Swine Flu Update: DHS/CDC/White House joint press conference; WHO pandemic alert level; epidemiology update
By the Staff of the Center for Biosecurity | April 26, 2009 | 7:45 PM, EST
Joint DHS/CDC/White House Press Conference, 12:30 PM, Sunday, April 26
Case Updates: At a joint Centers for Disease Control and Prevention (CDC)/Department of Homeland Security (DHS) held at the White House this afternoon, Acting Director Richard Besser announced that the CDC had 20 cases of swine flu in the United States: 7 in California, 2 in Texas, 2 in Kansas, 8 in New York City, and 1 in Ohio. Dr. Besser noted that although human-to-human transmission is still suspected, to-date, there has only been only 1 case documented, by viral isolate, of person to person spread (an individual in California who went to Mexico and subsequently transmitted the virus to his/her spouse).
Strategic National Stockpile: DHS Secretary Janet Napolitano announced the release of 25% of the 50 million treatment courses of antivirals in the Strategic National Stockpile (SNS) to states and cities. Priority for receipt of antivirals will be awarded to those states with confirmed cases to supplement that state’s stockpile. In addition, the Department of Defense has prepositioned 7 million courses of antivirals (the locations were not announced in the press conference).
Surveillance: DHS is implementing passive surveillance for symptoms among individuals who are arriving at U.S. borders. This means that individuals arriving in this country will be asked if they are or have been sick. Any travelers who present with symptoms will be isolated and medically evaluated according to existing federal procedure. DHS is also conducting an inventory of resources such as personal protective equipment that are available for Customs and Border Protection personnel. Increased surveillance undertaken by the United States Department of Agriculture (USDA) has not indicated any problems with either the U.S. food supply or with U.S. livestock health.
HHS Public Health Emergency Declaration: During the press conference, DHS Secretary Napolitano also announced that the Department of Health and Human Services (HHS) has declared a “public health emergency.” Specifically, HHS Acting Secretary, Charles Johnson declared a public health emergency under section 319 of the Public Health Service Act (42 U.S.C. § 247d) for the swine flu outbreak “as a consequence of confirmed cases of Swine Influenza A (swH1N1) in California, Texas, Kansas, and New York . . . and after consultation with public health officials as necessary.”1 Through the declaration, the Acting Secretary determined “that a public health emergency exists nationwide involving Swine Influenza A that affects or has significant potential to affect national security.”
This type of emergency declaration is standard procedure for HHS during a significant event.2 As Secretary Napolitano explained, the declaration enables HHS agency to take steps to prepare for and respond to an emergency, such as gaining access to federal assets (e.g., funding, medicines through the S NS, etc.) and implementing certain liability or regulatory protections (e.g., waivers of (EMTALA), sanctions for hospital emergency departments),3 if needed.
World Health Organization (WHO) Will Reconvene Expert Panel to Determine Pandemic Alert Level
Yesterday (4-25-09), the WHO convened an expert panel to discuss the possibility of raising the from its current level 3, but decided against such an adjustment. The rationale for this decision was not publicly reported. Today, that WHO spokesman Gregory Hartl indicated that the panel will reconvene on Tuesday after gathering more epidemiological evidence from Mexico.
Epidemiology Update: Cases in the U.S. and Other Countries
New York City: New York City (NYC) Mayor Michael Bloomberg announced today that the 8 probable cases of swine flu from students at St. Francis Preparatory School in Queens, NY, have been confirmed by CDC laboratory tests as swine influenza.4 At a press conference today, Mayor Bloomberg and NYC Health Commissioner Thomas Frieden reported that all 8 students with confirmed swine flu have recovered. Some students at the school apparently had recently been in Mexico.5
News reports indicate that NYC health officials are also investigating 30 reported cases of possible flu at a day-care center in the Bronx. At a press conference today, it was announced that 6 clinical samples from the day-care center came back negative; one was inconclusive and will be re-tested.6
Yesterday, the New York State Department of Health announced that it had shipped 1,500 treatment courses of oseltamivir to NYC to treat probable cases as well as individuals with underlying chronic health conditions who had been in contact with probable swine flu patients.7
Ohio: The Ohio Department of Health (ODH) announced and the CDC confirmed today a case of swine flu in a 9-year-old boy from Lorain County. According to the ODH, the patient “is considered to have a mild case of the disease and is recovering at home.”8
Mexico: The BBC reports that Mexico's Health Secretary, Jose Cordova, said a total of 1,324 people had been admitted to hospital with suspected symptoms since April 13 and were being tested for the virus. "In that same period, 81 deaths were recorded probably linked to the virus, but only in 20 cases we have the laboratory tests to confirm it," he said.9
New Zealand: reported at 6:04 a.m. EDT this morning that New Zealand's health minister said that 10 students who just returned from Mexico had tested positive for influenza and that the cases are "likely" to be swine flu. A 11:36 EDT, CNN reported that officials in New Zealand said 25 students and teachers at Auckland's Rangitoto College returned from a 3-week-long trip to Mexico via Los Angeles on Saturday (April 25). Fourteen have shown flu-like symptoms. It is not clear whether anyone else who was on the plane with them has shown signs of the disease.
Canada: At 4:40 PM EDT, the reported that Canadian health officials have confirmed 6 cases of swine flu in British Columbia and Nova Scotia. None have required hospitalization.
Other countries: Unconfirmed cases in several other countries, including France, Spain, and Israel.
U.S. Department of Health and Human Services. Determination that a Public Health Emergency Exists. https://www.phe.gov/emergency/news/healthactions/phe/Pages/h1n1.aspx. April 26, 2009.
Bradsher K, Healy J. U.S. declares public health emergency over swine flu. New York Times. April 26, 2009.
Courtney B. Waiving EMTALA sanctions in response to public health emergencies. Biosecur Bioterror 2008;6(3):213-217.
CDC confirms cases of swine flu at Queens school. New York One. April 26, 2009. . Accessed April 26, 2009.
Ohioan tests positive for swine flu [news release]. Columbus, OH; Ohio Department of Health. April 26, 2009. /. Accessed April 26, 2009.