Coconino County Health Department (CCHD) officials announced today the first case of H1N1 (swine) flu in Coconino County. The Arizona Department of Health Services Lab confirmed that a 24 year-old male from the Navajo Nation has tested positive for the illness. The man went to the Tuba City Regional Health Care Corporation Emergency Department with flu-like symptoms and was tested. He is now recovering from the illness.

As of May 20, the Arizona Department of Health Services (ADHS) reported 452 confirmed cases and three H1N1 (swine) flu related deaths in Arizona. There are no other confirmed H1N1 (swine) flu cases in Coconino County. 

The Coconino County Health Department is closely monitoring the H1N1 (swine) flu situation in coordination with the Navajo Nation Division of Health, Arizona Department for Health Services (ADHS) and the Centers for Disease Control and Prevention (CDC). The CCHD is also working with Coconino County schools to monitor absences and respiratory illness and to promote good health habits among students and staff members. 

There are things that everyone can do to help them stay healthy. The Coconino County Health Department and the Navajo Nation Division of Health recommend the following preventative measures: 

Read more….

As of 11 AM, May 25, CDC is reporting 6,764 confirmed and probable cases and 10 deaths in 48 states (including the District of Columbia). CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.

Summary of Situation

A New Influenza Virus

Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009. The virus is infecting people and is spreading from person-to-person, sparking a growing outbreak of illness in the United States. An increasing number of cases are being reported internationally as well.

It’s thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus.

It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses. Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks.

Novel influenza A (H1N1) activity is now being detected through CDC’s routine influenza surveillance systemsand reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories. The fact that novel H1N1 activity can now be monitored through seasonal surveillance systems is an indication that there are higher levels of influenza-like illness in the United States than is normal for this time of year. Most of the influenza viruses being detected now are novel H1N1 viruses.

Read more….

As a Dallas-based physician, there has been a recent flurry of panic about the H1N1 (swine influenza). School districts closed down. Intramural sports statewide were cancelled. Some even suggested closing the border with Mexico, where approximately three quarters of a million people routinely cross back and forth every day. The panic certainly was fueled by the media reports. Likewise, the media can serve to educate the public about health issues.

For that reason, I have created this column to respond to frequently asked questions about H1N1 and reassure the public that pork is safe and will continue to be safe to consume.

What is H1N1 (swine flu)?

H1N1 (previously referred to as “swine flu”) is a respiratory illness. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

Why was the H1N1 virus originally called “swine flu”?

This virus was originally referred to as “swine flu” because laboratory testing showed that some of the genes in this new virus were similar to influenza viruses that have occurred in pigs. But further study has shown that this H1N1 virus is very different from what normally circulates in North American pigs. In fact, this strain is unique and was not previously recognized in either people or pigs.

Read more….

As of 11 AM, May 22, CDC is reporting 6,552 confirmed and probable cases and 9 deaths in 48 states (including the District of Columbia). CDC continues to take aggressive action to respond to the outbreak. CDC’s response goals are to reduce the spread and severity of illness, and to provide information to help health care providers, public health officials and the public address the challenges posed by this new public health threat.

Read more….

(ChinaPost.com.tw) – Adults older than 52 may have been exposed to a virus that gives some protection against A(H1N1) flu, explaining why younger people account for the largest percentage of those hospitalized, a U.S. scientist said.

The virus that caused the 1918 Spanish flu pandemic circulated until a bird flu virus replaced it in a 1957 world outbreak, Daniel Jernigan, deputy director of the Centers for Disease Control and Prevention influenza division, told reporters today. Exposure to the earlier virus “may allow you to have some protection” to swine flu, Jernigan said.

Swine flu, called H1N1, has sickened more than 10,000 people in 41 countries, according to the World Health Organization. Researchers have been trying to explain why more than 60 percent of U.S. cases have been among those aged 5 to 25, Jernigan said. Swine flu also lands people younger than 50 in the hospital more often than seasonal flu.

“It’s one of the few good reasons to be over the age of 50,” Robert Belshe, director of St. Louis University’s vaccine center, said today in an interview. People born before 1957 were probably infected with a swine flu relative that left antibodies giving some natural immunity, he said.

The swift spread of swine flu in Japan has pushed WHO to consider declaring a pandemic, said Hitoshi Oshitani, former head of the agency’s Western Pacific region. WHO has confirmed 80 deaths and the U.S. counts 5,710 cases. Utah today reported the ninth U.S. death.

Read more….

The news today included a lot of information about H1N1 continuing to spread, but I am going to continue my critique of the initial response. Even if the spread continues, in the US we have settled down from the initial emergency response and are getting geared up for a longer term response, making this a good time to look at how things went.

The main thing I wanted to say about states also relates to HHS and CDC. Specifically, a hope that states that received and at least partially distributed SNS assets (which is the majority at this point) are granted an exception from the grant requirements that they run a pandemic-related exercise. Instead, they should be required to complete the same analysis and corrective action development program that is normally followed after an exercise to study and improve their performance in receiving and distributing the assets. After all, which is better – an exercise where everyone tries to act like its real, or an actual event?

Trust me on this, my day job is organizing and analyzing state and Federal emergency response exercises, no matter how hard you try the simple fact is there are too many artificialities in exercises for them to really feel like the real thing.

We have a majority of states that have had to implement at least segments of their public health emergency operations plans (EOPs) and either their pandemic- or SNS-specific plans. As I mentioned in my last post, this gives us a potentially unique opportunity to evaluate some of these pandemic plans based on an actual activation, but one that was brief enough that the resources weren’t stressed to the breaking point. Instead, the plans and departments were tested enough to find the holes, and now we have a chance to plug them.

Read more….

Continuing in the same line as the last two days, I want to talk about a few specific areas of the public health response. As I see it, there were three things that the public health community was primarily responsible for in this event. They are:

1. Crisis communication
2. Distribution of SNS and other medical assets
3. Surveillance (in this case I mean it very broadly to cover everything from initial detection to case confirmation

I will take each one in a little more depth below, especially the last.

1) Crisis communications: I’ve already said some of my thoughts on this topic, and Jimmy Jazz has an excellent post on it. In short, public health (at all levels, but especially the Feds from HHS and CDC) should have been the go-to people for messages about the outbreak, how serious it really was, and what actions people should take. Our media being what it is, things didn’t always work out that way. The Feds tried to stay in front of the story, with daily CDC calls, daily DHS, HHS press conferences, and other similar activities, but a lot of that was knocked down by a Vice President with a chronic case of leap-before-you-look.

2) Distribution of SNS: One of the biggest actions that HHS took was a deployment of 25% of the 66% of the flu items in the SNS to impacted states. Let me try and make that a little more clear – of the pandemic supplies in the SNS 66% was purchased by the federal government, and 33% was purchased by the states; as the H1N1 outbreak was ramping up, HHS made the decision to deploy 25% of the Federal portion (the 66%) to states without their having to request it. This is the medical equivalent of pre-positioning food/water stockpiles before a hurricane hits the Gulf Coast. It’s too early to get a good read on how much of that deployment was necessary, but even so it proved an invaluable test of the system itself. Now, instead of looking at the main SNS deployment numbers, which are “within 48 hours from the time a request is approved” and which are based on a single community or area needing assets, HHS can look at the time it actually took to activate a nationwide deployment. Additionally, states and locals have a chance to evaluate their Receipt, Staging, and Storage (RSS) plans and the rest of their distribution system.

3) Surveillance: As I said, I’m using this far more broadly that is probably legitimate, but there are a couple of related issues that I’d rather talk about together. On the one hand, we have what seems to be a failure of the US surveillance system to pick up the worrying cases in Mexico until after Canadian authorities. On the other, we have the time delay in getting specimens processed and confirmed as H1N1 by the CDC labs. (NOTE – this is based primarily on a daily brief I was receiving at work that included information on the attempts to get more testing kits out into the wild and the fact that there were jumps in cases whenever the labs got new kits – I don’t have a link to verify with.) Both of these point to problems with the lab system, and I am in no position to identify the best solution. One suggestion that is sure to surface is to pump more resources (read: money) into the CDC, NIH, or other arm of HHS to allow them to increase their capability. The flip side of that coin is to pump those same resources (read: even more money) out to the states to increase their capabilities. At least one private company is suggesting that, at least for early detection, their data-crawling program is the way to go.

Like I said, I don’t have the answer, but I’m willing to make some predictions: Over the next year there will be a lot of Federal money allocated to laboratory programs (either state, Federal, or both) to increase capacity; this increase will allow labs to add personnel, purchase fancy new equipment, and increase the use of programs like BioWatch, BioSense, etc (which have a fantastic track record); NONE of this funding will be added to the budget of the agency (HHS) but will all be emergency funding or some other kind of appropriation; in a year or two, when some new monster of the week rolls around the funding will go away and the labs will be left underfunded and will have to cut back to the levels of personnel, equipment, and systems they have now leaving us no better protected from the next outbreak.

My take-away from all of this? We really need to develop a sustainable model for improving our public health lab capabilities. This includes getting more funding to allow states and locals to hire more personnel and it also means getting those personnel to identify a data-sharing system that works and focus efforts on expanding it to where every public health lab in the country is using it. As for the other areas (communications, SNS), I think we need a full and thorough after action review (as I’ve pushed in other posts this week) to drill down to the core good/bad performances and identify the ways to make necessary improvements before this happens again.

Read more….