H1N1 Pandemic US Situation Update and CDC International Response

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H1N1 PandemicUS Situation 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
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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
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Epidemiology/SurveillanceWeekly Influenza
Activity Reported by SLTTs
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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
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Epidemiology/SurveillanceCumulative rate of
hospitalization/ 100,000 populationages 0-4,
EIP, 2003-2009
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Epidemiology/SurveillanceCumulative rate of
hospitalization/ 100,000 populationages 5-17,
EIP, 2003-2009
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Epidemiology/SurveillanceCumulative rate of
hospitalization/ 100,000 populationages 18-64,
EIP, 2005-2009
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Epidemiology/SurveillanceCumulative rate of
hospitalization/ 100,000 populationages 65,
EIP, 2005-2009
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Epidemiology/Surveillance Weekly Lab-Confirmed
Deaths (n411)Influenza Week 41 23 OCT 2009
Deaths (n)
Reporting Period End Date
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Epidemiology/SurveillanceLab-Confirmed Deaths by
Age Group through Week 41 (n411) Influenza
Week 41 23 OCT 2009
Deaths (n)
Age Group
Numbers are cumulative from start of MMWR week
35 (August 30, 2009)
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Epidemiology/SurveillanceLab-Confirmed Mortality
per 100,000 Population by Age Group (n411)
Influenza Week 41 23 OCT 2009
Deaths per 100,000 Population
Age Group
Deaths with unknown ages are not included (n0).
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/fi
les/NC-EST2007-ALLDATA-R-File24.csv
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International response
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Objectives

• Better understand pandemic influenza
• Support countries in preventing and mitigating

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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?

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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

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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

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Global Spread of Pandemic H1N1 2009
April-September

Month of first reported H1N1 case
April
May
June
July
August
September
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Proportion of all influenza types that are 2009
H1N1
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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

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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

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End