CDC Now Reports Lab-Confirmed Swine Flu Cases in 10 States
Agency's Web Site Has Guidance Documents for Docs
By News Staff
The CDC said April 29 that the number of laboratory-confirmed cases of swine-origin influenza A (H1N1) virus infection had climbed to 91 people in 10 states, up from 64 cases in five states a day earlier.
Meanwhile, the first swine flu-related death in the United States was reported April 29 by the Texas Department of State Health Services. The state agency said a 22-month-old boy from Mexico City died earlier in the week at a Houston-area hospital after traveling April 4 to visit relatives in Brownsville, Texas.
State health officials said none of the boy's known close contacts has become ill with influenza-like symptoms.
State health officials said none of the boy's known close contacts has become ill with influenza-like symptoms.
WHO Raises Pandemic Threat Alert Level
Shortly after this story posted, World Health Organization, or WHO, Secretary-General Margaret Chan, M.D., announced that WHO had raised the global influenza pandemic alert level from phase 4 to phase 5.
According to the WHO classification system, "Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."
According to the WHO classification system, "Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."
The CDC said it is investigating other reports of critically ill patients, but it did not offer a number of known hospitalizations. However, the agency said it is beginning to see a pattern of more severe illness among U.S. cases. Additional cases, hospitalizations and deaths are likely, according to the CDC.
As of April 29, states with confirmed cases of swine-origin influenza A (H1N1) viral infection are Arizona (1), California (14), Indiana (1), Kansas (2), Massachusetts (2), Michigan (2), Nevada (1), New York (51), Ohio (1) and Texas (16). All of New York's confirmed cases are in New York City.
As of April 29, states with confirmed cases of swine-origin influenza A (H1N1) viral infection are Arizona (1), California (14), Indiana (1), Kansas (2), Massachusetts (2), Michigan (2), Nevada (1), New York (51), Ohio (1) and Texas (16). All of New York's confirmed cases are in New York City.
Emergency Guidance
CDC officials said the list of states and the number of confirmed cases will be updated daily at 11 a.m. EDT on its Web page dedicated to the outbreak. The CDC also encouraged physicians to visit its clinical guidance Web page, which is expected to be updated regularly, as well.
The agency has issued guidance on the use of antiviral medications for patients with confirmed, probable or suspected swine influenza A (H1N1) virus infection and their close contacts. The CDC also posted a Morbidity and Mortality Weekly Report Dispatch on April 28 that details the susceptibility of the virus to various antiviral medications.
Antiviral drugs work best when treatment begins within two days of symptom onset, said CDC officials, but treatment with antiviral drugs still should be considered after 48 hours of onset, particularly for hospitalized patients or people at high risk for influenza-related complications.
On April 27, the FDA issued Emergency Use Authorizations to address off-label use of antiviral medications. The FDA action allows physicians to use oseltamivir to treat influenza in children younger than 1 year of age and as prophylaxis in children ages 3 months to 1 year.
Accordingly, the CDC has issued a guidance document for physicians caring for children with confirmed or suspected swine-origin influenza A (H1N1) virus infection.
The FDA's emergency authorizations also allow the CDC to distribute real-time reverse transcriptase polymerase chain reaction, or rRT-PCR, Swine Flu Panel diagnostic tests to public health laboratories and other qualified labs that have the needed equipment and personnel trained to perform and interpret the results.
The agency has issued guidance on the use of antiviral medications for patients with confirmed, probable or suspected swine influenza A (H1N1) virus infection and their close contacts. The CDC also posted a Morbidity and Mortality Weekly Report Dispatch on April 28 that details the susceptibility of the virus to various antiviral medications.
Antiviral drugs work best when treatment begins within two days of symptom onset, said CDC officials, but treatment with antiviral drugs still should be considered after 48 hours of onset, particularly for hospitalized patients or people at high risk for influenza-related complications.
On April 27, the FDA issued Emergency Use Authorizations to address off-label use of antiviral medications. The FDA action allows physicians to use oseltamivir to treat influenza in children younger than 1 year of age and as prophylaxis in children ages 3 months to 1 year.
Accordingly, the CDC has issued a guidance document for physicians caring for children with confirmed or suspected swine-origin influenza A (H1N1) virus infection.
The FDA's emergency authorizations also allow the CDC to distribute real-time reverse transcriptase polymerase chain reaction, or rRT-PCR, Swine Flu Panel diagnostic tests to public health laboratories and other qualified labs that have the needed equipment and personnel trained to perform and interpret the results.
Testing Recommendations Updated
Earlier this week, the CDC had advised clinicians to consider swine flu infection in the differential diagnosis of patients with acute febrile respiratory illness who have had close contact with people with confirmed swine flu or who traveled to Mexico or one of the 10 states with one or more confirmed swine flu cases during the seven days preceding onset of their illness.
However, based on the rapid spread of the virus, the agency broadened its testing recommendations on April 29. CDC officials now say that even in regions with few or no reported cases of swine-origin influenza, physicians should consider testing the following individuals:
However, based on the rapid spread of the virus, the agency broadened its testing recommendations on April 29. CDC officials now say that even in regions with few or no reported cases of swine-origin influenza, physicians should consider testing the following individuals:
- patients who present to providers participating in the U.S. Outpatient Influenza-like Illness Surveillance Network and who meet the case definition of influenza-like illness,
- patients with an influenza-like illness who have traveled within seven days to a community in the United States or internationally where there are one or more confirmed swine influenza A (H1N1) cases, and
- patients admitted to the hospital with an influenza-like illness.
If swine flu is suspected, clinicians should obtain a respiratory swab for testing, refrigerate it, and promptly contact their state or local health departments to facilitate transport and timely diagnosis at a state public health laboratory. The CDC has issued specific guidance on specimen collection and processing.
Treatment, Other Guidance Available
The CDC also has issued a guidance document for physicians caring for patients with suspected or confirmed swine-origin influenza A (H1N1). The guidance includes information about transmission, incubation period, testing, reporting, groups at high risk for complications, treatment and infection control.
In addition, the CDC Web site provides specific swine flu case definition information, as well as information to help clinicians optimize infection control practices in their practices and advise patients and community leaders about nonpharmaceutical measures that can help reduce virus transmission and associated morbidity and mortality.
In addition, the CDC Web site provides specific swine flu case definition information, as well as information to help clinicians optimize infection control practices in their practices and advise patients and community leaders about nonpharmaceutical measures that can help reduce virus transmission and associated morbidity and mortality.
Related ANN Coverage
CDC Issues Swine Flu Guidance After 40 Cases Confirmed in Five States
Physicians Asked to Collect Samples for Testing
More From AAFP
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Special American Family Physician Editorial: "Basic Rules of Influenza: How to Combat the H1N1 Influenza (Swine Flu) Virus" (published ahead of print on May 5, 2009)
Special AFP Editorial: "Telephone Triage of Patients with Influenza" (published ahead of print on May 5, 2009)
CDC Issues Swine Flu Guidance After 40 Cases Confirmed in Five States
Physicians Asked to Collect Samples for Testing
More From AAFP
H1N1 Flu
Special American Family Physician Editorial: "Basic Rules of Influenza: How to Combat the H1N1 Influenza (Swine Flu) Virus" (published ahead of print on May 5, 2009)
Special AFP Editorial: "Telephone Triage of Patients with Influenza" (published ahead of print on May 5, 2009)
