Influenza A (H1N1) News Update Archive


Report for May 7, 2009, 1215pm


NORTH CAROLINA
(Source: NC Division of Public Health, DHHS)

FYI – Effective Friday, May 8, 2009, NC DPH will return to a more normal 8-hour workday. Weekend activity will include shorter shifts covering epidemiology and surveillance.

Friday’s briefing (May 8) will be the last daily briefing, with only two briefings scheduled for the week of May 11-15 (Tuesday and Thursday). This schedule is expected to continue unless something dramatically changes.

The CDC today posted new guidance and documents (9) to assist clinicians. These can be found below or at http://www.cdc.gov.

Update:
496 specimens received by the State Laboratory, with 26 pending test results.
40, or 8% of specimens, have tested positive for some version of influenza virus:

  • 7 Novel Influenza A (H1N1)

  • 12 Seasonal A H1
  • 9 Seasonal A H3
  • 12 Influenza B*


*State Laboratory notes that not all specimens were tested for influenza B virus, so the number is artificially low.

At this time, there are “four viruses are present in the state, but influenza A (H1N1) is not prevalent.”

Confirmed: 7
2– Onslow County
4– Craven County
1– Carteret County (linked to Craven cluster)

Median age for confirmed cases is 27, with age range 6 to 40.

Probable: 0

Previous probable cases, 1-Wake and 1-Buncombe, have tested negative for influenza A (H1N1) virus.

For additional information and the latest updates, log onto the N.C. DHHS web site, http://www.ncdhhs.gov/
The NC Division of Public Health (NCDPH) has issued new guidance for physicians and clinicians treating suspected or probable cases of influenza A (H1N1).



Physicians are urged to regularly check http://www.ncmedsoc.org for future updates, with additional information available in the weekly Bulletin.

NATIONWIDE
(Source: CDC)

Confirmed: 986 cases in 41 states 2 deaths

Confirmed cases in states surrounding NC:
South Carolina: 17
Georgia: 3
Tennessee: 2
Virginia: 11

States with 25 or more cases:
Illinois: 204*
New York: 98
California: 106
Texas: 91
Arizona: 48
Massachusetts: 71
Delaware: 38
Wisconsin: 26

*Health officials say they do not yet know why Illinois has so many confirmed influenza A (H1N1) cases.

CDC Recommendations (posted: http://www.CDC.gov)

  • School closure is not advised for a suspected or confirmed case of novel influenza A (H1N1) and, in general, is not advised unless there is a magnitude of faculty or student absenteeism that interferes with the school’s ability to function.

  • Schools that were closed based on previous interim CDC guidance related to this outbreak may reopen.

  • Students, faculty or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or go into the community except to seek medical care for at least seven days even if symptoms resolve sooner.

  • Students, faculty and staff who are still sick seven days after they become ill should continue to stay home from school until at least 24 hours after symptoms have resolved.

  • Students, faculty and staff who appear to have an influenza-like illness at arrival or who become ill during the school day should be isolated promptly in a room separate from other students and sent home.

  • Parents and guardians should monitor their school-aged children, and faculty and staff should self-monitor every morning for symptoms of influenza-like illness.

  • Ill students should not attend alternative child care or congregate in settings other than school.

  • School administrators should communicate regularly with local public health officials to obtain guidance about reporting of influenza-like illnesses in the school.



INTERNATIONAL
(Source: WHO)

Confirmed: 2,099 cases in 23 countries

Largest concentration of cases (25 or more):
Mexico: 1,112 (42 deaths)
USA: 642 (2 deaths)
Canada: 201
Spain: 73
United Kingdom: 28


Report for May 6, 2009, 1:00pm


NORTH CAROLINA
(Source: NC Division of Public Health, DHHS)

467 specimens received by the State Laboratory, which is now testing for influenza A (H1N1) virus.

Confirmed:
7 total

  • 2– Onslow County

  • 4– Craven County
  • 1– Carteret County (linked to Craven cluster)


Median age for confirmed cases is 27, with age range 6 to 40.

Probable:

  • 1–Buncombe County, child, awaiting test results

  • 1–Wake County, N1H1 ruled out; tests underway for other viruses



For additional information and the latest updates, log onto the N.C. DHHS web site, http://www.ncdhhs.gov/

The NC Division of Public Health (NCDPH) has issued new guidance for physicians and clinicians treating suspected or probable cases of influenza A (H1N1). Documents include:



Physicians are urged to regularly check www.ncmedsoc.org for future updates, with additional information available in the weekly Bulletin.

NATIONWIDE
(Source: CDC)

Confirmed: 642 cases in 41 states

Confirmed cases in states surrounding NC:

  • South Carolina: 16

  • Georgia: 3
  • Tennessee: 2
  • Virginia: 3


States with 25 or more cases:

  • Illinois: 122

  • New York: 97
  • California: 67
  • Texas: 61
  • Arizona: 48
  • Massachusetts: 45
  • Delaware: 33



CDC Recommendations (posted: www.CDC.gov)

    School closure is not advised for a suspected or confirmed case of novel influenza A (H1N1) and, in general, is not advised unless there is a magnitude of faculty or student absenteeism that interferes with the school’s ability to function.

  • Schools that were closed based on previous interim CDC guidance related to this outbreak may reopen.

  • Students, faculty or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or go into the community except to seek medical care for at least seven days even if symptoms resolve sooner.

  • Students, faculty and staff who are still sick seven days after they become ill should continue to stay home from school until at least 24 hours after symptoms have resolved.

  • Students, faculty and staff who appear to have an influenza-like illness at arrival or who become ill during the school day should be isolated promptly in a room separate from other students and sent home.

  • Parents and guardians should monitor their school-aged children, and faculty and staff should self-monitor every morning for symptoms of influenza-like illness.

  • Ill students should not attend alternative child care or congregate in settings other than school.

  • School administrators should communicate regularly with local public health officials to obtain guidance about reporting of influenza-like illnesses in the school.



INTERNATIONAL
(Source: WHO)

Confirmed: 1,516 cases in 22 countries

Largest concentration of cases (50 or more):

  • Mexico: 822, 29 deaths

  • USA: 403, 2 deaths
  • Canada: 165
  • Spain: 57


WHO says “it is prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national (CDC) authorities. WHO advises no restriction of regular travel or closure of borders.”

Report for Tuesday, May 5, 2009, 9:15am


NORTH CAROLINA

State Health Director Jeffrey Engel, MD, announced Monday afternoon that state health officials have shifted from an individual to a community containment focus in tracking the influenza A (H1N1) virus.

The shift will include cases identified by physicians and clinics in the Sentinel Provider Network, which involves 70-80 sites statewide, cases involving people who are hospitalized with influenza-like symptoms, and cases involving high transmission risk, such as schools, daycares, long-term care facilities and hospitals. The decision to move from an individual to a community containment strategy was based on the large number of samples that tested negative for influenza A (H1N1) virus.

As of 3:00pm Monday, the State Laboratory had received 433 samples, with 382 testing negative, 40 pending and 3 determined to be unsatisfactory for conclusive results. During the Monday afternoon briefing, Dr. Engel said the state would no longer continue daily media briefings but is not abandoning surveillance but is placing emphasis at the local level in determining need and response.

Turnaround time for testing samples is expected to be faster, as reagents used to confirm the influenza A (H1N1) virus have arrived as the State Laboratory, allowing the state to do its own testing and eliminating the need to send samples to the CDC for further testing.

The state is awaiting results on 7 probable cases, including a cluster of five cases centered in Craven and Carteret counties. The cases include four adults and a child of one of the adults. One adult lives in Carteret and works with the other adults in Craven County. Dr. Engel said the child had attended Arthur Edwards Elementary School in Craven County on Friday while ill. That prompted officials to close the school for seven days, starting Monday. Dr. Engel said one of the adults recently traveled to New York City, where 73 cases have been confirmed, many involving students and young adults.

The remaining probable cases include the spouse of the adult in Onslow County who tested positive for the virus, and a Canadian traveler who briefly visited Wake County and returned to Canada. The CDC is running further tests on the Canadian traveler because the first sample was inconclusive.

Yesterday, the NC Division of Public Health (NCDPH) issued new guidance for physicians and clinicians treating suspected or probable cases of influenza A (H1N1). These documents are available at www.ncmedsoc.org, under the Influenza A (H1N1) Outbreak Updates at the top of the home page. You will also find updates on the Doctor-to-Doctor Blog, which is accessible on the home page, as well (see upper right-hand corner of screen).

Physicians are urged to review Testing and Treatment for Novel N1H1 Virus: Algorithm for Clinicians, which is among the three new documents. As show in the Algorithm, testing and treatment for Novel H1N1 Virus will be limited to patients who are hospitalized with fever at 100 degrees, respiratory symptom (may include cough, sore throat, etc.) and no alternate explanation for acute symptoms. More information is found in a second document, Novel N1H1 Influenza Virus Infection in North Carolina: Update for NC Clincians.

The third document, Home Respiratory Isolation for Novel H1N1 Influenza, is designed for physicians to give to patients who are directed to remain at home until the virus runs its course.

Physicians are urged to regularly check www.ncmedsoc.org for future updates, with additional information available in the weekly Bulletin.

NATIONWIDE (CDC)

As of Monday afternoon, the CDC reported a total of 286 confirmed cases of influenza A (H1N1) virus in 36 states. Only 1 death has been reported in the U.S. thus far, involving a toddler who had traveled to Texas from Mexico.

The CDC is recommending school closure for two weeks in those areas where and outbreak of the virus involves clusters.

INTERNATIONAL (WHO)
Tuesday morning, the World Health Organization (WHO) reported that 21 countries have officially reported 1,124 cases of influenza A(H1N1) infection.

Mexico reports 590 confirmed human cases of infection, including 25 deaths.

WHO says “it is prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national (CDC) authorities. WHO advises no restriction of regular travel or closure of borders.”


Report for Monday, May 4, 2009, 5:00pm



NORTH CAROLINA

State Health Director Jeffrey Engel, MD, announced Monday afternoon that state health officials will continue to monitor influenza cases identified through the Sentinel Provider Network. However, the state will alter its strategy by shifting from an individual to a community focus in tracking the influenza A (H1N1) virus.

The shift will include cases identified through the Sentinel Provider Network, which involves 70-80 providers statewide, cases involving people who are hospitalized with influenza-like symptoms, and cases involving high transmission risk, such as schools, daycares, long-term care facilities and hospitals.

The decision to move from an individual to a community containment strategy was based on the large number of samples that tested negative for influenza A (H1N1) virus.

As of 3:00pm Monday, the State Laboratory had received 433 samples, with 382 testing negative, 40 pending and 3 determined to be unsatisfactory for conclusive results.

The state is awaiting results on 7 probable cases, including a cluster of five cases centered in Craven and Carteret counties. One of four adults in the cluster lives in Carteret and works with the other adults in Craven County. The fifth case is a child of one of the adults .Dr. Engel said the child had attended Arthur Edwards Elementary School in Craven County on Friday while ill. That prompted officials to close the school for seven days, starting today. Dr. Engel revealed that the cases apparently began after one of the adults returned to Craven County after traveling to New York City. New York health officials have confirmed 73 cases, many involving students and young adults.

The remaining probable cases include the spouse of the adult in Onslow County who tested positive for the virus, and a Canadian traveler who briefly visited Wake County and returned to Canada. The CDC is running further tests on the Canadian traveler because the first sample was inconclusive.

Earlier today the NC Division of Public Health (NCDPH) issued new guidance for physicians and clinicians treating suspected or probable cases of influenza A (H1N1).

Physicians are urged to review Testing and Treatment for Novel N1H1 Virus: Algorithm for Clinicians, which is among the three new documents. As show in the Algorithm, testing and treatment for Novel H1N1 Virus will be limited to patients who are hospitalized with fever at 100 degrees, respiratory symptom (may include cough, sore throat, etc.) and no alternate explanation for acute symptoms. More information is found in a second document, Novel N1H1 Influenza Virus Infection in North Carolina: Update for NC Clincians.

The third document, Home Respiratory Isolation for Novel H1N1 Influenza, is designed for physicians to give to patients who are directed to remain at home until the virus runs its course.

Supplies of masks and antivirals were received over the weekend from the national stockpile and were redistributed to local receiving centers today. Testing kits also arrived allowing the State Laboratory to test for the influenza A (H1N1) virus and avoid having to send samples to the CDC laboratory in Atlanta.

Physicians are urged to regularly check www.ncmedsoc.org for future updates, with additional information available in the weekly Bulletin.

NATIONWIDE

(Source: CDC)
The CDC reported Monday that a total of 286 cases of influenza A (H1N1) virus in 36 states.
Only 1 death has been reported in the U.S. thus far.

The CDC is recommending school closure for two weeks in those areas where and outbreak of the virus involves clusters.

INTERNATIONAL
The World Health Organization reported Monday that the number of confirmed cases worldwide was 985 in 20 countries. The WHO alert level for the influenza A (H1N1) virus remains at Phase 5, which is defined as human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

Mexico reports 590 confirmed human cases of infection, including 25 deaths.

WHO earlier reported that the influenza A (H1N1) virus had been identified in a swine herd in Alberta, Canada. It is believed the pigs were exposed to the virus from a Canadian farm worker who recently returned from Mexico and exhibited symptoms of the virus. Further testing is underway. There is no risk of infection from the influenza A (H1N1) virus from consumption of well-cooked pork and pork products.

Report for Sunday, May 3, 2009, 4:30pm



NEW DEVELOPMENTS/NORTH CAROLINA

North Carolina has its first confirmed case of influenza A (H1N1)


During a Sunday afternoon briefing, Governor Beverly Perdue announced that the CDC in Atlanta had confirmed that a patient in Onslow County had tested positive for the virus.

State Health Director Jeffrey Engel, MD, said the spouse of the patient was among six probable cases that are now being tested at the CDC lab. Test results are expected Monday, and Dr. Engel said it is probable the spouse will also test positive, since that individual was exposed to the same virus. Both recently traveled to San Antonio, Texas where they stayed for about five days before returning to North Carolina. Both the confirmed case and the spouse are following CDC isolation guidelines at home. Dr. Engel said that quick action by local health department officials led him to believe that the virus had been contained in Onslow County.

Of the six probable samples being tested by the CDC:
4 from Craven County
1 from Onslow County
1 from Wake County

In the Wake County case, Dr. Engel revealed that the patient was a traveler from Canada who had restricted contact with people while in Wake, and that the CDC reported his test was inconclusive. It is being rerun at the CDC lab in Atlanta.

Dr. Engel said the four patients in Craven County all know one another and are in isolation as they await the result of their tests.

Since the state was made aware of the influenza A (H1N1) virus on Friday, April 24, 413 samples have been tested, with 320 negative and 65 pending results.

Asked about school closings, Dr. Engel said the CDC was reviewing its guidelines and was expected to announce any updates Sunday night.

Department of Health and Human Services Secretary Lanier Cansler said that health department employees had worked 1500 man hours, or about 200 man hours a day, since they became aware of the virus more than a week ago.

Governor Perdue urged North Carolina residents to take precautions by following CDC recommendations, including frequent washing of hands, covering the mouth and nose when sneezing or coughing, and staying home from school or work if feeling ill.

Ten trucks carrying supplies from the national stockpile arrived in Raleigh over the weekend, bringing supplies of masks, medicine and other items that are being used in response to the virus. Shipments to local receiving centers has begun and will continue over the next few days. Dr. Engel says up to three more trucks are expected with more supplies, as the state receives its 25% of its allotment from the federal stockpile. Presently, enough medicine is on hand to treat about one in every nine people in the state. Dr. Engel said earlier this week that supplies at pharmacies appeared to be adequate to meet the current demand. He said today that the response to the influenza A (H1N!) virus was going according to the state’s response plan.

State Veterinarian David Marshall, DVM, said the state is constantly monitoring its swine population, and that so far there have been no signs of the virus. The state is working with the US Department of Agriculture to isolate any cases that might be detected through the constant monitoring system that is in place.


NATIONWIDE

(Source: CDC)
The CDC reported Sunday afternoon a total of 266 cases of influenza A (H1N1) virus in 30 states, up from 161 confirmed cases in 21 states on Saturday. Most of the patients are older children and young adults, with 30 hospitalized. Only 1 death has been reported in the US since the virus was first reported.

Only 1 death has been reported in the U.S. thus far.

The CDC is recommending school closure for two weeks in those areas where and outbreak of the virus involves clusters of cases.

INTERNATIONAL
The World Health Organization reported Sunday that the number of confirmed cases worldwide was 898 in 18 countries. The WHO alert level for the influenza A (H1N1) virus remains at Phase 5, which is defined as human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

WHO also reported that the influenza A (H1N1) virus had been identified in a swine herd in Alberta, Canada. It is believed the pigs were exposed to the virus from a Canadian farm worker who recently returned from Mexico and exhibited symptoms of the virus. There is no risk of infection from the influenza A (H1N1) virus from consumption of well-cooked pork and pork products.

May 1 Update: Jeffrey Engel, MD, State Health Director




For weekend updates, visit the NCMS Blog: www.ncmedsoc.org/blog.

Report for Friday, May 1, 4:15pm


NEW DEVELOPMENTS/NORTH CAROLINA
At a briefing held at 4:00pm on Friday, State Health Director Jeffrey Engel, MD, reported that the state has received 334 samples, with 202 testing negative and 103 pending. Two probable samples of influenza A (H1N1) are being tested at the CDC lab in Atlanta. Dr. Engel says the state is awaiting word on whether tests confirm the samples are positive for the virus.

The two cases are located in Onslow and Wake counties. The Wake County case was a visitor to North Carolina. The Onslow County patient has been issued an isolation order for seven days after symptoms first appeared, or until the lab has ruled the patient negative for H1N1 flu. The family has been given instructions in ways to avoid spreading the illness to others, including proper hand washing techniques and medical care, and family members will be monitored for signs of illness.

Local health officials are working to determine who might have been exposed before the patients showed symptoms. Officials will be notifying anyone with whom there was close contact. People who have been in close contact with the patients will be advised to go home at the earliest sign of illness and to minimize contact in the community to the extent possible.

Dr. Engel says testing kits to allow the State Laboratory to confirm cases of influenza A (H1N1) have not yet arrived, but he expects those kits to be available by the weekend. This will eliminate the state having to send probable cases to the CDC lab in Atlanta, improving the time needed to confirm whether the sample is positive or not.

NATIONWIDE
(Source: CDC)

141 Confirmed cases in 19 states:

  • Arizona: 4

  • California: 13
  • Colorado: 2
  • Delaware: 4
  • Illinois: 3
  • Indiana: 3
  • Kansas: 2
  • Kentucky: 1
  • Massachusetts: 2
  • Michigan: 2
  • Minnesota: 1
  • Nebraska: 1
  • Nevada: 1
  • New Jersey: 5
  • New York: 50
  • Ohio: 1
  • South Carolina: 16
  • Texas: 28
  • Virginia: 2



Only 1 death has been reported in the U.S. thus far. 61% of the confirmed cases involve patients under 18 years of age. Only 30% of the confirmed cases have involved travel to Mexico. Nine of the patients have been hospitalized.

The CDC is recommending school closure for two weeks in those areas where and outbreak of the virus involves clusters of cases.

INTERNATIONAL
The World Health Organization reports that the number of confirmed cases worldwide is 365 in 13 countries. The WHO alert level for the influenza A (H1N1) virus remains at Phase 5, which is defined as human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

Report for Friday, May 1, 2009, 12:15pm


NEW DEVELOPMENTS

Two Probable Cases of H1N1 Flu Virus Identified in N.C.

State health officials are awaiting the results of tests by the CDC lab in Atlanta on two samples of suspected influenza A (H1N1). The probable cases were detected Thursday during lab tests on specimens sent to the State Laboratory of Public Health as part of the state’s efforts to defend against the new strain of flu. The CDC will test the samples to make a final confirmation that the cases are the H1N1 flu. The time for the CDC to complete these tests is averaging about two days.

The two cases are located in Onslow and Wake counties. The Wake County case was a visitor to North Carolina. The Onslow County patient has been issued an isolation order for seven days after symptoms first appeared, or until the lab has ruled the patient negative for H1N1 flu. The family has been given instructions in ways to avoid spreading the illness to others, including proper hand washing techniques and medical care, and family members will be monitored for signs of illness.

Local health officials are working to determine who might have been exposed before the patients showed symptoms. Officials will be notifying anyone with whom there was close contact. People who have been in close contact with the patients will be advised to go home at the earliest sign of illness and to minimize contact in the community to the extent possible.

In the meantime, the CDC reports the number of confirmed cases has expanded to 141 in 19 states.

NORTH CAROLINA
State Health Director Jeffrey Engel, MD, is scheduled to hold his next briefing at 4:00pm today. Yesterday, Dr Engel revealed that the State Lab has tested or is testing 235 samples. 100 of those samples tested negative, two were listed as probable and sent to the CDC, and results are pending for remaining samples.

Reagents that will allow the State Lab to confirm cases of influenza A (H1N1) arrived last night. This will eliminate the state having to send probable cases to the CDC lab in Atlanta, improving the time needed to confirm whether the sample is positive or not.

Dr. Engel said shipments from the national stockpile began arriving Thursday and will be redistributed to local receiving centers starting this weekend. Already stockpiled in the Triangle are 660,000 courses (10 doses to the course), with 80% Tamaflu and 20% Relenza (including Pediatric doses).

Dr. Engel said guidelines will be issued on supplies and medicines once the need is known.

NATIONWIDE

141 Confirmed cases:

  • Arizona 4

  • California 13
  • Colorado 2
  • Delaware 4
  • Illinois 3
  • Indiana 3
  • Kansas 2
  • Kentucky 1
  • Massachusetts 2
  • Michigan 2
  • Minnesota 1
  • Nebraska 1
  • Nevada 1
  • New Jersey 5
  • New York 50
  • Ohio 1
  • South Carolina 16
  • Texas 28
  • Virginia 2


Only 1 death has been reported in the U.S. thus far.

INTERNATIONAL
The World Health Organization reports that the number of confirmed cases worldwide is 331 in 11 countries. The WHO alert level for the influenza A (H1N1) virus remains at Phase 5, which is defined as human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

Report for Friday, May 1, 2009, 9:00am

New Developments:

Two Probable Cases of H1N1 Flu Virus Identified in N.C.
(From a news release issued by NC DHHS, April 30, 2009)

RALEIGH – State Health Director Jeffrey Engel yesterday reported that two probable cases of the H1N1 flu have been identified in North Carolina. Gov. Bev Perdue was notified Thursday morning and joined Dr. Engel in assuring that the state is working with the county health officials where the patients are located to provide any assistance they need in responding.

“I am in close contact with our state public health leaders,” said Gov. Perdue. “I want to assure the public that North Carolina is fully prepared to respond to any cases of the H1N1 flu virus. Public safety is North Carolina’s top priority.”

“I am very proud of the way North Carolinians have been responding to this outbreak,” Dr. Engel said. “It is natural that people are concerned, and everyone is keeping things in perspective and doing all the things they should to protect themselves. The best thing to do now is to continue the proper prevention practices — cover your mouth when you cough or sneeze, wash your hands often, avoid close contact with those who are sick and stay home if you are sick.”

The probable cases were detected Thursday during lab tests on specimens sent to the State Laboratory of Public Health as part of the state’s efforts to defend against the new strain of flu. The Centers for Disease Control and Prevention (CDC) will test the samples in Atlanta, Ga., to make a final confirmation that the cases are the H1N1 flu. The time for the CDC to complete these tests is averaging about two days.

The two cases are located in Onslow and Wake counties. The Wake County case was a visitor to North Carolina. Further information about the patients cannot be released at this time for privacy purposes.

The Onslow County patient has been issued an isolation order for seven days after symptoms first appeared, or until the lab has ruled the patient negative for H1N1 flu. The family has been given instructions in ways to avoid spreading the illness to others, including proper hand washing techniques and medical care, and family members will be monitored for signs of illness.

Local health officials are working to determine who might have been exposed before the patients showed symptoms. Officials will be notifying anyone with whom there was close contact. People who have been in close contact with the patients will be advised to go home at the earliest sign of illness and to minimize contact in the community to the extent possible.

North Carolina:
At his latest briefing (4:00pm Thursday), State Health Director Jeffrey Engel, MD, revealed that the State Lab has tested or is testing 235 samples, with 108 arriving today. Of the 235 samples, 100 have tested negative, but two are listed as probable cases and will be sent to the CDC lab for confirmation. Results are pending from the remaining samples.

Reagents that will allow the State Lab to confirm cases of influenza A (H1N1) arrived last evening. hat will eliminate the state having to send probable cases to the CDC lab in Atlanta for testing, thus speeding the process needed to confirm whether the sample is positive or not.

Dr. Engel said shipments from the national stockpile began arriving yesterday morning and will be redistributed to local receiving centers starting this weekend. Already stockpiled in the Triangle are 660,000 courses (10 doses to the course), with 80% Tamaflu and 20% Relenza (including Pediatric doses).

Dr. Engel said guidelines will be issued on supplies and medicines once the need is known.

Nationwide:

109 Confirmed cases:

  • Arizona: 1

  • California: 14
  • Indiana: 1
  • Kansas: 2
  • Massachusetts: 2
  • Michigan: 1
  • Nevada: 1
  • New York: 50
  • Ohio: 1
  • South Carolina: 10
  • Texas: 26



Only 1 death has been reported in the U.S. thus far.

International:
The World Health Organization reports that the number of confirmed cases worldwide is 257, with the number of countries rising to 13. On Wednesday, WHO upgraded its alert level for the influenza A (H1N1) virus to Phase 5, human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

FYI:
CDC Guidance for Professionals is available at http://www.cdc.gov/swineflu/guidance/.

For the most current information about the influenza A (H1N1) outbreak, visit the Centers for Disease Control and Prevention (CDC) website at: www.cdc.gov/swineflu. You will find consumer and provider fact sheets, current information, and steps you can take to protect yourself against infection. At the CDC site you will also be able to download a widgit that you can post to your own website to help your membership get the most current and accurate information.

Please observe:
When obtaining clinical specimens for suspected or confirmed H1N1 influenza, physicians and other personnel should wear a fit-tested disposable N95 respirator (mask), and use only Dacron or rayon swabs with plastic or metal shafts. Do not use calcium alginate topped or wooden shafted swabs, as they may contain substances that inactivate some viruses and/or inhibit amplification.
(Specimen Collection for Influenza Testing, NC DPH, DHHS, 4-27-09).

NC DPH is attempting to maintain updated guidance for clinicians, public health professionals, and the public on our website at www.ncpublichealth.com. The same documents are available through www.ncpanflu.gov. New guidance documents are being added and existing documents updated frequently

The NCMS will be updating this Website as new information arrives. We encourage physicians, PAs, and others to frequently check for updates and other information throughout the day.

Questions or comments may be directed to Mike Edwards, NCMS, 800-722-1350 or medwards@ncmedsoc.org.


Report for Thursday, April 30, 2009, 4:30pm



New Developments:
Two probable cases of influenza A (H1N1) in North Carolina. That’s the word this afternoon from State Health Director Jeffrey Engel, MD. Dr. Engel says the samples have been sent to the CDC lab in Atlanta, with results expected within the next two days. One case involves a resident of Onslow County, who recently traveled to Texas. The other involves a traveler in Wake County, who is not a resident of North Carolina. That patient is under an isolation order.

Public health officials today confirmed 10 cases of influenza A (H1N1) in South Carolina. These are the first confirmed cases of the virus in the Southeast.

Fort Worth, Texas, today became the first major city school district in the US to close schools as a precaution against the fast spreading influenza A (H1N1). The move affects 80,000 students in the nation’s 17th largest city, keeping them out of the classroom through May 11, 2009. Similar closings have affected 53,000 other pupils in smaller communities throughout Texas, as well as students in hundreds of other schools across the U.S.

(At the request of health officials, the NCMS will be using influenza A (H1N1) to identify the virus that was previously known as “swine flu.” This conforms to an announcement made by the World Health Organization today.)

North Carolina:
At his latest briefing (4:00pm today), State Health Director Jeffrey Engel, MD, revealed that the State Lab has tested or is testing 235 samples, with 108 arriving today. Of the 235 samples, 100 have tested negative, but two are listed as probable cases and will be sent to the CDC lab for confirmation. Results are pending from the remaining samples.

Reagents that will allow the State Lab to confirm cases of influenza A (H1N1) are expected today. That will eliminate the state having to send probable cases to the CDC lab in Atlanta for testing, thus speeding the process needed to confirm whether the sample is positive or not.

Dr. Engel said shipments from the national stockpile began arriving this morning and will be redistributed to local receiving centers starting this weekend. Already stockpiled in the Triangle are 660,000 courses (10 doses to the course), with 80% Tamaflu and 20% Relenza (including Pediatric doses).

Dr. Engel said guidelines will be issued on supplies and medicines once the need is known.

Nationwide:

109 Confirmed cases:

  • Arizona: 1

  • California: 14
  • Indiana: 1
  • Kansas: 2
  • Massachusetts: 2
  • Michigan: 1
  • Nevada: 1
  • New York: 50
  • Ohio: 1
  • South Carolina: 10
  • Texas: 26



International:
The World Health Organization today raised the number of confirmed cases to 257, with the number of countries rising to 13. Yesterday, WHO upgraded its alert level for the influenza A (H1N1) virus to Phase 5, human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

FYI:

CDC Guidance for Professionals is available at http://www.cdc.gov/swineflu/guidance/.

For the most current information about the influenza A (H1N1) outbreak, visit the Centers for Disease Control and Prevention (CDC) website at: www.cdc.gov/swineflu. You will find consumer and provider fact sheets, current information, and steps you can take to protect yourself against infection. At the CDC site you will also be able to download a widgit that you can post to your own website to help your membership get the most current and accurate information.

Please observe:
When obtaining clinical specimens for suspected or confirmed H1N1 influenza, physicians and other personnel should wear a fit-tested disposable N95 respirator (mask), and use only Dacron or rayon swabs with plastic or metal shafts. Do not use calcium alginate topped or wooden shafted swabs, as they may contain substances that inactivate some viruses and/or inhibit amplification.
(Specimen Collection for Influenza Testing, NC DPH, DHHS, 4-27-09).

NC DPH is attempting to maintain updated guidance for clinicians, public health professionals, and the public on our website at www.ncpublichealth.com. The same documents are available through www.ncpanflu.gov. New guidance documents are being added and existing documents updated frequently

The NCMS will be updating this Website as new information arrives. We encourage physicians, PAs, and others to frequently check for updates and other information throughout the day.

Questions or comments may be directed to Mike Edwards, NCMS, 800-722-1350 or medwards@ncmedsoc.org.

Report for Thursday, April 30, 2009, 12:30pm

New Developments:
Public health officials today confirmed 10 cases of swine flu in South Carolina. These are the first confirmed cases of the H1N1 influenza virus in the Southeast.

At the request of health officials, the NCMS will be using H1N1 to identify the influenza virus that was previously known as “swine flu.”

North Carolina:
State Health Director Jeffrey Engel, MD, reported yesterday afternoon that of 41 specimens sent to the State Laboratory, 20 tested negative, 4 tested positive for regular seasonal influenza, and 17 are pending results. A briefing to update the results and other information is scheduled for 4:00pm today.

Nationwide:

109 Confirmed cases:

  • Arizona: 1

  • California: 14
  • Indiana: 1
  • Kansas: 2
  • Massachusetts: 2
  • Michigan: 1
  • Nevada: 1
  • New York: 50
  • Ohio: 1
  • South Carolina: 10
  • Texas: 26



International:
Yesterday, the World Health Organization (WHO) upgraded its alert level for the H1N1 influenza epidemic to Phase 5, human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

WHO has confirmed at least 105 cases of H1N1 influenza in seven countries, including Germany, Spain, Britain, Scotland, Canada, New Zealand and Mexico, which is considered the epicenter of the H1N1 influenza outbreak, with more than 150 suspected deaths and at least 2,000 suspected cases.

FYI:

CDC Guidance for Professionals is available at http://www.cdc.gov/swineflu/guidance/.
For the most current information about the H1N1 influenza oubreak, visit the Centers for Disease Control and Prevention (CDC) website at: www.cdc.gov/swineflu. You will find consumer and provider fact sheets, current information, and steps you can take to protect yourself against infection. At the CDC site you will also be able to download a widgit that you can post to your own website to help your membership get the most current and accurate information.

NC DPH is attempting to maintain updated guidance for clinicians, public health professionals, and the public on our website at www.ncpublichealth.com. The same documents are available through www.ncpanflu.gov. New guidance documents are being added and existing documents updated frequently

The NCMS will be updating this Website as new information arrives. We encourage physicians, PAs, and others to frequently check for updates and other information throughout the day.

Questions or comments may be directed to Mike Edwards, NCMS, 800-722-1350 or medwards@ncmedsoc.org.

Report for Wednesday, April 29, 2009, 4:00pm



New Developments:
The World Health Organization (WHO) has upgraded the swine influenza epidemic to Phase 5, just one number shy of a full blown pandemic. Phase 5 is human-to-human contact and infection in at least two regions. Phase 6 is a true pandemic, with widespread human infection.

The Centers for Disease Control (CDC) this morning reported the first U.S. death associated with swine influenza , a 23-month old child in Texas. The New York Times reported that the child had traveled from Mexico to Brownsville, Texas and was later taken to Houston after becoming ill Monday night.

North Carolina:
State Health Director Jeffrey Engel, MD, reported at 4:00 this afternoon that of 41 specimens sent to the State Laboratory, 20 tested negative, 4 tested positive for regular seasonal influenza, and 17 are pending results.

Confirmation kits are expected to arrive tonight from the CDC, allowing the State Laboratory to have the ability to confirm any swine influenza cases, without having to send more samples to the CDC for confirmation. Dr. Engel said it was miraculous that we have the ability to test for a brand new virus on the state level within a week of its discovery. The state’s allotment of federal supplies of Tamiflu (antiviral), masks and other items also are expected to arrive tonight.

Nationwide:

91 Confirmed cases:

  • Arizona: 10

  • California: 14
  • Indiana: 1
  • Kansas: 2
  • Massachusetts: 2
  • Michigan: 2
  • Nevada: 1
  • New York: 51
  • Ohio: 1
  • Texas: 16


International:
WHO confirmed 105 cases of swine influenza in seven countries, including Germany, Spain, Britain, Scotland, Canada, New Zealand and Mexico, which is considered the epicenter of the swine influenza outbreak, with more than 150 suspected deaths and at least 2,000 suspected cases.

FYI:
For the most current information about swine flu, visit the Centers for Disease Control and Prevention (CDC) website at: www.cdc.gov/swineflu. You will find consumer and provider fact sheets, current information, and steps you can take to protect yourself against infection. At the CDC site you will also be able to download a widgit that you can post to your own website to help your membership get the most current and accurate information.

NC DPH is attempting to maintain updated guidance for clinicians, public health professionals, and the public on our website at www.ncpublichealth.com. The same documents are available through www.ncpanflu.gov. New guidance documents are being added and existing documents updated frequently

The NCMS will be updating this Website as new information arrives. We encourage physicians, PAs, and others to frequently check for updates and other information throughout the day.

Questions or comments may be directed to Mike Edwards, NCMS, 800-722-1350 or medwards@ncmedsoc.org.

Wednesday, April 29,2009, 12:00noon



New Developments:
The Centers for Disease Control (CDC) this morning reported the first U.S. death associated with swine influenza , a 23-month old child in Texas. The New York Times reported that the child had traveled from Mexico to Brownsville, Texas and was later taken to Houston after becoming ill Monday night.

North Carolina:
Zach Moore, MD, Respiratory Disease Epidemiologist for the NC Division of Public Health reported at noon today that there have been no confirmed cases of swine influenza in North Carolina. Fifteen tests done yesterday were all negative, with 50 new specimens from suspected cases now being tested at the State Laboratory. The results are expected tomorrow.

Wednesday, April 29, 2009,9:30am


New Developments:
The Centers for Disease Control (CDC) this morning reported the first U.S. death associated with swine influenza , a 23-month old child in Texas.

North Carolina:
State Health Director Jeffrey Engel, MD, released the following information during a briefing Tuesday afternoon (5:00pm):

  • State laboratory released results on 15 suspected cases; all were negative for any influenza virus. Included were two travelers, one of whom was isolated in Charlotte until test results were confirmed.

  • Buncombe County health officials revealed that they had two suspected cases, but test results will not available until today. Both cases involve patients who recently traveled out of state.


Nationwide:

  • 64 confirmed cases (85% not associated with travel; median age is 16, most of those in NY City)

  • NY: 45
    (Number involves students at St. Francis Prep in NY City, outbreak occurred last week. Late yesterday afternoon, two new possible outbreaks reported, one at a NYC public school (12 with fever), and 6 at a Catholic Parochial School in West Manhattan (6 with fever – tests pending)

  • California: 10
  • Texas: 6
  • Kansas: 2
  • Ohio: 1



International:

  • Spain and Scotland confirmed cases Tuesday.

  • Mexico has increased lab space to help speed testing of pending samples.


Dr. Engel said the CDC was discouraging stockpiling of antivirals at home or at businesses.

NC is still awaiting first delivery of antivirals from federal stockpile.

The NCMS will be updating this Website as new information arrives. We encourage physicians, PAs, and others to frequently check for updates and other information throughout the day.

Questions or comments may be directed to Mike Edwards, NCMS, 800-722-1350 or medwards@ncmedsoc.org.



Monday, April 27


The NCMS is working with the NC Division of Public Health in making available to physicians and their practices information concerning Swine Influenza A (H1N1).

The CDC and WHO have reported 40 confirmed cases of human infection with the novel swine influenza (H1N1) virus among US residents. No confirmed cases have yet been identified in North Carolina.



Physicians are urged to regularly check NCMS Online for future updates, with additional information available in the weekly Bulletin.

 
 

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