2010 Updates :

August 10, 2010 -- The World Health Organization declared H1N1 has run its course and they declared we are in the post-pandemic phase. Localized outbreaks as currently happening in New Zealand are expected and these situations will be monitored.

April 2010, H1N1 activity has slowed, with the exception of a increase in cases seen in the southeast US with more hospitalizations reported now than last fall when H1N1 was widespread in the US.  Officials are monitoring the situation and waiting to see if this is the beginning of a third wave of the pandemic virus.  The World Health Organization (WHO) is monitoring the situation in the southern hemisphere before declaring we are in the post peak pandemic phase.

In the United States, winter is the traditional time for seasonal influenza. Flu outbreaks can happen as early as October, however most of the time influenza activity peaks in January or later. In 2009, the flu season did not end, but continued with the outbreak and worldwide spread of  2009 H1N1. This new virus was first detected in Mexico and then in the United States, April 2009.  June 2009, the World Health Organization (WHO) declared 2009 H1N1 a pandemic and warned to expect a second wave of the virus, fall 2009. 

Seasonal influenza is a respiratory illness that can be transmitted from person to person.  Most people have some immunity to seasonal flu and typically seasonal flu vaccine is available for populations at risk and the general public.  Each year in the United States, more than 200,000 people are hospitalized due to seasonal flu an estimated 36,000 people die from flu-related complications.

Pandemic influenza is a global outbreak of disease that occurs when a new influenza A virus appears in the human population, causing serious human illness and spreading easily from person-to-person worldwide. Because people have little or no immunity protection from such a new virus, there can be high levels of illness, death, social disruption, and economic loss. There have been on average, three pandemics every 100 years and they can occur years apart or back-to back. The last major influenza pandemic occurred in 1918 (known as the Spanish Flu) and killed as many as 50 million people worldwide, including more than 500,000 in the United States.  This is not the only pandemic influenza to occurr in the US in the past 100 years.  For details of the 1957-1958 and 1968-1969 pandemics see  the Center for Infectious Diseases, Research & Policy (CIDRAP).

2009 H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people worldwide. This new virus was first diagnosed in people in the United States, April 2009. On June 11, 2009, the World Health Organization  signaled that a pandemic of 2009 H1N1 flu was occurring and elevated the Pandemic Alert to Phase 6.  This designation was a signal to the world to plan and prepare. 

August 2009, the 2009 H1N1 influenza virus is the predominate influenza virus in circulation worldwide. The epidemiology (study of factors affecting the health and illness of populations) of the disease caused by the 2009 H1N1 influenza virus currently circulating in the Southern Hemisphere is very similar to that seen in the United States earlier this year. According to CDC and WHO, the current virus circulating looks similar to A/California/07/2009 (the reference virus selected by WHO as a potential candidate for the new 2009 H1N1 vaccine).  

August 30, 2009  marked the beginning of the 2009-2010 influenza season as as of that date CDC began providing aggregate reports of all influenza and pneumonia-associated hospitalizations and deaths, including 2009 H1N1 and seasonal flu.  The official influenza season began October 4, 2009. 

December 10, 2009 the CDC released revised estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the US April through November 14 of this year.  The revised estimates indicate about 47 million people have had 2009 H1N1, there have been 213,000 hospitalizations and almost 10,000 deaths, about 1,000 in youth under the age of 18. For more information on how these estimates were derived see -- CDC flu estimates. 

2009 H1N1 vaccine shipment and distribution has begun in the United States, with first doses of vaccine being given to first responders, with priority high risk groups to follow.  As vaccine supply has increased,  vaccine distribution has expanded to all children over 6 months of age and under 24 years old.  It remains only those over 24 and under 64  with chronic health conditions should receive the vaccine.  To track supply and distribution for your state, check, CDC 2009 H1N1 Vaccine Supply page.

As H1N1 has spread, in recent weeks there has been concern about the growing number of cases and deaths in the Ukraine, which has led to speculation the virus may have mutated.   WHO released a good news statement that in fact preliminary tests indicate there have been no significant changes in the virus.  Mutations to the virus have been detected in other countries including most recently Norway.  WHO reports scientists are tracking the changes and thus far there is no indication the virus has become more virulent. 

There has also been recent reports on identification of H1N1 anti-viral resistant clusters in the UK and US.  CIDRAP reports in both instances the patients were severely ill added to the mutation ability of influenza viruses, this finding did not surprise the medical professionals, but surveillance continues on this front. 

The Centers for Disease Control recommends the following to help reduce the spread of seasonal or pandemic influenza:

• Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.   Remain at home for 7 days after your symptoms begin or until you have been symptom-free (no fever) for 24 hours, whichever is longer
• Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
• Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
• Clean your hands. Washing your hands often will help protect you from germs.
  Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
• Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

The United States Department of Health and Human Services has an excellent series of webcasts,  Know What to do About the Flu with information for parents, care givers, employers, schools and other community organizations and groups. 

The US Department of Health and Human Services released a 2009 H1N1 self-flu evaluator to help individuals determine their flu status.  CDC has published guidelines for self-care or care for a family member with 2009 H1N1 as well as information when to seek emergency medical treatment. 

Pandemic Influenza  2009 H1N1, as any disaster has the potential to create a myriad of mental health issues for children, adults and first responders.  Fear and anxiety about the disease, caring for sick children or family members, death of a loved one or friend, loss of wages, no health insurance are just a few examples of what may lead to disaster mental health issues.  Many communities have as part of their disaster preparedness plan have trained first responders in disaster mental health counseling, thus check in your area.  CDC has some excellent resources to help individuals and families cope with a disaster:

Coping with Disaster or Traumatic Event

As well there is an excellent EDEN Topic page -- Children and Disasters

Novel 2009 and Pets

In addition, all types of birds and several non-ruminant mammals (dogs, ferrets, pigs, and horses) are susceptible to influenza viruses.  Cases of 2009 H1N1 influenza virus infection “spilling over” into these animals may occur if they come into close contact with an H1N1-infected human. On October 9, 2009, an USDA laboratory confirmed 2009 H1N1 infection in a ferret. The ferret's owner had previously been ill.  November 4, 2009  another case of 2009 H1N1 was confirmed in a pet ferret in Nebraska.  Also reported the same day by the Iowa State Department of Health was a confirmed case of 2009 H1N1 in a domestic (indoor) cat.  In both of these cases the owners has been ill.  Reports continue of cats, dogs, pet birds, and ferrets becoming ill after exposure to owners infected with H1N1.

The best advice is to always follow common sense guidelines when dealing with animals (eg, washing your hands). In addition, it's more important than ever that pet owners keep a good eye on their pet's health and consult a veterinarian if their pet is showing any signs of illness. Keeping your pets healthy reduces their risk of becoming ill. Companion animals including , pot-bellied pigs, and birds should be monitored closely for signs of flu-like illness. Just like in people, treatment by your veterinarian will include efforts to treat the symptoms and/or prevent secondary bacterial pneumonia. It is unknown at this time whether an infected pet will harbor enough virus to spread the infection to a cage mate or uninfected humans.  See the American Veterinary Association FAQs for more information or the CDC 2009 H1N1 and companion animals.

As we have seen, pandemic influenza is not a local, state or regional disaster. For this reason, communities, states and nations will stand alone to respond and recover. August 2009, Secretary of Health and Human Services Kathleen Sebelius  warned that in anticipation of the second and third waves of 2009 H1N1, preparedness starts with individuals and families.  Pandemic influenza is not a short duration disaster such as a tornado or  hurricane. The scope, duration and likely disruption of commerce and daily life as we know it, demands individuals and communities be prepared to take care of themselves for two to six weeks.  While a 72-hour kit emergency kit may work well for some disasters it likely will not be sufficient for pandemic influenza. There are many excellent resources to help individuals, families, schools, businesses, child care facilities, and faith-based/volunteer and community organizations plan and prepare for pandemic influenza.  Please refer to the following resources: 

• United States Department of Health and Human Services and  CDC
  Information for K-12 schools, colleges and universities, child care facilities, business/employers and faith-based/volunteer organizations
  
• United States Department of Homeland Security -- Ready America 
  Get a kit, Make a Plan, Be Informed and Get Involved (4 steps to prepare)
  
• EDEN online learning opportunities:
• Pandemic Preparedness for Business 
• Pandemic Preparedness for Faith-Based Organizations

Individual and family planning and preparation is essential in any community for two reasons: 1) first responders must be ready at home to be able to respond in the community, and 2) the better prepared citizens are in a community the less stress on responders and demand for limited resources.  However, for many, the task of making a pandemic plan is overwhelming, but that need not be the case.  There are four steps for being prepared:

1.  Get a Kit. This means putting together food, water, medicine and supplies for yourself and your family for a period of two weeks, though for pandemic planning purposes, six weeks would be better. The biggest challenge for many is determining how much food and water is needed for two weeks or longer.  Breadykit Wizard is an online resource to help you build your kit based on the size of your family and the age of your family members.  The kit will also determine pet supplies needed. Breadykit Wizard will develop a purchase plan to help you build your kit over time.

2.  Make a Plan. Every individual and family needs a communication plan for a disaster, pandemic or otherwise, and  Ready America, Make a Plan is an easy-to-use online resource for developing a communication plan.  A communication plan must have contact information for all family members, including school, child care facilities, and medical information for each family member. Individuals and families must have a plan for sheltering in place or evacuating.

3.  Be Informed.  Individuals and families must be aware of the types of disasters, natural and man-made, likely to occur in their area and plan accordingly.  For instance, while flooding or wildfires may require evacuation, blizzards and pandemic influenza will require sheltering in place.  To learn more about disasters for your area go to Ready America - Be Informed.

4.  Get Involved. Don't delay, learn today what your community has done or is doing to plan and prepare for pandemic influenza.  The U.S. pandemic influenza plan and individual state plans may be found at Pandemic.gov.

EDEN Institution Pages On Pandemic Preparedness

• New Mexico State University
  
• North Carolina State University DIsaster Information Center
  
• South Dakota State University
  
• Texas A&M University EDEN
  
• Utah State University  

The severity and extent of the second wave of 2009 H1N1 in the United States and the world cannot be fully predicted. In Mexico, during the first wave, daily life and business was disrupted and in  the United States schools were closed for up to three weeks. Here is what we have seen thus far and may expect with the second and subsequent waves of 2009 H1N1:

1. Rapid spread. The virus spread worldwide from the initial outbreaks in Mexico and the United States, to Europe and Asia to the southern hemisphere and now back to the northern hemisphere.  Countries may close borders and/or restrict travel but these efforts may only delay not stop the spread of the virus.
   
2. Health care system overload. Most people have little or no immunity to novel a pandemic virus, as we have seen with 2009 H1N1.  Many people have become ill and required some form of medical care. In the second wave, many countries will not have the staff, facilities, equipment, and hospital beds needed to cope with large numbers of people who suddenly fall ill, as was seen in Mexico.  In some parts of the United States medical surge capacity is being exceeded, which is one of the reasons President Obama declared 2009 H1N1 a national emergency.  This declaration should allow for more rapid treatment and expanded treatment facilities with less paperwork.  The death rate from pandemic influenza is determined by four factors: (1) the number of people who become infected, (2) the virulence of the virus, (3) the underlying characteristics and vulnerability of affected populations and (4) the effectiveness of preventive measures. Thus far, epidemiological data indicate pregnant women, children/young adults, severely obese and immune compromised are the at risk populations for novel H1N1. 
   
3. Medical supplies will not be adequate. The initial demand for vaccine is exceeding supply.  Worldwide, there may be a shortage of antiviral medications, though the United States, in preparing for pandemic influenza, has been stockpiling antiviral for several years. 
   
4. Economic and social disruption.  As seen in Mexico, pandemic influenza can cause economic and social disruption due to travel bans, closings of schools and businesses, and cancellations of events. Tourism, entertainment, restaurants, and sporting events will suffer severe economic loss. It is estimated, 30-40% illness with the second wave and thus this rate of illness combined with caring for sick family members and fear of exposure to the virus may result in significant worker absenteeism and possibly loss of a business and/or employment.  August 2009, the federal government released leave guidelines for employers in anticipation of the second wave of 2009 H1N1.