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H1N1 Pandemic US Situation Update and CDC International Response Peter Nsubuga, MD, MPH

This update provides information on the H1N1 pandemic situation in the US and the CDC's international response. It includes data on influenza-like illness visits, hospitalization rates, lab-confirmed deaths, and international support objectives. The update also highlights CDC activities in various countries, including epidemiologic studies and vaccine donation.

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H1N1 Pandemic US Situation Update and CDC International Response Peter Nsubuga, MD, MPH

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  1. H1N1 PandemicUSSituation Update and CDC International Response Peter Nsubuga, MD, MPH On behalf of Dr. Steve Blount Director Coordinating Office for Global HealthCenters for Disease Control and PreventionNovember 2, 2009

  2. Epidemiology/SurveillancePercentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet),National Summary 2008-09 and Previous Two Seasons

  3. Epidemiology/SurveillanceWeekly Influenza Activity Reported by SLTT’s

  4. Epidemiology/SurveillancePercentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet),National Summary October 1, 2006 – October 17, 2009 While ILI syndromic surveillance data do not provide an indication of severity, ,they show how much influenza is circulating at any given time and provide a basis for interpreting trends in hospitalization and death

  5. Epidemiology/SurveillanceCumulative rate of hospitalization/ 100,000 populationages 0-4, EIP, 2003-2009

  6. Epidemiology/SurveillanceCumulative rate of hospitalization/ 100,000 populationages 5-17, EIP, 2003-2009

  7. Epidemiology/SurveillanceCumulative rate of hospitalization/ 100,000 populationages 18-64, EIP, 2005-2009

  8. Epidemiology/SurveillanceCumulative rate of hospitalization/ 100,000 populationages 65+, EIP, 2005-2009

  9. Epidemiology/Surveillance Weekly Lab-Confirmed Deaths (n=411)Influenza Week 41 – 23 OCT 2009 Deaths (n) Reporting Period End Date

  10. Epidemiology/SurveillanceLab-Confirmed Deaths by Age Group through Week 41 (n=411*) Influenza Week 41 – 23 OCT 2009 Deaths (n) Age Group *Numbers are cumulative from start of MMWR week 35 (August 30, 2009)

  11. Epidemiology/SurveillanceLab-Confirmed Mortality per 100,000 Population by Age Group (n=411*) Influenza Week 41 – 23 OCT 2009 Deaths per 100,000 Population Age Group *Deaths with unknown ages are not included (n=0). Excludes jurisdictions for which age distribution information is not available. Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: http://www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File24.csv

  12. International response

  13. Objectives • Better understand pandemic influenza • Support countries in preventing and mitigating

  14. Monitoring Global Activity • Who is at risk of severe disease? • Is the virus changing? • Is there resistance to antivirals? • How effective is the vaccine? • Is the virus causing more severe illness and death? • How easily is the virus transmitted? • Can health care system handle patients?

  15. CDC International Support • Laboratory support for diagnostics • In-country epidemiologic expertise • CDC field offices and international influenza staff • Deployments • Training • Laboratory (PCR) • Infection control • Special studies • Community mitigation – e.g., school closure studies • Vaccine studies • Population-based studies • Support WHO in administration of vaccine donation • Work closely with PAHO, WHO, MoHs, others

  16. Country HighlightsEpidemiology Staff sent to Argentina (14), Chile (4), Mexico (36), South Africa (2), Australia (2) Kenya (1) Studies conducted or supported disease pyramids Mexico, Chile, Argentina, Australia Serologic studies Mexico, Chile, Peru Studies of severe disease and risk factors Argentina, Mexico, Thailand Household transmission and secondary attack rates Mexico, South Africa, Argentina, Kenya, Thailand Effectiveness and Economic impact of school closures Argentina Analysis of health care capacity Argentina

  17. Global Spread of Pandemic H1N1 2009 April-September Month of first reported H1N1 case April May June July August September

  18. Proportion of all influenza types that are 2009 H1N1

  19. What have we learned? • Stable virus overall • Little resistance to antivirals • Severity not worsening • Certain risk groups consistently more vulnerable (pregnant women, underlying disease) • Young and non-senior adults most affected with severe disease 6) Unusual seasonality

  20. US Vaccine Donation • 10% of US vaccine order will go to other countries • Other countries are also sharing vaccine • WHO is distributing • CDC is leading assessment of vaccine effectiveness and safety

  21. End

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