NEW: questions and answers: 2009 H1N1 and pregnancy

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Questions & Answers

This website is archived for historical purposes and is no longer being maintained or updated. For updated information on the 2010-2011 flu season, see the CDC Seasonal Flu website.

April 21, 2010 10:30 AM ET

This document provides updated information on pregnancy as a risk factor for serious 2009 H1N1-related complications based on findings from a recent study. 

Yes. Pregnant women were shown to be at increased risk for severe complications from influenza in previous pandemics, during seasonal influenza outbreaks, and from early data on 2009 H1N1. A study conducted during the first month of the outbreak found that the rate of hospitalizations for 2009 H1N1 was four times higher in pregnant women than the rest of the population. Compared with people in the general population, pregnant women with 2009 H1N1 flu are more likely to be hospitalized or die.

In order for a pregnant woman to adapt to carrying a fetus that is genetically different from her, her immune system must undergo changes.  Those changes make women more likely to be severely affected with some infections, including influenza.  Changes in women’s cardiac and respiratory systems also play a role.

Researchers analyzed surveillance data of 2009 H1N1 in pregnant women reported to CDC with symptom onset from April to August 2009, including data on maternal characteristics, underlying illness, severity of illness, and maternal outcomes related to timing of antiviral treatment, to further describe the effects of 2009 H1N1 on pregnant women in the United States.

Data from this study are consistent with previous studies from the United States  and other countries  that show pregnant women are at increased risk for serious illness and death associated with 2009 H1N1 infection.

Although pregnant women account for approximately 1% of the U.S. population, this group accounted for 5% of U.S. deaths from 2009 H1N1 reported to CDC from April 14 – August 21, 2009.

Data were updated with information on women admitted to an intensive care unit (ICU) or women who died with symptom onset through December 31, 2009.  During the entire time period (from April through December 2009), CDC received reports of 280 pregnant women with 2009 H1N1 who were admitted to ICUs, 56 of whom died.

A high rate of preterm birth (30%) was reported among women who had been infected with 2009 H1N1 influenza, although data on infant outcomes were incomplete. These data are consistent with data suggesting a high rate of preterm delivery during previous pandemics.  The usual rate of preterm birth in the United States is ~ 13%.

A higher proportion of ICU admissions and deaths occur in the second and especially third trimester, although pregnant women in all three trimesters are at increased risk of influenza-associated complications. 

Based on reports to CDC from state and local health departments, 280 pregnant women with 2009 H1N1 influenza with symptom onset between April and December 2009 were admitted to an intensive care unit – of these, 56 women died. 

Delayed treatment with antiviral medications was associated with more severe illness and death, consistent with previous data on seasonal influenza and 2009 H1N1, where early treatment has been associated with reduced illness duration, symptom severity, death, secondary complications, hospitalizations, and need for antibiotics.

Receipt of early (within 2 days from symptom onset) and intermediate (3-4 days from symptom onset) treatment with antiviral medications among pregnant women was associated with less severe disease, fewer admissions to an ICU and fewer deaths. Pregnant women with intermediate treatment were nearly 10 times more likely to die than those treated early (5% compared to 0.5%) and those treated late were much more likely to die (27% compared to 0.5%) than those treated early.  Data on timing of antiviral treatment were available for pregnant women with symptom onset before August 21, 2009 – during that time, 30 pregnant women died and only one of those had been treated with an antiviral medication within 2 days of symptom onset. 

Underlying conditions were common among hospitalized pregnant women (55%), women admitted to ICU (63%), and deaths (78%). The most common underlying condition was asthma, seen in 23% of hospitalized patients, 26% of ICU admissions and 44% of deaths.  Obesity was the second most common underlying condition (13%), followed by pregestational or gestational diabetes (7%), anemia (3%), and hypertension (3%).

Demographic and clinical characteristics of pregnant women with severe outcomes (hospitalization, ICU admission and maternal deaths) were assessed, but associations were unable to be determined due to reporting bias.

Hispanic was the most commonly reported racial-ethnic group, (33%), followed by non-Hispanic white (23%), non-Hispanic black (19%), and Asian/Pacific Islander (6%).  However, this racial-ethnic breakdown was similar to the racial/ethnic distribution of live births forthe states that reported the most cases.

Maternal age ranged from 14–43 years, with a median of 25 years among all reported women, and was similar among deaths.

Getting a flu vaccine against 2009 H1N1 is the most important action people can take to prevent 2009 H1N1 influenza and its complications.  Because pregnant women are at a higher risk of serious 2009 H1N1-related complications, it’s especially important that they get vaccinated against 2009 H1N1.

With the Advisory Committee on Immunization Practices recommendation on February 24, 2010 to adopt universal influenza vaccination for the 2010-2011 season, everyone 6 months and older is now recommended to get an annual flu vaccination.  Next year’s seasonal influenza vaccine will contain the 2009 H1N1 virus, in addition to two other viruses that research indicates are most likely to circulate during the upcoming season.

For many years pregnant women have been advised to receive the seasonal influenza vaccine – this vaccine has been shown to reduce the risk of influenza in the woman and in her baby up to 6 months of age (at an age when the baby is too young to get the flu vaccine because they don’t have an adequate immune response at this age).  Studies have shown no evidence of increased maternal or fetal risks from influenza vaccines when used during pregnancy.

Pregnant women should get the flu shot (the killed vaccine), not the nasal spray (the live attenuated vaccine).  The live attenuated vaccine is not approved for use in pregnant women.

Pregnant women who think they have influenza should contact their doctor promptly.  If their doctor thinks a pregnant patient might have 2009 H1N1 influenza, she should be treated as soon as possible.  Treatment should not be delayed while awaiting test results because rapid testing for 2009 H1N1 has been shown to have low sensitivity.

State and local health departments report data to CDC on a voluntary basis. 

Information on a specific state’s experience should be obtained from the individual state.  We are unable to provide data on a state-by-state basis.

No – some states did not report data to CDC, and mild cases were likely missed in all states.  However, the states that reported data represented more than 97% of all births in the United States.  In addition, states had different requirements for case reporting and these changed as the outbreak continued.  In addition, testing for 2009 H1N1 changed as the outbreak continued.  Especially during later months, some states focused on cases that were more severely ill (hospitalized, admitted to an intensive care unit or died).  Therefore, we believe that severely affected cases were more likely to be reported to CDC and included in this report.  

The seasonal flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. The 2009 H1N1 flu vaccine was made in the same way and at the same places where the seasonal flu vaccine is made.

Preliminary data from a time of limited vaccine availability suggest that the uptake of 2009 H1N1 influenza vaccine was higher than is usually seen for seasonal influenza vaccine – based on a survey of only 150 women – uptake was 38% (95% CI 24-52%).  We are not aware of data on percent of women who received the seasonal influenza vaccine during the 2009-2010 influenza season.

We don’t fully understand the effects of influenza infection on the fetus.  Some studies have shown that pregnant women who develop a fever in the first trimester have an increased risk of having a baby with a certain group of birth defects of the brain and spine, called neural tube defects (these include spina bifida and anencephaly).  For that reason, pregnant women with a fever need to be treated with acetaminophen (Tylenol).  Whether influenza causes other problems for a fetus is not known.  In most cases, it appears that the influenza virus does not cross the placenta to infect the baby, although this has occurred in some cases.

In most cases, it appear that the influenza virus does not cross the placenta to infect the baby, although this has occurred in some cases, including one pregnant woman who had 2009 H1N1 near the end of her pregnancy whose newborn was infected with 2009 H1N1.  However, this appears to be rare.

The way vaccines are made takes time – for a vaccine to be produced, the virus needs to grow for a time in eggs.  The 2009 H1N1 virus grew more slowly than was initially anticipated, resulting in a delay in availability.

We don’t know if 2009 H1N1 was worse than seasonal influenza for pregnant women.  Pregnant women are more severely affected with both seasonal influenza and 2009 H1N1 influenza (pregnant women are more likely to be hospitalized for both seasonal and 2009 H1N1 influenza and to die when they have 2009 H1N1 influenza)

There is no evidence that thimerosal (a mercury preservative in vaccine that comes in multi-dose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about thimerosal during pregnancy, vaccine companies made preservative-free seasonal flu vaccine and 2009 H1N1 flu vaccine in single-dose syringes for pregnant women and small children. CDC advises pregnant women to get flu shots either with or without thimerosal.

There is no adjuvant in the flu vaccines that are available in the United States.

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MMWR: after receiving the preliminary result: 2009 monovalent influenza (H1N1), observe Gillan Valley vaccine - United States, 2009 - 2010

Update: influenza H1N1 (swine flu): resources for pregnant women

This site is archived for historical purposes and is no longer supported or updated. Flu season 2010 - 2011, update, see the CDC seasonal flu.

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Take time to get vaccinated. Daily preventive action. If you take influenza antiviral medications, your doctor recommends it to take.

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New: frequently asked questions: Behavioral risk factor surveillance system (BRFSS) 2009 sick modules like H1N1 influenza, influenza (peace), vaccinations

NEW: 2009 H1N1 and seasonal flu-community: questions and answers

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This website is archived for historical purposes and is no longer being maintained or updated. For updated information on the 2010-2011 flu season, see the CDC Seasonal Flu website.

February 16, 2010, 2:20 PM ET

Since April 2009, the 2009 H1N1 influenza virus has been spreading from person-to-person worldwide, affecting all racial and ethnic groups. This 2009 H1N1 and Seasonal Flu and Hispanic Communities: Questions and Answers document summarizes current understanding of the impact of 2009 H1N1 and seasonal influenza viruses on Hispanics, describes some of the barriers to uptake of 2009 H1N1 and seasonal influenza vaccines, and outlines potential strategies for improving health and increasing vaccine coverage in Hispanic communities.

2009 H1N1 and seasonal influenza materials for all individuals are available in English and Spanish at www.flu.gov, www.cdc.gov and www.cdc.gov/h1n1flu.

2009 H1N1 and seasonal flu data on racial and ethnic groups have been taken from a wide range of sources and geographic areas and show differing results. For instance:

Although Hispanics comprise approximately 15% of the US population, 1 they were overrepresented in the enhanced surveillance case reports during the early spring wave of the 2009 H1N1 pandemic, comprising about 30% of all reported cases.2 This is not unexpected since 2009 H1N1 was first identified in US cities with large Hispanic populations.Behavioral Risk Factor Surveillance System (BRFSS) data from household interviews conducted from September 1st – November 30, 2009 show self-reported influenza-like illness and having sought medical care for that illness was similar among Hispanic and non-Hispanic white respondents.3From April 15 - August 31, 2009, 15 percent of people hospitalized with 2009 H1N1 in 13 metropolitan areas of 10 states were Hispanic. Approximately 13 percent of the catchment area population studied is Hispanic.2  Of note, in previous influenza seasons Hispanics without underlying medical conditions were overrepresented in hospitalized cases (ranging from 16 – 25% of cases without an underlying medical condition).  From April, 2009 – December 31, 2009, laboratory-confirmed 2009 H1N1 hospitalization rates were almost 2.5 times higher for Hispanics (31.5/100,000) compared to non-Hispanic whites (12.7/100,000) in the State of Illinois.  The disparity in hospitalization rates was even greater for Hispanic children less than 5 years old (89/100,000) compared to non-Hispanic white children of the same age (29.1/100,000).4From May 19 – June 30, 2009, Hispanic residents of Salt Lake County, Utah with confirmed 2009 H1N1 infection were 2.8 more likely to require hospitalization in the intensive care unit compared to non-Hispanic whites.5Hispanic children younger than 18 years of age account for 27% of 210 reported 2009 H1N1 influenza-associated deaths in the United States.6 Their representation in the US population is 21%.7

Rates of influenza-associated hospitalizations and deaths vary among different age groups and across influenza seasons.8

The age distribution of the Hispanic population is very different from that of the non-Hispanic white population.7 The median age of the Hispanic populations, 26.9 years, is approximately 13 years younger than that of the non-Hispanic white population.9   The 2009 H1N1 influenza pandemic is primarily affecting a young population with more than 50% of hospitalized cases in persons younger than 25 years old.

Many medical conditions are associated with an increased risk of complications from influenza.  Disparities in certain underlying high-risk conditions, such as diabetes, pregnancy and asthma, may contribute to the impact of 2009 H1N1 on Hispanic communities.

From April 2009 – September 2009:

Approximately 10 percent of people hospitalized with complications from 2009 H1N1 influenza have been diabetic.  Among adults 20 years of age and older, diabetes is more prevalent among Hispanics (10%), with the highest prevalence rates among Mexican Americans (12%) and Puerto Ricans (13%), compared with non-Hispanic whites (7%).10Pregnant women represent approximately 6% of confirmed 2009 H1N1 hospitalized cases and deaths although they represent only 1% of the general population.  The fertility rate is higher for Hispanic women (101.5/1000) than for non-Hispanic white women (59.5/1000).11Almost one-third of people hospitalized with complications from 2009 H1N1 influenza to date have been persons with asthma.  Hispanics 15 years of age and over have a lower prevalence of asthma (5.4%) than non-Hispanic whites  15 years of age and over (8.0%).12 

There is no epidemiological or clinical evidence that suggests that Hispanics are more susceptible to either 2009 H1N1 or seasonal influenza or to poorer health outcomes by virtue of their race alone.  Therefore, further investigation is essential to more clearly elucidate factors that might contribute to disproportionate influenza-associated hospitalization and pediatric mortality among Hispanics.

CDC recommends a three-step approach for everyone to fight the flu

Get vaccinated;Take everyday preventive actions, including covering coughs and sneezes, frequent hand washing, and staying home when sick; andUse antiviral drugs correctly if your doctor recommends them.

Although the most effective way to prevent both 2009 H1N1 and seasonal influenza and their complications is to be vaccinated, overall 2008-2009 seasonal influenza vaccination coverage was low across racial and ethnic groups (figure 3).  Further, many Hispanics were less likely than non-Hispanic whites to receive influenza vaccination.13

Disparities in vaccination coverage are also evident this influenza season.  As of mid-December, 2009, only 24.7% of Hispanic adults had received seasonal influenza vaccine compared to 38.6% of non-Hispanic white adults.3  No significant differences were seen in cumulative 2009 H1N1 vaccination coverage by race/ethnicity among adults overall.14

Many Hispanics intend to obtain seasonal and 2009 H1N1 influenza vaccinations for themselves and their children.  In a national poll conducted by C.S. Mott Children’s Hospital in August 2009, 52% of Hispanic parents planned to obtain H1N1 Flu vaccination for their children compared to 38% of non-Hispanic white parents.15Similarly, in a recent online survey, 46% of Hispanic parents indicated their intent to obtain 2009 H1N1 vaccination for their children compared to 32% of non-Hispanic white parents.  A higher percent of Hispanic respondents (42%) also intended to obtain 2009 H1N1 vaccination for themselves compared to non-Hispanic whites (28%), but no difference was found related to intent to obtain seasonal flu vaccination (43%, 44% respectively).16Hispanic Medicare beneficiaries (25.9%) were 40% less likely than Non-Hispanic white Medicare beneficiaries (42%) to have a vaccination-initiated visit.17Marginalized Hispanic populations (non-English speakers, migrant workers, undocumented, and those living in rural and undeveloped areas) are unlikely to access health care services except in emergency situations.18Socioeconomic disparities among racial/ethnic groups may impact ability to access health care and obtain recommended vaccinations and treatment. According to the 2009 Current Population Report,19  23% of Hispanics were living below poverty level in 2008 and 31% of Hispanics were uninsured in 2008.Language barriers may interfere with one’s ability to access services and comprehend health education messages.9Undocumented residency status may deter some Hispanics from seeking vaccinations for fear of being required to provide proof of legal status in order to receive vaccine. 20

Promotion of 2009 H1N1 and seasonal influenza vaccinations in Hispanics is a key part of the response.  Vaccination campaigns should be inclusive and transparent, engaging all stakeholders in the Hispanic community in order to more effectively address community concerns, and to inform and educate the public.21   Faith-based organizations,  health “promotores/as”, Spanish-language media including radio, TV and web-based outlets, and the dissemination of culturally and linguistically appropriate health educational materials have been effectively utilized in other community health campaigns in the Hispanic community.

It is important to continue to increase the number, accessibility of, and use of vaccination sites, particularly within underserved communities.  Availability of low-cost and free 2009 H1N1 vaccine to all residents, regardless of legal status, and at non-traditional sites (such as pharmacies) should be broadly communicated in the Hispanic community.

Both the 2009 H1N1 and seasonal influenza vaccines are safe. The 2009 H1N1 vaccine is made the same way as the seasonal vaccine that has been used safely and successfully for many years. CDC and FDA believe that the benefits of vaccination with the 2009 H1N1 influenza vaccine will far outweigh the risks. Both seasonal and 2009 H1N1 vaccines reduce risk of serious complications from influenza for people with certain underlying medical conditions and for the very young and the elderly.

Hispanics are a diverse population with varying degrees of cultural assimilation in the United States.  Therefore, it is important to determine feasibility of incorporating Hispanic ancestry, nativity, and English language fluency into current data collection tools.  It is also important to analyze influenza-associated hospitalizations, deaths, and influenza vaccine coverage for the different subpopulations of Hispanics.  In addition, analyses of age-specific hospitalization and mortality rates by race/ethnicity would be especially useful in analyzing disparities among racial/ethnic populations with very different age distributions from that of non-Hispanic whites.  Further investigation is also recommended to identify contributory factors to the overrepresentation of Hispanics among influenza-associated hospitalized patients without an underlying medical condition that is known to increase risk for complications from influenza.

H1N1 Flu:  General Information

2009 H1N1 Flu: Free Resources

Flu Shot Locator

U.S. Census Bureau, Population Division, Table 3: Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2008 (NC-EST2008-03). Release Date: May 2009. CDC. Emerging Infections Program. Unpublished data. CDC. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009. Unpublished data.Illinois Department of Public Health, 2009. Unpublished data.Miller RR 3rd et al. Clinical findings and demographic factors associated with intensive care unit admission in Utah due to 2009 novel influenza A (H1N1) infection. Chest. Prepublished online Nov 20 2009. DOI 10.1278/chest.09-2517.CDC. Nationally Notifiable Disease Surveillance System. Surveillance for Influenza-Associated Pediatric Mortality, 2009. Unpublished data.U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008. Internet release date: September 2009.CDC. Use of Influenza A (H1N1) 2009 Monovalent Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. Morb Mortal Wkly Rep. 2009 Aug 21; 58(Early Release); 1-8.U.S. Census Bureau, American Community Survey Reports, The American Community—Hispanics, 2004, ACS-03, Issued February 2007. Accessed 7, Dec 2009.CDC. National Diabetes Fact Sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, 2008.CDC. National Center for Health Statistics. Health, United States, 2008. Accessed 22, December 2009.CDC. Barnes PM, Schiller JS, Heyman KM. Early release of selected estimates based on data from January-June 2009 National Health Interview Survey. National Center for Health Statistics. December 2009.CDC. Influenza Vaccination Coverage Among Children and Adults ---United States, 2008-2009 Influenza Season. Morb Mortal Wkly Rep. 2009 Oct 9; 58(39):1091-5.CDC. Interim Results – Influenza A (H1N1) 2009 Monovalent Vaccination Coverage – United States, October – December 2009, 2010. Morb Mortal Wkly Rep. 2010 Jan 22; 59(2); 44-48.C.S. Mott Children’s Hospital. National Poll on Children’s Health. Vol. 8 Issue 1, September 24, 2009. Accessed 28 November 2009.CDC. H1N1: Perception of Risk, Attitudes Towards Vaccine and Motivating Messages for African-American and Hispanic Consumers, Online Survey, October 2009.  National Center for Immunization and Respiratory Diseases. Unpublished data.Herbert, Paul L, Frick, Kevin D, Kane, Robert L, McBean, A. Marshall. Causes of Racial and Ethnic Differences in Influenza Vaccination Rates. Health Services Research 40:2 (April 2005).Barriers to and Facilitators of Effective Risk Communication Among Hard-to-Reach Populations in the Event of a Bioterrorist Attack or Outbreak, Feb 2004. Publication #19-11984. Texas Department of Health.U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty and Health Insurance Coverage in the United States: 2008, Issued September 2009. Accessed 7, December 2009.CDC. Sector-Specific Partner Outreach and Engagement Project-Top of Mind Summary Latino Faith, November 6, 2009. Report compiled by ICF Macro, an ICF International Company.Hutchins SS, et al. Protection of Racial and Ethnic Minority Populations during an Influenza Pandemic. Am J Public Health 2009; Suppl: S261-S270.

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H1n1 swine Flu: a virus evolution

The strain of influenza that has hit Mexico and USA implies, in many cases, a strain of the virus H1N1, pictured of never seen before. Influenza virus is famous for its ability to mutate and grow new features enabling him to escape his immune defence systems victims. The emergence of new strains of influenza is a problem for doctors and scientists.

And famous experts warning last night that might be too late to contain the epidemic again, given the magnitude of the case. If the death has confirmed the onset of a pandemic, then chances are incubated anywhere in the world today, said Dr. Michael Osterholm, an expert of influenza at the University of Minnesota.

In New York City health officials say about 75 students in a school in Queens fell sick with flu-like symptoms and tests are underway that the rule is the same strain of swine flu found in Mexico.

No one knows how many current generic Vaccine protection could provide specifically that no vaccine protects against swine flu. A genetically modified version combined with new swine influenza virus was created by Centers for Disease Control, said Dr. Richard Besser, a.i. of the Agency's Director. However, it can take months to create enough supplies for mass-vaccination programmes, if Governments decide to vaccine production is required.

Tamiflu and Relenza, drugs appears to be effective against the new strain. Rock, the producer of Tamiflu, said he was ready to immediately deploy a reserve if requested drugs. Two drugs should be taken at the beginning, a few days after the onset of symptoms, more effective.

XML version vaccine status report now available, a daily supply of new features:

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MMWR: Update: target activity---USA, 1 August 30, 2009, 4, 9, 2010

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The emergence and spread of the 2009 pandemic influenza A (H1N1) virus (2009 H1N1) resulted in extraordinary influenza activity in the United States throughout the summer and fall months of 2009 (1,2). During this period, influenza activity reached its highest level in the week ending October 24, 2009, with 49 of 50 states reporting geographically widespread disease. As of January 9, 2010, overall influenza activity had declined substantially. Since April 2009, the dominant circulating influenza virus in the United States has been 2009 H1N1. This report summarizes U.S. influenza activity* from August 30, 2009, through January 9, 2010.

Viral Surveillance

During August 30, 2009--January 9, 2010, World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in the United States tested 310,151 respiratory specimens for influenza viruses; 81,179 (26.2%) were positive, 80,951 (99.7%) of those specimens were positive for influenza A, and 228 (0.3%) were positive for influenza B. Of the 61,726 influenza A viruses for which subtyping was performed, 61,332 (99.4%) were 2009 H1N1 viruses. Only 29 viruses (<0.1%) were seasonal influenza A (H1), 52 (<0.1%) were influenza A (H3) viruses, and 313 (0.5%) were influenza A, but could not be subtyped because of specimen quantity or quality.

CDC has antigenically characterized 944 viruses that were 2009 H1N1, one seasonal influenza A (H1N1), seven influenza A (H3N2), and six influenza B viruses collected since September 1, 2009. A total of 942 (99.8%) 2009 H1N1 viruses tested were related to the A/California/7/2009 (H1N1) reference virus selected by WHO as the 2009 H1N1 vaccine virus; only two viruses (0.2%) showed reduced titers with antisera produced against A/California/7/2009.

One seasonal influenza A (H1N1) virus was related to the influenza A (H1N1) component of the 2009--10 Northern Hemisphere influenza vaccine (A/Brisbane/59/2007). The seven influenza A (H3N2) viruses collected during September 22--November 1, 2009, showed reduced titers with antisera produced against A/Brisbane/10/2007, the 2009--10 Northern Hemisphere influenza A (H3N2) vaccine component, and were antigenically related to A/Perth/16/2009, the WHO-recommended influenza A (H3N2) component of the 2010 Southern Hemisphere vaccine formulation. The six influenza B viruses tested belong to the B/Victoria lineage and are related to the influenza vaccine component for the 2009--10 Northern Hemisphere influenza vaccine (B/Brisbane/60/2008).

Antiviral Resistance of Influenza Virus Isolates

CDC conducts surveillance for resistance of circulating influenza viruses to both classes of influenza antiviral medications: adamantanes (amantadine and rimantadine) and neuraminidase inhibitors (zanamivir and oseltamivir). Since September 1, 2009, 39 (1.3%) of 2,926 total 2009 H1N1 viruses tested by neuraminidase inhibition assay and/or by detection of a single known mutation in the virus which confers oseltamivir resistance, H275Y, have shown oseltamivir resistance. This proportion of oseltamivir-resistant 2009 H1N1 viruses might overestimate the prevalence of oseltamivir-resistant 2009 H1N1 viruses in the United States because most of these viruses were tested because of clinical suspicion for oseltamivir resistance. Three additional cases of oseltamivir resistance among 2009 H1N1 viruses have been identified by other laboratories where antiviral resistance testing also is performed; thus, a total of 42 oseltamivir-resistant 2009 H1N1 viruses have been reported to CDC since September 1, 2009.

Since April 2009, a total of 52 oseltamivir-resistant 2009 H1N1 viruses have been detected in patients in the United States. Forty (77%) of the 52 patients had documented exposure to oseltamivir through either treatment or chemoprophylaxis; exposure to oseltamivir in nine (17%) patients has not yet been determined, and three patients (6%) had no known exposure. One seasonal influenza A (H1N1) was tested and was resistant to oseltamivir. One influenza B virus was tested and was not resistant to oseltamivir. None of eight influenza A (H3N2) viruses tested were resistant to oseltamivir. All tested viruses were sensitive to the neuraminidase inhibitor zanamivir. One seasonal influenza A (H1N1) virus was found to be sensitive, and nine (81.8%) of 11 influenza A (H3N2) and 834 (99.6%) of 837 2009 H1N1 virus isolates tested were found to have resistance to the adamantanes (amantadine and rimantadine).

State-Specific Activity Levels

The largest number of states to date reporting widespread activity occurred during the week ending October 24, 2009, when 49 jurisdictions reported widespread activity.† During the week ending January 9, 2010, no jurisdiction reported widespread activity. The early widespread state-specific activity contrasts with the previous three influenza seasons (October to May), when state-specific influenza activity did not reach comparable levels until mid-February or early March.

Outpatient Illness Surveillance

In the week ending October 24, 2009, the weekly percentage of outpatient visits for influenza-like illness (ILI)§ reported by the U.S. Outpatient ILI Surveillance Network (ILINet) reached 7.7%, the highest level to date this influenza season. As of January 9, 2010, ILI activity had decreased to 1.9% (Figure 1). During the previous three influenza seasons, peak ILI activity occurred later in the season and ranged from 3.5% during the week ending February 17 of the 2006--07 season to 6.0% during the week ending February 17 of the 2007--08 season. As of the week ending January 9, one of 10 regions was reporting weekly percentages of outpatient visits for ILI at or above its region-specific baseline. ILI activity was at or above the national baseline of 2.3% during the entire period of November--December 2009.¶

Influenza-Associated Hospitalizations

Laboratory-confirmed influenza-associated hospitalizations are monitored using a population-based surveillance network that includes sites in 10 states in the Emerging Infections Program (EIP) and sites in six additional states added during 2009.** This season, cumulative hospitalization rates have been highest in children aged 0--4 years, and generally rates have declined with age. As of January 9, 2010, cumulative rates of laboratory-confirmed influenza-associated hospitalizations reported for children aged 0--4 years were 5.9 per 10,000 population by EIP and 9.7 per 10,000 population by the new sites (Figure 2). Rates for other age groups were as follows: 5--17 years, 2.5 by EIP and 3.6 by the new sites; 18--49 years, 2.2 by EIP and 1.7 by the new sites; 50--64 years, 2.9 by EIP and 1.8 by the new sites; and =65 years, 2.4 by EIP and 1.7 by the new sites. In comparison, EIP cumulative hospitalization rates for the entire October-May influenza reporting seasons of 2006--07, 2007--08, and 2008--09, ranged as follows: ages 0--4 years (2.6 to 4.2), 5--17 years (0.4 to 0.6), 18--49 years (0.3 to 0.7), 50--64 years (0.4 to 1.5), and =65 years (1.4 to 7.5) (Figure 2).

In response to the emergence of 2009 H1N1 viruses, the Council of State and Territorial Epidemiologists (CSTE) instituted reporting of 2009 H1N1-confirmed hospitalizations and deaths to CDC. On August 30, CDC and CSTE instituted modified case definitions for aggregate reporting of influenza-associated hospitalizations and deaths. This cumulative jurisdiction-level reporting is referred to as the Aggregate Hospitalization and Death Reporting Activity (AHDRA).†† During August 30, 2009--January 9, 2010, a total of 38,454 hospitalizations associated with laboratory-confirmed influenza virus infections were reported to CDC through AHDRA. The median number of states reporting hospitalizations per week through AHDRA was 33 (range: 25--35).

Pneumonia and Influenza-Related Mortality

Pneumonia and influenza-associated deaths are monitored by the 122 Cities Mortality Reporting System and AHDRA. For the week ending January 9, pneumonia or influenza was reported as an underlying or contributing cause of death for 7.3% of all deaths reported through the 122 Cities Mortality Reporting System, below the week-specific epidemic threshold of 7.6%§§ (Figure 3). The longest period that pneumonia and influenza-related mortality was above the epidemic threshold was for 11 consecutive weeks from the week ending October 3, 2009, to the week ending December 12, 2009. The highest level of pneumonia and influenza-related mortality was 8.1% for the week ending November 21, 2009. In contrast, peak pneumonia and influenza-associated mortality did not occur until later in the three previous seasons, peaking at 7.7% during the week ending February 24, 2007, during the 2006--07 influenza season and at 9.1% in the week ending February 16, 2008, during the 2007--08 season.

During August 30--January 9, a total of 1,779 deaths associated with laboratory-confirmed influenza virus infections were reported to CDC through AHDRA. The 1,779 laboratory-confirmed deaths are in addition to the 593 laboratory-confirmed deaths from 2009 H1N1 that were reported to CDC from April through August 30, 2009. Since August 30, cumulative deaths associated with laboratory-confirmed 2009 H1N1 infection per 100,000 population were 0.31 for persons aged 0--4 years, 0.26 for 5--18 years, 0.38 for 19--24 years, 0.60 for 25--49 years, 1.03 for 50--64 years, and 0.65 for =65 years. For the period August 30--January 9, the median number of states reporting laboratory-confirmed deaths per week through AHDRA was 34 (range: 23--38).

Influenza-Associated Pediatric Mortality

CDC has received 236 reports of pediatric deaths associated with laboratory-confirmed influenza infection that occurred and were reported since August 30, 2009, the start of the 2009--10 influenza season (Figure 4). A total of 195 (83%) cases were associated with laboratory-confirmed 2009 H1N1 virus. Forty pediatric deaths were associated with an influenza A infection for which the subtype was undetermined but likely was 2009 H1N1 based on the predominance of this virus among those circulating. One death was associated with an influenza B virus infection (Figure 4).

Of the 236 pediatric deaths reported occurring since August 30, a total of 43 (18.2%) were among children aged <2 years, 26 (11.0%) were among children aged 2--4 years, 87 (36.9%) were among children aged 5--11 years, and 80 (33.9%) were among children aged 12--17 years. Since the week ending May 2, CDC has received 255 reports of pediatric deaths associated with laboratory-confirmed 2009 H1N1 virus. During the 2005--06, 2006--07, and 2007--08 influenza seasons, the mean number of reported pediatric influenza deaths was 74.

WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza. L Brammer, MPH, S Epperson, MPH, L Blanton, MPH, T Wallis, MS, A Fiore, MD, L Gubareva, PhD, J Bresee, MD, L Kamimoto, MD, X Xu, MD, A Klimov, PhD, N Cox, PhD, Influenza Div; L Finelli, DrPH, National Center for Immunization and Respiratory Diseases; S Graitcer, MD, EIS Officer, CDC.

As of January 9, 2010, the vast majority of influenza activity this season had been from 2009 H1N1. Activity was highest during the week ending October 24, 2009, and has since declined. The number of influenza-associated pediatric deaths reported to date for the 2009--10 season (236) is more than three times the average number (74) reported for the 2005--06, 2006--07, and 2007--08 influenza seasons. Resistance to antiviral neuraminidase inhibitors has been low among the 2009 H1N1 viruses, and the vast majority of 2009 H1N1 viruses tested remain related to the A/California/7/2009 (H1N1) reference virus selected by WHO as the 2009 H1N1 vaccine virus.

January and February are months during which seasonal influenza activity usually increases; thus, increased influenza activity from 2009 H1N1 viruses, seasonal influenza viruses, or both might occur in the remainder of the influenza season. In all three 20th century influenza pandemics (in 1918, 1957, and 1968), multiple waves of influenza activity were observed (3). The 2009 H1N1 virus is likely to continue to circulate through the winter months, resulting in more cases, hospitalizations, and deaths. Although limited supplies of influenza A (H1N1) 2009 monovalent vaccine had previously necessitated prioritizing vaccination among certain groups, approximately 130 million doses have been shipped since the vaccine was released, and most jurisdictions are encouraging vaccination of all persons aged =6 months (4). The 2009 H1N1-related morbidity and mortality described in this report point to the importance of a continued focus on vaccination, both among persons in the initial target groups as well as the rest of the population.

As the season progresses, public health officials should maintain the ability to detect changes in influenza activity. Testing, including subtyping of influenza A viruses to detect both pandemic and seasonal influenza strains, should continue for all hospitalized and severely ill patients, including patients aged =65 years. Timely reporting of all pediatric deaths associated with laboratory-confirmed influenza remains essential to detecting changes in severity of disease among children (includeing reporting no cases). Continued reporting of ILI through ILINet also will be important to tracking changes in influenza activity. Using previously established reporting channels, health-care providers should continue reporting to local or state health departments any particularly severe or unusual influenza cases or any cases among health-care workers and persons at risk for severe complications from influenza (e.g., pregnant women and immunocompromised persons). Institutional closings or clusters of influenza infections in prisons, schools, colleges, and long-term care facilities also should be reported through state and local health departments. In addition, any adverse reactions to influenza vaccines should continue to be reported via the Vaccine Adverse Event Reporting System (http://vaers.hhs.gov/index), and any adverse events after use of antivirals should be reported to MedWatch (http://www.fda.gov/safety/medwatch). Changes in the geographic spread, type, and severity of the circulating influenza viruses will continue to be monitored with updates reported weekly in the online national influenza surveillance summary, FluView.¶¶ Additional information regarding prevention and treatment of the 2009 pandemic influenza A (H1N1) is also available online.***

This report is based, in part, on data contributed by participating state and territorial health departments and state public health laboratories, World Health Organization collaborating laboratories, National Respiratory and Enteric Virus Surveillance System collaborating laboratories, the U.S. Outpatient ILI Surveillance Network, the Emerging Infections Program, the Aggregate Hospitalization and Death Reporting Activity, the Influenza Associated Pediatric Mortality Surveillance System, and the 122 Cities Mortality Reporting System.

CDC. Swine influenza A (H1N1) infection in two children---southern California, March--April 2009. MMWR 2009;58:400--2. CDC. Update: influenza activity---United States, August 30--October 31, 2009. MMWR 2009;58:1236--41.Miller MA, Viboud C, Balinska M, Simonsen L. The signature features of influenza pandemics---implications for policy. N Eng J Med 2009;360:2595--8.CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR 2009;58(No. RR-10).What is already known on this topic?

The 2009 pandemic influenza A (H1N1) virus emerged in the United States in April 2009 and caused substantial disease worldwide.

What is added by this report?

In recent weeks, declines have been observed in 2009 H1N1 influenza activity; however, rates of influenza-related hospitalizations and deaths among persons aged <65 years during this season have been substantially higher than in recent influenza seasons.

What are the implications for public health practice?

Epidemiologic data in this report support expanded recommendations by CDC that the influenza A (H1N1) 2009 monovalent vaccine be offered to all persons aged =6 months, depending on local availability.

FIGURE 1. Percentage of visits for influenza-like illness (ILI) reported by the U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet), by surveillance week --- United States, 2006--07, 2007--08, 2008--09, and 2009--10* influenza seasons

Alternative Text: The figure above shows the percentage of visits for influenza-like illness (ILI) reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), by surveillance week in the United States for the 2006-07, 2007-08, 2008-09, and 2009-10 influenza seasons. In the week ending October 24, 2009, the weekly percentage of outpatient visits for ILI reported by the U.S. Outpatient ILINet reached 7.7%, the highest level to date this influenza season and a level higher than the three preceding seasons. After peaking, the ILI level decreased to 1.9% in the week ending January 9, 2010.

FIGURE 2. Number of laboratory-confirmed influenza-associated hospitalizations and cumulative hospitalization rates per 10,000 population, by age group and surveillance week --- Emerging Infections Program (EIP) and new sites,* 2006--07, 2007--08, 2008--09,† and 2009--10§ U.S. influenza seasons

Alternative Text: The figure above shows the number of 2009-10 laboratory-confirmed influenza-associated hospitalizations and cumulative hospitalization rates per 10,000 population, by age group and surveillance week from Emerging Infections Program (EIP), and new sites for the 2006-07, 2007-08, 2008-09,† and 2009-10§ influenza seasons. As of January 9, 2010, cumulative rates of laboratory-confirmed influenza-associated hospitalizations reported for children aged 0-4 years were 5.9 per 10,000 population by EIP and 9.7 per 10,000 population by the new sites.

FIGURE 3. Percentage of all deaths attributed to pneumonia and influenza (P&I), by surveillance week and year --- 122 Cities Mortality Reporting Sytem, United States, 2006--2010

Alternative Text: The figure above shows the percentage of all deaths attributed to pneumonia and influenza (P&I), by surveillance week and year for 122 U.S. cities from 2006-2010 from the Mortality Reporting System. For the week ending January 9, pneumonia or influenza was reported as an underlying or contributing cause of death for 7.3% of all deaths reported through the 122 Cities Mortality Reporting System, below the week-specific epidemic threshold of 7.6%.

FIGURE 4. Number of influenza-associated pediatric deaths, by week of death --- United States, 2006--07, 2007--08, 2008--09, and 2009--10* influenza seasons

Alternative Text: The figure above shows the number of influenza-associated pediatric deaths, by week of death in the United States for the 2006-07, 2007-08, 2008-09, and 2009-10 influenza seasons. CDC has received 236 reports of pediatric deaths associated with laboratory-confirmed influenza infection that occurred and were reporting since August 30, 2009.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All MMWR HTML versions of articles are electronic conversions from typeset documents. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (http://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

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Royal part 2

I decided to walk to the smoothie because it was so nice outside. The Sun was shining, but that wasn't too hot and there was a breeze unequivocally in the air. Butterflies were fluttering their wings and were chirping crickets. This is the kind of day when you want to sit outside and read a novel of love good.

The sense of nervousness engulf me that I was wondering what the hell I had understood me in. I was going to meet some guys who was very good looking, but I didn't even know his name. This kind of reminded me this song Carrie Underwood "Name", except that I did not know his name and we weren't somewhere in Vegas.

I came top of the Hill, and once I reached the Summit, place Smoothie caught my attention. Was a place where there was a NECTARS sell just stalled, but the rest of the place was outside. Some of them had parasols, customers of upcoming Sun shielding and glass tables and wrought iron.

I saw the guy sitting at a table and seemed in deep thought. He had already obtained a smoothie and from what I could say, it looked like strawberry. I walked at the table and said: "Hello".

He seemed surprised, but quickly smiled me and told me: "Hey". Sorry for the smoothie, was thirsty ... »

He cut off the coast, not ' a big deal. " Let me go get one and then you come and sit down.

He said: "agree" and then a big swig of his drink.

I walked in the stable of selling smoothies and thank God there was no line. I had tons of homework and I did tonight also work. Ordered my favorite, strawberry and banana and then I went and joined the guys at the table.

I put my hand bag my feet and then took a SIP of my drink. "So what was so urgent that I meet with you today." I asked.

"Obtuse, are we?

"No, asked why a boy, that I do not even know me out". Also, I don't even know your name. »

He chuckled and said, "my name is Charles and I needed to speak with you something."

"Moreover, I am going to drew Charlie you want if you." What say to me? I have tasks to do and then my job humbling and I just four hours.

He evil and said: "" I'm sorry, but you don't have time to do. ""

I asked, was confusedly tossing "Um … why"?

He stood and then offered me a hand. "Walk with me?

I refused his hand, but accepted the walk. I didn't even know the guy. Silently, I walked Park that was just a 2 minute walk. Had a wonderful pond in the Centre and benches around him. A small road side along the side, but there as a single machine exceeds today that seemed to be free.

We stopped under a tree, and I asked, "so why do I have time for assignments and my work."

Put a stone understand my size and said with a sparkle in his eyes, "because I'm deleting."

"Wait ... what? I asked, panic breaks out of through me. I tried to run, but it was too soon. There I picked up and I ran over his shoulder. I started screaming and beat my fist against your back.

He walked me to the only car on the street side and then gently placed me in the back seat. When he walked around the driver's seat, I tried to open the door, but would move. Then she opened the door to slide at its headquarters and began the car.

I yelled at him, "Let me this car."

He started to drive on the road and said: "I'm sorry, Alex." "I'm really".

"What the hell?" I have screamed and then began the strikes at the side of the window me. Kidnappers are usually regret that were? My stomach was tight and had broken a sweat on my forehead. The door had not yet opened. "Why are you doing this?

He sighed and said, "because you are parents want me."

Everything for my screeched to stop unexpectedly; "Wait … my real parents or my adoptive ones".

He hesitated a moment and then said, "are you for real".

I trampled, "Yeah, right.

And then fainted.

New: question and answer - 2009 H1N1 affects racial or ethnic origin.

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Update: 2009 H1N1 influenza international situation update.

This report uses August 6 to data collected through August 1, 2010, and the World Health Organization (WHO) influenza International provides updates.

If the WHO Laboratory confirmation the influenza H1N1 2009 death and status update report continues the Web page. How many death flu test actual number of these deaths and under-representation in recognized and no associated with influenza.

In General, H1N1 flu, seasonal flu is lower by 2009.

Influenza activity in the northern hemisphere, past month over slow or sporadic was.

Depends on the location of the most active areas in the southern hemisphere influenza activity level, fashionable South Asia and the tropical Americas limited field. Generally seasonal and pandemic influenza activity in the temperate low levels in the southern hemisphere South Africa. Distribution of East Africa, Southeast Asia seasonal influenza viruses, particularly influenza (H3N2) is displayed and continue.

Over Australia, New Zealand increase in influenza activity (or) rates in the last 6-8 weeks, reported last week. However, smaller yet seen in 2009. 2009 Is the influenza H1N1 influenza B viruses and low co-circulation influenza (H3N2) reported on the most frequently.

Chile as Argentina, overall reported influenza activity is low. 2009 H1N1 flu virus most often reported by Chile low co-circulation influenza B as (H3N2).

Central America still report of seasonal influenza viruses, particularly influenza (H3N2) circular.

In Asia, most active areas of influenza India, parts in 2009 H1N1 mainly occurs. Is the absence of any?, however overall breaking the observed in the first wave, showing strength and seriousness:. Activity levels-low the 2009 H1N1 South East Asia, Nepal, Bhutan country also.

showed that the virological data from major seasonal influenza B viruses (H3N2) peak is reached South Africa influenza activity early July. Sustainable transport 2009 H1N1 Ghana in June and July reports during the year 2010. Suggested evidence seasonal flu (H3N2) and b viruses continue and spread throughout the Eastern and Central Africa. Reported low incidence (H3N2) recently reported by Kenya, Cameroon flu influenza b level rocks.

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New: flu germs spread people

This site is archived for historical purposes and is no longer supported or updated. Flu season 2010 - 2011, update, see the CDC seasonal flu.

December 5, 2009, 6: 00 pm ET

Flu cough spread people of the Lord, who was suffering from the flu from sneezing is expected.

Flu viruses can surface, such as a doorknob, telephone, and Cup to even a few hours. To touch the hand wash surfaces with eyes, mouth and nose touch displays flu.

Both speak to whether or not the seasonal H1N1 influenza vaccine to the doctor. Covering the nose and mouth when you cough or sneeze. To use it and organization to trash bin to throw. Especially when you cough or sneeze wash hands with SOAP and water frequently. From rub hand SOAP and water are available, based on the alcohol stay sick people use possible.

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New: frequently asked questions: adults and children 2009 H1N1 in hospitalized in basic health state

This site is archived for historical purposes and is no longer supported or updated. Flu season 2010 - 2011, update, see the CDC seasonal flu.

February 2010 24, 6: 30 pm et

Hospitalized patients 2009 updated information on major diseases of H1N1 USA is offering 16 February - 2010 answers were reported to CDC on April 15, 2009. July 31, 2009, 2009 reported on a CDC chronic disease related to H1N1 hospitalization

Collect data from the CDC school influenza H1N1 2009 new infections (EIP) and aggregate reporting seniors and death (AHDRA). However, these two systems and information portal is just one to collect the information related to regular basic health. Keep downloads in 10 States en 13 urban was review influenza laboratory in more than 60 County Hospital (defined as a person under 18 years old) for children and adults for monitoring. Log in to control the infection of children and adults as part of a normal patient tests positive for influenza influenza hospitalization rates ensure Anne hospital laboratory and reception, the database associated to identify. Make sure chart en patient basic requirements for the compile. For more information about Anne cm. Is a summary of surveillance of influenza in the United States.

2009 2010 February revealed information portal from the 16th and hospitalised adults 85% and 58% 2009 H1N1 virus infection in hospitalized children with one or more than one medical condition.

From Anne hospitalization data gathering 15 April, 2009, 16 February 2010 show most people 2009 H1N1 influenza least hospitalization one major health. This is consistent data collected in the spring of 2009. Please see the schedule and b 2009 to visually represent the basic health of H1N1 following hospitalization, children and adults.

Chart data shows for adults, Anne hospital. 30% Of asthma, a general underlying health problems adults 2009 H1N1 hospitalization in. 23% Of the adult diabetes for hospital admission 2009 H1N1 hospitalization, associated with the second is the most common terms. Chronic cardiovascular disease (CVD) 2009 H1N1 hospitalization is 20% of the adult. Chronic obstructive pulmonary disease (COPD) 2009 H1N1 hospitalization accounted for 14% of adults. Pregnancy 9% admission 2009 H1N1 adult women in May. Neurological / development disabilities hospital admissions 2009 H1N1 represent 7% of adults. Finally, nerve muscle disease 2009 H1N1 hospitalization is 1% of adults.

* Schedule B nervous system development, if not separated in different categories of cerebral palsy, paralysis of disease.

(B), hospitalization information portal child figure. Asthma 33 %2009 H1N1 in hospitalized adults as among children is the most common baseline health status. Neurological / development handicapped children and 11% 2009 is the highest reported second for H1N1 hospitalized children. Moderately serious delay development conditions 2009 accounted for 20% of the H1N1 flu-related hospitalization of children. Seizure disorders account 2009 children's hospital related) 6% of the H1N1 influenza. Cerebral palsy is 3% 2009 H1N1 influenza-related hospitalization of children. Chronic lung condition is accounted for 5% 2009 H1N1 influenza-related hospitalization of children. Blood disorders such as sickle cell anemia, accounting 2009 H1N1 flu 5% of the children's hospital related. Diabetes is 1% of the 2009 H1N1 influenza related hospitalization of children. Finally, pregnancy 2009 1% of the H1N1 hospitalized children.

Publishes a list of people at high risk of complications from flu CDC.

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Audio: 30 sec radio ready PSA national influenza vaccination weekly downloads

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NEW: H1N1 flu vaccine for the open letter to the American people.

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Open Letter to the American People:

Since the 2009 H1N1 flu virus hit our shores, scientists, manufacturers, health providers, and federal, state, and local health officials have worked together to protect the health of the American people. Over 110 million doses of the H1N1 vaccine are now available, with more coming every day. Now is the time to protect yourself and those around you by getting vaccinated against the H1N1 flu.

The traditional flu season is just beginning and typically lasts until May. History tells us to prepare for another serious wave of illness. With H1N1 flu declining in many areas, we have a window of opportunity to help prevent the flu from spreading further and causing even more illness, hospitalization, and death.

The H1N1 flu vaccine is safe, effective, and the best way to protect yourself and your family from the H1N1 flu.

The H1N1 vaccine is made the same way seasonal flu vaccines are made every year. Extensive testing and monitoring have shown that the vaccine is not only safe, but also an excellent match for the H1N1 flu virus. And remember that when you get vaccinated, you don’t just help yourself; you help your community by preventing the spread of the flu virus.

We especially encourage people with underlying health conditions, pregnant women, children, young adults, caretakers of infants, and health care workers to get vaccinated against H1N1. Unlike the seasonal flu, H1N1 has hit children, young people, and adults under age 65 exceptionally hard. That is why we encourage you to get the H1N1 vaccine as soon as possible.

Fighting the flu is a shared responsibility. We ask you to join us in this fight to protect yourself and your community by getting the H1N1 flu vaccine.

Sincerely,

Nancy H. Nielsen, M.D., PhD
Immediate Past President
American Medical Association

Rebecca Patton, MSN, RN, CNOR
President
American Nurses Association

Welford C. Roberts, PhD, RS, REHS, DAAS
President
National Environmental Health Association

 

Susan Wysocki, WHNP-BC, FAANP
President & CEO
National Association of Nurse Practitioners in Women's Health

Geraldine “Polly” Bednash, PhD, RN, FAAN
CEO & Executive Director
American Association of Colleges of Nursing

Mark E. Rupp, MD
President
Society for Healthcare Epidemiology of America

 

Larry A. Wickless, DO
President
American Osteopathic Association

Tom Van Coverden
President & CEO
National Association of Community Health Centers

 

Sharon A. R. Stanley, PhD, RN, RS
Chief Nurse
American Red Cross

 

Steve H. Hanson, MPA, PAC, AAPA
President
American Academy of Physician Assistants

 

Elena Rios, MD, MSPH
President & CEO
National Hispanic Medical Association

Angela Gardner, MD, ACEP
President
American College of Emergency Physicans

 

Michael A. Barry, CAE
Executive Director
American College of Preventive Medicine

 

Richard J. Whitley, MD, FIDSA
President
Infectious Diseases Society of America

 

Jane L. Delgado, PhD, MS
President & CEO
National Alliance for Hispanic Health

 

Harold A. Schaitberger
General President
International Association of Fire Fighters

Lori Heim, MD
President
American Academy of Family Physicians

 

Denise Graham
Executive Vice President
Association for Professional in Infection Control & Epidemiology

 

Mitchel C. Rothlolz, RPh, MBA
Chief of Staff
American Pharmacists Association

Michelle Beauchesne, DNSc, RN, CPNP, FNAP, FAANP
President
National Association of Pediatric Nurse Practitioners

 

James C. Turner, MD, FACHA
President
American College Health Association

 

Joseph W. Stubbs, MD, FACP
President
American College of Physicians

Clare Coleman
President & CEO
National Family Planning & Reproductive Health Association

 

Sandi Delack, RN, BSN, MEd
President
Amy Garcia, RN, MSN
Executive Director
National Association of School Nurses

Michael R. Fraser, PhD
Chief Executive Officer
Affairs Association of Maternal & Child Health Programs

 

Lawrence A. McAndrews, FACHE
President & CEO
National Association of Childrens Hospitals and Related Institutions

Bruce T. Roberts, R.Ph
Executive Vice President and CEO
National Community Pharmacists Association

 

Rich Umbdenstock
President and CEO
American Hospital Association

Charles N. Kahn III
President and CEO
Federation of American Hospitals

 

Dr. Geoffrey Rutledge
Chief Medical Officer
Epocrates 

National Medical Association Willarda V. Edwards, M.D., MBA
President

American College of Occupational and Environmental Medicine
Pamela Hymel, MDMPH, FACOEM
President

National Foundation for Infectious Diseases
George C. Hill, Ph.D.
President

Premier Safety Institute
Gina Pugliese, RN MS
Vice President

Service Employees International Union
Andrew L. Stern
President

American Federation of State, County and Municipal Employees – United Nurses of America
Gerald W. McEntee
President

HHS does not endorse private products, services, or enterprises.

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Update: influenza H1N1 (swine flu): maternity caregivers resources

December 14, 2009, 15: 00 min ET

This site is archived for historical purposes and is no longer supported or updated. Flu season 2010 - 2011, update, see the CDC seasonal flu.

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Swine flu Scottish man dies

An old in Glasgow became the second British dying of swine flu.

73 Years, had other serious underlying medical problems and has not yet been appointed, died in hospital, Royal Alexandra Paisley late on Saturday evening. Was in intensive care for 15 days, said responsible for health.

The Scottish Health Secretary Nicola Sturgeon said: "our thoughts are with the families and friends of the patient at that time very sad and tragic." The family asked the identity of the patient to be maintained.

"Despite the fact that it is in the sense that the patient had swine flu we understand that the patient has had serious underlying health problems".

A spokesman for the family said: "our beloved relating to privacy and we want your privacy continues to be respected that we are trying to come to terms with our loss.

The first English to succumb to the H1N1 virus, Jacqui Fleming, died at the Royal Alexandra after premature birth to her third child. It was the first person outside of America to die from the virus.

Fleming had significant underlying health problems and had been sick for several weeks before his death. Her baby, named Jack from his partner, William McCann died the next day.

Health authorities have repeatedly stressed that the virus appears to be relatively mild, despite its rapid spread throughout the world.

The latest official figures show that 4.276 Brits are infected, major epidemics now in Birmingham, London and Glasgow region, but health experts believe that the true figure is much higher.

In Italy, experts from the Centers for disease control in Atlanta believe that at least a million Americans may have had swine flu and has not been diagnosed, although the official data of United States Friday confirmed 27,717, with the death of 127.

However, the virus is now spreading rapidly in the southern hemisphere, where it's inverno-the traditional seasonal influenza outbreaks.

From Australia, where the cases confirmed totalled 3,280, four people were now deceased, with underlying health problems. There are 21 deaths reported from Argentina World Health and seven to Chile. Last update that in case of total 59,814 with 263 dead.

Update: flu or pneumonia senior and killed people from August 30, 2009 to April 3, 2010.

'S * report may include flu-like illness laboratory confirmation hospitalization data or data elements are or can be based on the syndromic must unload the combination.

* Laboratory confirmation plus influenza includes test (rapid flu test, RT-PCR, mussels, IFA or culture there are done.

Following table influenza laboratory confirmation was hospitalized, and the 2009 mortality rates, such as the H1N1 flu season is 30 May 2009 lists reported in the summary. CDC receives from the region of the United States. This table is week Friday morning 11 flu season 2009 - 2010, based on the new definition of the status report hospitalization and mortality rates effective August 30 updated the.

CDC uses traditional monitoring system he continue to monitor progress of year 2009 - 2010 influenza season. For more information about influenza surveillance including accountability and influenza hospitalization and associated death. Questions and answers: 2009 monitor, such as the H1N1 influenza activity.

2009 H1N1 hospitalization, and CDC in April, according to the August 2009 and number of deaths is available since the last update is available.

Please contact the Department of public health.

International 2009 H1N1 influenza infection if
See also: World Health Organization.

* Download the CDC report and hospital admissions and from the type of all death syndrome and the influenza subtypes laboratory 1) review influenza hospitalization and mortality or 2) pneumonia and influenza. Laboratory confirmation if only contained in this report, but will continue analyzes data from the CDC laboratory confirmation and syndromic hospitalization and death.

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New: FluSurge Special Edition

2009 November 30, 12: 00 pm ET)

Is FluSurge v2.0 software previously available through CDC's website on the featured FluSurge www.cdc.gov/flu/tools/flusurge published. And based on a schedule program to provide special edition FluSurge software hospital administrators of adapting new-based estimate hospital employee health services demand 2009 H1N1 influenza during the surge. Compares the fans of the estimated number of featured FluSurge hospitalization and mortality of H1N1 flu (determined by the length and pathogenicity of users) and recognized group of people, required number of ICU care and support people need of H1N1 flu response from the hospital's existing buildings.

Download FluSurge Special Edition

Special Edition FluSurge evaluating v2.0 in particular hospital and pandemic flu affects FluSurge caregivers to help the Administrator Update, type H1N1 2009 hospital surge capacity. User can change any values that appear in the white text field, such as attack, duration, and rate of H1N1 pandemic and basic hospital resources (i.e. is ICU, ICU bed and fan), you can evaluate the length and the number of possible impact, and pathogenicity of fashion together.

Special will need to enter the age group of the language-specific to version FluSurge hospital. These groups 0-17 years old + 18 to 64, the 65-year-old. Also you can assign these resources influenza (H1N1) patient fans with a total capacity of the ICU bed bed ICU's specific availability will be to enter the total number and rate. FluSurge Special Edition builds a total number of deaths associated with H1N1 patient fans, provides a list of that impact hospital, hospital ICU capabilities, assumption data. This assumption data list, and clicking "change the prerequisites in the main menu page or view. You can change the

Have the opportunity to select the time interval between users in the H1N1 finally (6, 8, or 12 weeks) of is expected in the hospital, strength of the attack in the community. Attack is 15% (as well as the H1N1 infection spring 2009, 25% (is the most likely scenario might happen in 12 weeks duration of H1N1 infections of 25% and 35% (spring 2009 H1N1 infection of the more severe form) default default attack.

Age groups of the population in specific age restrictions by default, the United States represents throughout the country and region. Have been retrieved from the Census Bureau United States these values, estimate the population as March 1, 2008. (Http://www.census.gov/popest/national/asrh). Standby capacity to model specific hospital and community of users, you must change the age of the population in the light of the specific community.

Default attack 2009 was chosen to represent the rate of the possible attack of H1N1. You can change the value of these attack speed and pandemic period as stated earlier, the user has selected from the drop-down menu, select. Pull on the calculation of the number of older people who need hospitalization or death in the hospital uses the same methodology as a special issue of H1N1, FluAid KIA induced (in available: http://www.cdc.gov/flu/pandemic/preparednesstools.htm).

People associated with the total number of hospitalization and pandemic H1N1 deaths, Special Edition depends on pandemic season seasonal FluSurge software get multiple results, use list of assumptions and clinical attack rate.

Hospitalized, but the most likely scenario, and death of maximum and average in this attack and is the minimum number of death with the lowest maximum number of script hospitalization, and in the ratio of attacks occur.

Special generates a graph of the speed of the attack and the number of views each week, daily distribution specified in the version FluSurge period.

You can find various buttons FluSurge Special Edition to provide additional information. Examples of these buttons labels "?", duration and attack speeds?? "and"interpretation"... specific pages of the presentation, you must select the button if you want a detailed description of the specific information.

Windows * operating system (Windows 2000 or later, MS), Excel (MS Office 2000 or later), 486 Pentium with at least 1 GB of hard disk drive RAM15 MB of storage space.

We have successfully downloaded and Special Edition FluSurge in various desktop and portable computer by using the following Windows operating systems, run it to run Apple doesn't or using other operating systems such as Linux machines *

* In the MS Windows and Office product author of Microsoft, Washington. It is not one, and then use the name trade to United States Department of health and human services guarantee that only commercial source identification certificate.

Download and specially, you must change the security level of Excel version FluAid before you.
You must run the following steps.

Open a blank Excel worksheet. Click on the Tools button, then click the macro security level in SecuritySet. Click the OK button. Double-click the file, and then Special Edition FluAid to open. To enable the macro if you disable macros or to disable macros, you click.

* We load and FluAid special we recommend Edition spreadsheet and save on your computer and open the spreadsheet to your computer. Rather than a Web browser, this spreadsheet open in Excel will be.

This beta test version of the software that keep in mind. Derived from the use of FluSurge Special Edition number of predictions actually thought as epidemic during operation. Is not what would happen if you will, must be regarded as measures.

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