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2009 swine flu pandemic in the United States

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Main article: 2009 swine flu outbreak
Further information: 2009 swine flu outbreak by country

Template:WebSlice-begin

Cases by state
Last update: 30 April 2009 at 1:1 (UTC)
State Cases Deaths
Laboratory
confirmed 		Probable[1] Suspected‡ Confirmed
(unconfirmed)‡
(as of) Totals
April 27 28 - 200+ 0
April 28 68 - 255 0
Current 93 112+ 447+ 1
Texas 16[2][3] 14+[4] 6+[5] 1[2]
New York 51[2] 3+[6] 75[6] 0
California 14[2] 29[7] - 0[8]
Maine 3[9] - 12+[10][11] 0
Massachusetts 2[2] - 2[12] 0
Kansas 2[2] - 0 0
Indiana 1[2] 2[13] 0 0
Michigan 1[14] 1[15] 2[16] 0
Ohio 1[2] 1[17] 9[18][17] 0
Arizona 1[2] - 4[19] 0
Nevada 1[2] - 0 0
Arkansas 0 12[20] 0 0
South Carolina 0 10[21] 22[22] 0
Delaware 0 10[23] 0 0
Illinois 0 9[24] 0 0
Maryland 0 6[25] 0 0
New Jersey 0 7[26] 0 0
Oregon 0 0 14[27] 0
Connecticut 0 3[28] 5[27] 0
Iowa 0 2[29] 150[30] 0
Minnesota 0 1[31] 50+[32] 0
Colorado 0 2[33] 0 0
Nebraska 0 1[34] 6[35] 0
Pennsylvania 0 1[36] 0 0
Utah 0 1[37] 0 0
Alabama 0 0 31[38][39] 0
Florida 0 0[40] 21[41][42] 0
North Carolina 0 - 11[43] 0
Mississippi 0 - 10[44] 0
Tennessee 0 1[45] 10[46] 0
Missouri 0 1[47] 0 0
Idaho 0 - 4[48] 0
Wisconsin 0 - 3[49] 0
Oklahoma 0 - 1[50][51] 0
Rhode Island 0 0 1[52] 0
New Hampshire 0 - TBD[10][11] 0
‡ Not all cases have been confirmed to be due to this strain.
Some are cases of influenza-like illness (ILI) that have not been confirmed through testing to be due to this strain.

Template:WebSlice-end In March and April 2009, an outbreak of a new strain of influenza commonly known as swine flu infected many people in Mexico and parts of the United States, causing severe illness in the former. The new strain was identified as a combination of several different strains of Influenzavirus A, subtype H1N1, including separate strains of this subtype circulating in humans (see Human influenza) and in pigs (see Swine influenza). The strain transmits between humans and has been reported to have a relatively high mortality rate in Mexico. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have expressed serious concerns that the new strain has the potential to become an influenza pandemic.[53] It is reported that, because the virus is already widespread, containment will be impossible.[54] On April 26, 2009, a Sunday, numerous U.S. schools and school districts announced closures in response to the outbreak.[55] On April 28, 2009, the director of the Centers for Disease Control and Prevention confirmed the first official US death of swine flu. Tests confirmed that a 23-month old toddler from Mexico died from the flu while visiting Texas for medical treatment. [56] Also, on April 29, 2009, President Obama urged all U.S. schools to consider shutting down a future possibility if students are infected.[57][58][59]

Response

President Barack Obama discussing the swine flu outbreak during his address at the National Academy of Sciences on April 27.
Congruent U.S. Government and WHO Pandemic Response Charts.

An official for the White House said, "The White House is taking the situation seriously and monitoring for any new developments. The president has been fully briefed."[60] President Barack Obama stated that "We are closely monitoring the emerging cases of swine flu". He also noted, "This is obviously a cause for concern ... but it is not a cause for alarm".[61]

White House Press Secretary, Robert Gibbs said the effort to get a team in place to respond to the health scare has not been hindered by the lack of a secretary of Health and Human Services or appointees in any of the department’s 19 key posts.[62] The president's nominee, Kansas Gov. Kathleen Sebelius, was still awaiting confirmation from the U.S. Senate until passing on April,28th.[63] The President has not yet made appointments to either the Commissioner of the Food and Drug Administration, the Surgeon General, or the Director of the Centers for Disease Control and Prevention.[62][63] The current acting Surgeon General, Steven K. Galson, is also currently serving as the Acting Assistant Secretary for Health.[64]

The United States federal government has declared a public health emergency, and several U.S. states have indicated they may follow suit. Secretary of Homeland Security Janet Napolitano noted that this declaration was standard operating procedure, which was also done for the 2009 presidential inauguration and for flooding.[65][66]

The Federal response remains at US Pandemic Stage 0, congruent with the World Health Organization (WHO) Pandemic Phases 1, 2 and 3;[67][68] however, the WHO's Pandemic Phase was raised to 4 on April 27, which is congruent with US Pandemic Stage 2.[69] On April 29, the WHO raised the pandemic alert level to phase 5.[70]

Meanwhile, an April 28, 2009 CNN article stated, "There had been no confirmed deaths in the United States related to swine flu as of Tuesday afternoon. But another virus had killed thousands of people since January and is expected to keep killing hundreds of people every week for the rest of the year. That one? The regular flu... No fewer than 800 flu-related deaths were reported in any week between January 1 and April 18, the most recent week for which figures were available."[71]

In addition, the flu death toll in Mexico could be lower than first thought, said on 04/29/2009 Dr. Gregory Evans, head of the Association of Medical Microbiology and Infectious Disease Canada and a member of a federal pandemic-planning committee[72]:

There was a lot of speculation and what seemed to be evidence there were dozens and dozens of deaths. Careful analysis showed these people likely died of something else, and not flu. That's really good news, and that would fit with what we've seen outside of Mexico.

Moreover, another Canadian expert, Dr. Neil Rau, criticized the WHO's decision to raise its Pandemic alert to level 5, saying[73]:

I don't agree with (the WHO) because I think it's a panic metre, not a pandemic metre. [...] If that flu-like illness is not deadly, I don't know what the cause for alarm is for people who are not really sickened by this virus. [...] I'm really eager to know how much worse this is than seasonal flu. So far it's looking like it's not that serious.

Centers for Disease Control and Prevention (CDC)

Confirmed human cases with known dates of illness onset (USA, April 27, 2009).

In the United States, the majority of the 70 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories do not report the influenza A subtype. However, in 2007 human infection with a novel influenzavirus A became a nationally notifiable condition. Novel influenza A virus infections include all human infections with influenza A viruses that are different from currently circulating human influenza H1 and H3 viruses. These viruses include those that are subtyped as nonhuman in origin and those that are unsubtypable with standard methods and reagents.[74] The new strain responsible for this outbreak was one such virus.

The Centers for Disease Control and Prevention (CDC) identified the first two A/09(H1N1) swine flu cases in California on April 17, 2009 via the Border Infectious Disease Program, for the San Diego County child, and a naval research facility studying a special diagnostic test, where influenza sample from the child from Imperial County was tested.[75] By April 21, enhanced surveillance was established to search for additional cases in both California and Texas and the CDC determined that the virus strain was genetically similar to the previously known A(H1N1) swine flu circulating among pigs in the United States since about 1999. It was established that the virus was a combination of human, North American swine, and Eurasian swine influenza viruses; the viruses from the initial two Californian cases were also noted to be resistant to amantadine and rimantadine, two common influenza antiviral drugs.[76] No contact with pigs was found for any of the seven Californian nor either of the two Texas cases, suggesting human-to-human transmission of the virus.

At a press briefing on April 27, acting CDC director Dr. Richard Besser stated that out of 40 confirmed cases at that point, only one individual was hospitalized. He also revealed that the median age was 16 years "with a range in age of 7 to 54 years."[77]

Affected regions

As of UTC 21:19, April 29, 2009:
  Deaths confirmed
  Cases confirmed
  Cases unconfirmed (both suspected and probable cases)

California

CDC conference with the media on the swine flu outbreak on April 25, 2009

The first two cases detected in the US were two children living in San Diego County and Imperial County, who became ill on March 28 and 30.[78] A CDC alert concerning these two isolated cases was reported in the media on April 21.[79] As of April 24 eight human cases were known in the US, including six in Southern California. The patients have recovered.[80] The acting director of the US Centers for Disease Control (CDC) said that preliminary tests on seven out of fourteen samples from patients in Mexico had matched the virus found in the US, which experts say is a new strain of swine flu. None of the US patients had any contact with pigs, leading CDC officials to believe that human-to-human transmission has been occurring.[81]

Gov. Arnold Schwarzenegger and the state of California activated the Joint Emergency Operations Center of the Department of Public Health, and are coordinating with the California Emergency Management Agency, the CDC, and the Mexican government. They have additionally stepped up other preparations to lessen the flu's threat.[82] On April 28, Gov. Schwarzenegger declared a state of emergency which allows the state to deploy additional resources to the Department of Public Health and more quickly and easily purchase equipment and materials.[83]

St. Mels Catholic School in Fair Oaks was closed after Sacramento County Health Department notified the school that a 7th grade student who reportedly recently returned from a family vacation in Mexico tested positive for an unidentified strain of Influenzavirus A.[84] On April 27, CDC officials confirmed that the student tested positive for swine flu.[85] In Marin County, a grandmother and her 20-month-old granddaughter have been confirmed to have the flu.[86] By April 28, the CDC had confirmed 10 cases of swine flu in California.[2]

California State University, Long Beach reported on April 29 that a student had returned a "probable positive" test result for swine influenza. The student showed symptoms on Sunday April 26 and went to the campus health services office the following day. The test results were received by the school on April 28 and distributed to all students and faculty. The affected student had not attended any classes since falling ill and has an apparently mild case of the disease that does not appear life threatening. [87]

On April 29, 2009 in Southern California a desert high school was closed and will reopen on May 6, 2009. Indio High School, the school that has been affected, released their students midday due to the fact that one student had contracted the disease while in Mexico.

Kansas

On April 25, health officials in Kansas announced that two new cases of swine flu had been confirmed in Dickinson County, Kansas, after both were isolated. The week prior, one patient had traveled to Mexico by plane to attend a professional conference; both he and his wife experienced minor influenza symptoms.[88][89]

Michigan

On April 29, the the Michigan Joint Information Center confirmed that a 34-year-old woman from Livingston County, Michigan was Michigan's first reported case of swine flu.[14]

On April 28, health officials told the public not to panic while saying it is only a matter of time before more cases begin to emerge in Michigan.[90]

New England

On April 28, it was announced that there were four suspected cases of swine flu in three Connecticut towns. Two of those were students from East Haddam, leading to the closing of that school district that day.[91] Another case in Wethersfield was reported the next day.[27] In New Hampshire an undisclosed amount of people have been tested for swine flu and voluntarily quarantined themselves until it is determined if they have the strain.[10] And in Maine there are 3 confirmed cases [92] and at least 12 people currently being tested for the virus.[10][12] Two middle schoolers in Lowell, Massachusetts have been tested for swine flu on April 29, 2009. The two returned from a family trip from Mexico, and became mildly sick on returning home[12] A Rhode Island student may have swine flu. His family had recently returned from a Mexico vacation.

New York

On April 24, New York City Department of Health and Mental Hygiene dispatched a team of investigators to the private St. Francis Preparatory School in Queens after 150 students complained of symptoms consistent with the disease.[93] Several of the students had recently traveled to Mexico City.[94] New York City Health Commissioner Dr. Thomas Frieden reported on April 25 that eight of the New York school cases were "probable" swine flu. On April 26 in a 3:00 PM EDT advisory the Centers for Disease Control and Prevention (CDC) confirmed that the Queens cases are indeed associated with the H1N1 virus.[95][96] The students suffered only mild symptoms, and some have since recovered.[97] On April 27 federal officials confirmed 20 new U.S. cases at the same school in New York in which eight cases were confirmed earlier.[98] Representative Eric Massa (D-New York), a member of the House Homeland Security Committee, said "we need to close our borders to Mexico immediately and completely."[99] Two other suspected cases in the Albany suburbs have been reported.[100] The number has risen to 51 people infected with swine flu. There has been some rumors of swine flu at Penfield High School[citation needed].

Ohio

On April 26, the Ohio Department of Health reported that a nine-year-old boy attending Elyria City Schools in Elyria, Lorain County, had been diagnosed with a mild case of the new strain of swine influenza and that his immediate family was undergoing testing.[101] The Cleveland health department received numerous calls from concerned residents, though because the regular flu season is locally ongoing, doctors will likely have difficulty in differentiating between the swine flu and other strains.[102] After the confirmed case in Ohio and eight in New York occurred Federal officials declared a public health emergency. [103] On April 29, a case is reported probable in Columbus.[104]

Illinois

The state's first probable case of swine flu was reported on Wednesday, April 29. An elementary school in Chicago's Roger's Park neighborhood, on the city's Far North Side, was closed because a 12-year-old student was presumed to have the disease. The CDC is conducting laboratory tests to confirm, but the student reportedly was recovering at home.[105] In Batavia, Illinois, two students from Rotolo Middle School had a probable case of swine flu, causing the closing of the school.[106]

Indiana

On April 28, an unidentified Notre Dame student was confirmed as the first case of swine flu in this state. The patient had not recently traveled to Mexico or been in contact with anyone who has traveled to Mexico, and is "doing well" according to Judy Monroe, Indiana's state health commissioner. The student is currently in voluntary quarantine; Notre Dame has no other suspected cases at this time.[107]

Texas

Two students attending Byron P. Steele II High School in Cibolo were confirmed to have the A/H1N1 swine flu; the patients recovered.[80][81] A third possible case in a student who attends the same high school as the 2 other cases in Texas has been identified and the school is closed temporarily.[108] On April 25, the Texas Department of State Health Services (DSHS) decided to close Byron P. Steele II High School for the following week. Following the discovery of more possible swine flu illnesses, the DSHS ordered that all schools and district facilities in the Schertz-Cibolo-Universal City Independent School District be closed for the week.[109][110]

On April 27, a 7-year-old, a 24-year-old, and a 3-month-old in North Texas were confirmed to have swine flu. All three are recovering and were not hospitalized.[111] That same day, the Richardson Independent School District in the northern Dallas suburb of Richardson shut down an elementary school due to a confirmed and two suspected cases of swine flu.[112]

All schools in New Braunfels—private schools and all campuses of the Comal and New Braunfels Independent School Districts—have closed through May 10 on the recommendation of the Medical Authority of Comal County.[113] Due to the swine flu, the University Interscholastic League (UIL) has suspended all events in the state of Texas until May 11.[114]

On April 28, the City of Houston Health Department and Texas Children's Hospital sent samples in to the CDC. There are also possible cases at the Baylor College of Medicine outpatient clinic, Memorial Hermann Hospital, and St. Luke's Hospital.[115]

A 23-month-old Mexican toddler who had been brought to Houston from Brownsville died on April 28, making the child the first US death due to the outbreak.[116][117][118] The toddler had come to the U.S. for the purpose of receiving medical treatment.

Elsewhere

In South Carolina, the Department of Health and Environmental control looked into a group of individuals who have recently returned from a school trip to Mexico. Testing revealed that two were type A, unsubtypable, considered 'probable cases' and sent to the Centers for Disease Control and Prevention for further evaluation and testing.[119] Suspected cases are also under investigation in several other locations, including (but not limited to) Idaho,[48] Wisconsin,[49] North Carolina,[43] Alabama, Mississippi,[44] and New Jersey.[120] Test results for two suspected cases of swine flu in South Dakota came back negative.[121] The University of Nebraska Medical Center looked into suspicious specimens to determine if a Nebraska resident had the flu. However the test turned up negative,[122] but the Medical center is currently testing more than a dozen other specimens for the strain.[123][124][125] On April 28, it was reported that an individual in Florida had tested positive for influenza type A, of which swine flu is a subtype. A culture from that person has been sent to Jacksonville to be tested for swine flu, with results expected within 48 hours.[126] In Muskogee, Oklahoma a man who recently visited Mexico has been admitted into a hospital after having swine flu symptoms, test results will determine if he has the flu or not.[50][51][127] On April 29, health officials in Delaware reported that 4 students from the University of Delaware were exhibiting symptoms.[117] In Utah and Oregon, several samples collected by doctors around the state were being tested for swine flu as part of an active surveillance system. A probable case was found and has been forwarded to the CDC for confirmation.[128][129][26]

See also

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References

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  95. ^ Staff Writer (April 26, 2009). "U.S. declares swine flu public health emergency". MSNBC. Retrieved April 26, 2009.
  96. ^ "Human Swine Influenza Investigation". CDC. April 26, 2009. Retrieved April 26, 2009.
  97. ^ Staff Writer (April 26, 2006). "CDC: 8 New York students have swine flu". CNN. Retrieved April 26, 2009.
  98. ^ "73 cases of swine flu confirmed; hundreds more feared". CNN. April 27, 2009. Retrieved April 27, 2009.
  99. ^ "WENY-TV News - Local News". Weny.com. Retrieved April 26, 2009.
  100. ^ Staff Writer (April 28, 2009). "Region's first suspected cases of swine flu reported". Mid-Hudson News. Retrieved 2009-04-28.
  101. ^ "UPDATED: Ely School student has swine flu". Chronicle-Telegram. April 26, 2009. Retrieved April 26, 2009. {{cite web}}: Italic or bold markup not allowed in: |publisher= (help)
  102. ^ "Will swine flu hit Northeast Ohio? Health officials say it's too soon to say". Cleveland.com. April 26, 2009. Retrieved April 26, 2009.
  103. ^ Confirmed case in Ohio http://www.latimes.com/news/nationworld/nation/la-sci-swine-flu27-2009apr27,0,3534516.story?page=2
  104. ^ Columbus investigating probable swine flu case as threat level rises http://www.dispatch.com/live/content/local_news/stories/2009/04/29/flucase.html?sid=101
  105. ^ "1 Probable Case of Swine Flu Closes Rogers Park School". MSNBC.com. Retrieved 2009-04-29.
  106. ^ "1 Probable Case of Swine Flu Closes rotolo middle School". BPS101. Retrieved 2009-04-29.
  107. ^ "1 Sample in Indiana Confirmed for Swine Flu". Fox59.com. Retrieved 2009-04-28.
  108. ^ Texas Department of State Health Services (April 25, 2009). "School to Close, Other Flu Precautions Recommended" (PDF). Schertz-Cibolo-Universal City Independent School District. Retrieved April 25, 2009.
  109. ^ "Temporary Closure of All SCUCISD Campuses". Schertz-Cibolo-Universal City Independent School District. April 26, 2009. Retrieved April 26, 2009.
  110. ^ Ron Maloney (April 26, 2009). "Swine flu shuts down all of SCUCISD". Seguin Gazette-Enterprise. Retrieved April 26, 2009. {{cite web}}: Italic or bold markup not allowed in: |publisher= (help)
  111. ^ "3 additional swine flu cases confirmed in Texas". Houston Chronicle. Associated Press. April 27, 2009. Retrieved April 27, 2009.
  112. ^ Sherry Jacobson and Tawnell Hobbs (April 27, 2009). ""Richardson school shuts down; schools put on alert for swine flu"". Dallas Morning News. Retrieved April 28, 2009.
  113. ^ Patrick George (April 28, 2009). "New Braunfels, Comal ISD shut down due to swine flu fears". Austin American Statesman. Retrieved April 28, 2009.
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  115. ^ "Houston still waiting for word on city swine flu cases | Houston & Texas News | Chron.com - Houston Chronicle". Chron.com. Retrieved 2009-04-29.
  116. ^ CBS News, "Texas Toddler Is 1st U.S. Swine Flu Death", 29 April 2009
  117. ^ a b MBC, Inc. (2007-01-15). "First Swine Flu Death Confirmed in U.S. : WFMZ-TV 69News". Wfmz.com. Retrieved 2009-04-29.
  118. ^ "Sick child brought from Brownsville to Houston for treatment | Front page | Chron.com - Houston Chronicle". Chron.com. Retrieved 2009-04-29.
  119. ^ Ken Hawkins (April 28, 2009). "DHEC: Swine flu 'probable' in South Carolina school". TheDigitel. Retrieved April 28, 2009.
  120. ^ "NJ identifies 5 probable swine flu cases". Washington Post. Associated Press. April 27, 2009. Retrieved April 27, 2009.
  121. ^ "SD Suspect Cases Are Not Swine Flu". Keloland TV. April 27, 2009. Retrieved April 27, 2009.
  122. ^ "'Suspicious' Neb. Specimen Being Tested For Swine Flu". KETV. 1:17 pm CDT April 27, 2009. Retrieved April 28, 2009. {{cite news}}: Check date values in: |date= (help)
  123. ^ "UPDATE: UNMC Swine Flu Test Negative". KPTM. Retrieved 2009-04-28.
  124. ^ Timberly Ross and Nelson Lampe (April 27, 2009). "Neb. lab testing specimens for swine flu". Fremont Tribune. Retrieved 2009-04-28.
  125. ^ Staff Writer (April 27, 2009). "Neb. lab testing specimens for swine flu". Action 3 News. Retrieved 2009-04-28.
  126. ^ "Florida Hospital: No Swine Flu case". Myfoxorlando.com. Retrieved 2009-04-28.
  127. ^ "Probable swine flu closes Rogers Park school". Chicago BreakingNews Center. April 29, 2009. Retrieved 2009-04-29.
  128. ^ "Swine flu in Utah?". Deseret News. April 29, 2009. Retrieved 2009-04-29.
  129. ^ "Probable Case of Swine Flu in Utah, says Utah Dept. of Health". Fox 13 News. April 29, 2009. {{cite news}}: |access-date= requires |url= (help); Text "http://www.fox13now.com/news/kstu-probable-case-of-swine-flu-in-utah-says-utah,0,5234127.story" ignored (help)
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