu in Humans
Are there human infections with 2009 H1N1 virus in the U.S.?
Yes. Human infections with 2009 H1N1 are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.
CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.
Is 2009 H1N1 virus contagious?
The 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?
Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
Photo of nurse and child
What are the signs and symptoms of this virus in people?
The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.
How severe is illness associated with 2009 H1N1 flu virus?
Illness with 2009 H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.
In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.
Young children are also at high risk of serious complications from 2009 H1N1, just as they are from seasonal flu. And while people 65 and older are the least likely to be infected with 2009 H1N1 flu, if they get sick, they are also at “high risk” of developing serious complications from their illness. See People at High Risk of Developing Flu-Related Complications for more information about who is more likely to get flu complications that result in being hospitalized and occasionally result in death.
CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.
How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?
With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.
When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are relatively fewer cases and deaths reported in people 65 years and older, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.
How long can an infected person spread this virus to others?
People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.
Prevention & Treatment
What can I do to protect myself from getting sick? Oct 8
This season, there is a seasonal flu vaccine to protect against seasonal flu viruses and a 2009 H1N1 vaccine to protect against the 2009 H1N1 influenza virus (sometimes called “swine flu”). A flu vaccine is the first and most important step in protecting against flu infection. For information about the 2009 H1N1 vaccines, visit H1N1 Flu Vaccination Resources. For information about seasonal influenza vaccines, visit Preventing Seasonal Flu With Vaccination.
There are also everyday actions that can help prevent the spread of germs that cause respiratory illnesses like the flu.
Take these everyday steps to protect your health:
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. If soap and water are not available, use an alcohol-based hand rub.*
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.
Other important actions that you can take are:
* Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
* Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs * (for when soap and water are not available), tissues and other related items could help you to avoid the need to make trips out in public while you are sick and contagious.
What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.
If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?
Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If soap and water are not available, they should use an alcohol-based hand rub.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.
What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used.* You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
What should I do if I get sick?
For information about what to do if you get sick with flu-like symptoms this season, see What To Do If You Get Sick: 2009 H1N1 and Seasonal Flu. A downloadable flyer Adobe PDF file containing this information also is available HERE...
What are “emergency warning signs” that should signal anyone to seek medical care urgently?
In children:
* Fast breathing or trouble breathing
* Bluish skin color
* Not drinking enough fluids
* 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
* Fever with a rash
In adults:
* Difficulty breathing or shortness of breath
* Pain or pressure in the chest or abdomen
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
Are there medicines to treat 2009 H1N1 infection?
Yes. There are drugs your doctor may prescribe for treating both seasonal and 2009 H1N1 called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.
CDC does not recommend "swine flu parties" as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.
CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.
Contamination & Cleaning
How long can influenza virus remain viable on objects (such as books and doorknobs)?
Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
What kills influenza virus?
Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.
*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14
If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.
What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus?
To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus?
To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.
Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
Eating utensils should be washed either in a dishwasher or by hand with water and soap.
Exposures Not Thought to Spread 2009 H1N1 Flu
Can I get infected with 2009 H1N1 virus from eating or preparing pork?
No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.
Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.
Sunday, November 1, 2009
US rushing swine flu vaccine clinical trials
Editor's NOTE:
This piece is included in way of background to help demonstrate that the timing of the initial "Swine Flu" presentation last year demanded an expedited vaccine development phase and an accelerated vaccine clinical trial phase.
As mentioned in my "Primer" HERE... the data from these clinical trials is incomplete to date and must be carefully monitored. Nevertheless, members of high-risk groups should strongly consider getting the vaccine when it is made available as to date the reported complication rate appears to be acceptably low.
--Dr. J. P. Hubert
By: Deborah Shlian
July 28, 2009
Miami Health Care Examiner
As the swine flu continues to rapidly move across the globe, the World Health Organization has stopped asking governments to report new cases, claiming the effort is too great now that the disease has become so widespread. Instead, the focus is on developing strategies for preventing what some experts fear will be a new, more serious outbreak of swine flu in the fall and winter months just when seasonal flu arrives.
Pharamceutical companies are rushing to develop a vaccine by early fall. Clinical trials have already started in Australia. Canadian trials will begin by September or early October. Federal health officials announced that the first US clinical trials will begin in August and will be conducted in what Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease described as “a two month compressed time frame” in which about 2400 volunteers will be tested. The initial tests will be of vaccines made by Sanofi-Pasteur, a European company, and CLS Biotherapies, an Australian company that has supplied seasonal flu shots in the US for years. A third company, Novartis, is conducting separate trials for FDA licensing.
Adult volunteers for the clinical trials will be recruited at 8 separate sites including Emory University in Atlanta, the University of Maryland School of Medicine in Baltimore, Vanderbilt University in Nashville, Baylor College of Medicine in Houston, Children’s Hospital Medical Center in Cincinnati, Group Health Cooperative in Seattle, the University Iowa in Iowa City, and St. Louis University.
Initial studies will determine whether one or two 15-microgram doses of A/H1N1 swine flu vaccine are needed to produce an immune response in healthy adult volunteers (18 to 64 years) and elderly people (65 years and older).
The doses will be given 21 days apart. If there are early indications that the vaccines are safe, similar trials in healthy children (six months to 17 years) will begin. According to Fauci, later tests may include pregnant women, who are at higher risk for swine flu complications.
Vaccines will be given to different sets of volunteers before, after or at the same time as the seasonal flu vaccine. Every volunteer will be monitored for negative side effects including allergic reactions to the chicken eggs that the vaccines are grown in.
Researchers will also look out for Guillain-Barré syndrome , a rare reaction to any vaccine which can cause fever, serious nerve damage and muscle weakness. The 1976 vaccination of 40 million people after a swine flu outbreak in Fort Dix, N. J., was halted after some people developed the syndrome. However, the vaccine was never proved to be the cause. According to a 2009 worldwide literature review, approximately one person in 100,000 develops Guillain-Barré syndrome for unknown reasons. Unfortunately because the US vaccine trials are so small, it is unlikely to pick up such a rare side effect. “You’d have to vaccinate several hundred thousand or millions of people to do that,” Fauci said.
In addition to checking for adverse reactions, volunteers will have their blood tested about three weeks after the shot to see if antibodies to the virus have developed. Those with high levels of antibodies to the specific strain should be immune to the infection or at the very worst, get only a mild case of the flu if exposed to it.
Once these trials are completed and the vaccine is determined to be safe and effective, health officials can then make specific recommendations as to how to conduct a vaccination program and who should be vaccinated. (Editor's emphasis throughout)
Assuming things go according to schedule, the hope is to have as many as 160 million doses ready in the US by mid October and then 80 million doses a month later. Depending on how much vaccine is available and assuming most individuals will require two shots, it could take until March to vaccinate the full U.S. population of 300 million people.
None of the first trials will test a vaccine containing an adjuvant, which is an additive -generally an oil-water emulsion- that stimulates the immune system to react more strongly and helps to stretch the number of doses of vaccine needed. Adjuvants are common in veterinary vaccines and tend to cause more side effects. They are not now used in flu shots in the United States. But they are “not off the board,” Fauci said. “We’ve developed a mix-and-match protocol for them, but we want to see the data on vaccine safety first.” According to a report from Reuters, the U.S. Health and Human Services Department has contracted for 120 million doses of adjuvant which they might use if the flu mutates into a more dangerous form and the demand for more shots than are available results.
Federal advisers plan a meeting tomorrow to discuss who should receive the vaccination.
This piece is included in way of background to help demonstrate that the timing of the initial "Swine Flu" presentation last year demanded an expedited vaccine development phase and an accelerated vaccine clinical trial phase.
As mentioned in my "Primer" HERE... the data from these clinical trials is incomplete to date and must be carefully monitored. Nevertheless, members of high-risk groups should strongly consider getting the vaccine when it is made available as to date the reported complication rate appears to be acceptably low.
--Dr. J. P. Hubert
By: Deborah Shlian
July 28, 2009
Miami Health Care Examiner
As the swine flu continues to rapidly move across the globe, the World Health Organization has stopped asking governments to report new cases, claiming the effort is too great now that the disease has become so widespread. Instead, the focus is on developing strategies for preventing what some experts fear will be a new, more serious outbreak of swine flu in the fall and winter months just when seasonal flu arrives.
Pharamceutical companies are rushing to develop a vaccine by early fall. Clinical trials have already started in Australia. Canadian trials will begin by September or early October. Federal health officials announced that the first US clinical trials will begin in August and will be conducted in what Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease described as “a two month compressed time frame” in which about 2400 volunteers will be tested. The initial tests will be of vaccines made by Sanofi-Pasteur, a European company, and CLS Biotherapies, an Australian company that has supplied seasonal flu shots in the US for years. A third company, Novartis, is conducting separate trials for FDA licensing.
Adult volunteers for the clinical trials will be recruited at 8 separate sites including Emory University in Atlanta, the University of Maryland School of Medicine in Baltimore, Vanderbilt University in Nashville, Baylor College of Medicine in Houston, Children’s Hospital Medical Center in Cincinnati, Group Health Cooperative in Seattle, the University Iowa in Iowa City, and St. Louis University.
Initial studies will determine whether one or two 15-microgram doses of A/H1N1 swine flu vaccine are needed to produce an immune response in healthy adult volunteers (18 to 64 years) and elderly people (65 years and older).
The doses will be given 21 days apart. If there are early indications that the vaccines are safe, similar trials in healthy children (six months to 17 years) will begin. According to Fauci, later tests may include pregnant women, who are at higher risk for swine flu complications.
Vaccines will be given to different sets of volunteers before, after or at the same time as the seasonal flu vaccine. Every volunteer will be monitored for negative side effects including allergic reactions to the chicken eggs that the vaccines are grown in.
Researchers will also look out for Guillain-Barré syndrome , a rare reaction to any vaccine which can cause fever, serious nerve damage and muscle weakness. The 1976 vaccination of 40 million people after a swine flu outbreak in Fort Dix, N. J., was halted after some people developed the syndrome. However, the vaccine was never proved to be the cause. According to a 2009 worldwide literature review, approximately one person in 100,000 develops Guillain-Barré syndrome for unknown reasons. Unfortunately because the US vaccine trials are so small, it is unlikely to pick up such a rare side effect. “You’d have to vaccinate several hundred thousand or millions of people to do that,” Fauci said.
In addition to checking for adverse reactions, volunteers will have their blood tested about three weeks after the shot to see if antibodies to the virus have developed. Those with high levels of antibodies to the specific strain should be immune to the infection or at the very worst, get only a mild case of the flu if exposed to it.
Once these trials are completed and the vaccine is determined to be safe and effective, health officials can then make specific recommendations as to how to conduct a vaccination program and who should be vaccinated. (Editor's emphasis throughout)
Assuming things go according to schedule, the hope is to have as many as 160 million doses ready in the US by mid October and then 80 million doses a month later. Depending on how much vaccine is available and assuming most individuals will require two shots, it could take until March to vaccinate the full U.S. population of 300 million people.
None of the first trials will test a vaccine containing an adjuvant, which is an additive -generally an oil-water emulsion- that stimulates the immune system to react more strongly and helps to stretch the number of doses of vaccine needed. Adjuvants are common in veterinary vaccines and tend to cause more side effects. They are not now used in flu shots in the United States. But they are “not off the board,” Fauci said. “We’ve developed a mix-and-match protocol for them, but we want to see the data on vaccine safety first.” According to a report from Reuters, the U.S. Health and Human Services Department has contracted for 120 million doses of adjuvant which they might use if the flu mutates into a more dangerous form and the demand for more shots than are available results.
Federal advisers plan a meeting tomorrow to discuss who should receive the vaccination.
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What/Where is the Roman Catholic Church?
In light of Traditional Catholic dogma/doctrine, how should the Second Vatican Council be viewed ? Is it consistent with Sacred Scripture, Sacred Tradition and prior Magisterial teaching?What explains the tremendous amount of "bad fruit" which has been forthcoming since the close of the Council in 1965? “By their fruits you shall know them” (Matt. 7:16)
This site explores these questions and more in an attempt to place the Second Vatican Council in proper perspective.