Swine H1N1 Explosion in United States

[HenryN]

Re: Swine H1N1 Explosion in United States

this is no more than a bad seasonal wave in New York, Boston so far, right ?
Is it worse than 2003/2004 seasonal H3N2 ?
(which maybe would have been considered a pandemic epidemiologically,
but it was still the old H3N2)

and apparantly it is going down, at least in New York (revere,05.Jun)
and nationwide (CDC, Schuchat 26.May)

also down in Mexico (Cordoba,02.May)
and ("probably") in Canada (Butler Jones,19.May)

Please.

[HenryN]

Re: Swine H1N1 Explosion in United States

2008-2009 Influenza Season Week 21 ending May 30, 2009
All data are preliminary and may change as more reports are received.
(Due to the response to the novel influenza A (H1N1) investigation, surveillance regions were changed from Census Divisions to Department of Health and Human Services (HHS) Regions.)
Synopsis:

During week 21 (May 24 - 30, 2009), influenza activity decreased in the United States, however, there are still higher levels of influenza-like illness than is normal for this time of year.

• Two thousand seventy-four (31.1%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Five influenza-associated pediatric deaths were reported.
• The proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. Three of the 10 surveillance regions reported ILI at or above their region-specific baseline.
• Five states reported geographically widespread influenza activity, 10 states reported regional influenza activity, the District of Columbia and 14 states reported local influenza activity, and 21 states reported sporadic influenza activity.

<TABLE class=table border=0 cellSpacing=0 cellPadding=3 align=center><CAPTION>National and Regional Summary of Select Surveillance Components

</CAPTION><TBODY><TR vAlign=top><TH vAlign=bottom rowSpan=2 width=85>

HHS Surveillance Regions*

</TH><TH width=260 colSpan=3 noWrap align=middle>Data for current week</STRONG></TH><TH width=280 colSpan=7 noWrap align=middle>Data cumulative for the season</TH></TR><TR vAlign=center><TH width=72 align=middle>Out-patient ILI?</TH><TH width=70 align=middle>% positive for flu?</TH><TH width=75 align=middle>Number of jurisdictions reporting regional or widespread activity?</TH><TH width=58 noWrap align=middle>A (H1)</TH><TH width=58 noWrap align=middle>A (H3)</TH><TH width=58 noWrap align=middle>Novel A (H1N1)</TH><TH width=58 noWrap align=middle>A (could not be subyped)?</TH><TH width=60 align=middle>A(Unsub-typed)</TH><TH width=55 noWrap align=middle>B</TH><TH width=55 align=middle>Pediatric Deaths</TH></TR><TR><TD width=85 align=left>Nation</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>31.1 % </TD><TD width=75 noWrap align=middle>15 of 51 </TD><TD width=58 noWrap align=middle>7,565</TD><TD width=58 noWrap align=middle>1,992</TD><TD width=58 noWrap align=middle>6,247</TD><TD width=58 noWrap align=middle>691</TD><TD width=60 noWrap align=middle>12,536</TD><TD width=55 noWrap align=middle>10,231</TD><TD width=55 noWrap align=middle>67</TD></TR><TR><TD width=85 align=left>Region I</TD><TD width=72 noWrap align=middle>Elevated</TD><TD width=72 noWrap align=middle>25.7 % </TD><TD width=75 noWrap align=middle>2 of 6</TD><TD width=58 noWrap align=middle>520</TD><TD width=58 noWrap align=middle>148</TD><TD width=58 noWrap align=middle>781</TD><TD width=58 noWrap align=middle>12</TD><TD width=60 noWrap align=middle>1,107</TD><TD width=55 noWrap align=middle>800</TD><TD width=55 noWrap align=middle>1</TD></TR><TR><TD width=85 align=left>Region II</TD><TD width=72 noWrap align=middle>Elevated</TD><TD width=72 noWrap align=middle>23.8 % </TD><TD width=75 noWrap align=middle>2 of 2</TD><TD width=58 noWrap align=middle>270</TD><TD width=58 noWrap align=middle>127</TD><TD width=58 noWrap align=middle>295</TD><TD width=58 noWrap align=middle>16</TD><TD width=60 noWrap align=middle>1,311</TD><TD width=55 noWrap align=middle>710</TD><TD width=55 noWrap align=middle>8</TD></TR><TR><TD width=85 align=left>Region III</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>28.9 % </TD><TD width=75 noWrap align=middle>3 of 6</TD><TD width=58 noWrap align=middle>1,223</TD><TD width=58 noWrap align=middle>196</TD><TD width=58 noWrap align=middle>461</TD><TD width=58 noWrap align=middle>265</TD><TD width=60 noWrap align=middle>624</TD><TD width=55 noWrap align=middle>1,351</TD><TD width=55 noWrap align=middle>9</TD></TR><TR><TD width=85 align=left>Region IV</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>11.8 % </TD><TD width=75 noWrap align=middle>2 of 8</TD><TD width=58 noWrap align=middle>808</TD><TD width=58 noWrap align=middle>98</TD><TD width=58 noWrap align=middle>169</TD><TD width=58 noWrap align=middle>33</TD><TD width=60 noWrap align=middle>1,754</TD><TD width=55 noWrap align=middle>1,190</TD><TD width=55 noWrap align=middle>6</TD></TR><TR><TD width=85 align=left>Region V</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>32.8 % </TD><TD width=75 noWrap align=middle>1 of 6</TD><TD width=58 noWrap align=middle>1,630</TD><TD width=58 noWrap align=middle>174</TD><TD width=58 noWrap align=middle>3,171</TD><TD width=58 noWrap align=middle>103</TD><TD width=60 noWrap align=middle>500</TD><TD width=55 noWrap align=middle>1,294</TD><TD width=55 noWrap align=middle>11</TD></TR><TR><TD width=85 align=left>Region VI</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>10.2 % </TD><TD width=75 noWrap align=middle>1 of 5</TD><TD width=58 noWrap align=middle>737</TD><TD width=58 noWrap align=middle>107</TD><TD width=58 noWrap align=middle>361</TD><TD width=58 noWrap align=middle>4</TD><TD width=60 noWrap align=middle>3,998</TD><TD width=55 noWrap align=middle>2,561</TD><TD width=55 noWrap align=middle>12</TD></TR><TR><TD width=85 align=left>Region VII</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>12.4 % </TD><TD width=75 noWrap align=middle>0 of 4</TD><TD width=58 noWrap align=middle>496</TD><TD width=58 noWrap align=middle>57</TD><TD width=58 noWrap align=middle>126</TD><TD width=58 noWrap align=middle>174</TD><TD width=60 noWrap align=middle>458</TD><TD width=55 noWrap align=middle>526</TD><TD width=55 noWrap align=middle>0</TD></TR><TR><TD width=85 align=left>Region VIII</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>14.8 % </TD><TD width=75 noWrap align=middle>1 of 6</TD><TD width=58 noWrap align=middle>469</TD><TD width=58 noWrap align=middle>208</TD><TD width=58 noWrap align=middle>373</TD><TD width=58 noWrap align=middle>53</TD><TD width=60 noWrap align=middle>1,444</TD><TD width=55 noWrap align=middle>491</TD><TD width=55 noWrap align=middle>6</TD></TR><TR><TD width=85 align=left>Region IX</TD><TD width=72 noWrap align=middle>Normal</TD><TD width=72 noWrap align=middle>19.6 % </TD><TD width=75 noWrap align=middle>3 of 4</TD><TD width=58 noWrap align=middle>1,045</TD><TD width=58 noWrap align=middle>600</TD><TD width=58 noWrap align=middle>356</TD><TD width=58 noWrap align=middle>13</TD><TD width=60 noWrap align=middle>1,007</TD><TD width=55 noWrap align=middle>649</TD><TD width=55 noWrap align=middle>13</TD></TR><TR><TD width=85 align=left>Region X</TD><TD width=72 noWrap align=middle>Elevated</TD><TD width=72 noWrap align=middle>27.2 % </TD><TD width=75 noWrap align=middle>0 of 4</TD><TD width=58 noWrap align=middle>367</TD><TD width=58 noWrap align=middle>277</TD><TD width=58 noWrap align=middle>154</TD><TD width=58 noWrap align=middle>18</TD><TD width=60 noWrap align=middle>333</TD><TD width=55 noWrap align=middle>659</TD><TD width=55 noWrap align=middle>1</TD></TR></TBODY></TABLE>
* HHS regions (Region I: CT, ME, MA, NH, RI, VT; Region II: NJ, NY, Puerto Rico, US Virgin Islands; Region III: DE, DC, MD, PA, VA, WV; Region IV: AL, FL, GA, KY, MS, NC, SC, TN; Region V: IL, IN, MI, MN, OH, WI; Region VI: AR, LA, NM, OK, TX; Region VII: IA, KS, MO, NE; Region VIII: CO, MT, ND, SD, UT, WY; Region IX: AZ, CA, Guam, HI, NV; and Region X: AK, ID, OR, WA)
? Elevated means the % of visits for ILI is at or above the national or region-specific baseline
? National data are for current week; regional data are for the most recent three weeks
? Includes all 50 states and the District of Columbia
? The majority of influenza A viruses that cannot be sub-typed as seasonal influenza viruses are novel A (H1N1) influenza viruses upon further testing
U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza.
During the 2008-09 season, influenza A (H1), A (H3), and B viruses have co-circulated in the United States. On April 15 and 17, 2009, CDC confirmed that two cases of febrile respiratory illness occurring in children who reside in adjacent counties in southern California were caused by infection with a novel influenza A (H1N1) virus. As of June 5, 2009, 13,217 confirmed and probable infections with novel influenza A (H1N1) virus have been identified by CDC and state and local public health departments. Reporting of novel influenza A (H1N1) viruses by U.S. WHO collaborating laboratories began during week 17. The results of tests performed during the current week are summarized in the table below.
<TABLE class=table border=0 cellSpacing=0 cellPadding=2 align=center><TBODY><TR><TH width=225 align=left></TH><TH width=150 noWrap align=middle>Week 21</TH></TR><TR><TD width=225 align=left>No. of specimens tested</TD><TD width=150 noWrap align=middle>6,679</TD></TR><TR><TD width=225 align=left>No. of positive specimens (%)</TD><TD width=150 noWrap align=middle>2,074 (31.1%)</TD></TR><TR><TD colSpan=2 align=left>Positive specimens by type/subtype</TD></TR><TR><TD width=225 align=left> Influenza A</TD><TD width=150 noWrap align=middle>2,057 (99.2%)</TD></TR><TR><TD width=225 align=left> A (H1)</TD><TD width=150 noWrap align=middle> 4 (0.2%)</TD></TR><TR><TD width=225 align=left> A (H3)</TD><TD width=150 noWrap align=middle> 36 (1.8%)</TD></TR><TR><TD width=225 align=left> A (unsubtyped)</TD><TD width=150 noWrap align=middle> 311 (15.1%)</TD></TR><TR><TD width=225 align=left> A (could not be subtyped)</TD><TD width=150 noWrap align=middle> 148 (7.2%)</TD></TR><TR><TD width=225 align=left> A (novel influenza H1N1)</TD><TD width=150 noWrap align=middle> 1,558 (75.7%)</TD></TR><TR><TD width=220 align=left> Influenza B</TD><TD width=150 noWrap align=middle>17 (0.8%)</TD></TR></TBODY></TABLE>
During week 21, seasonal influenza A (H1), A (H3), and B viruses continue to co-circulate at low levels with novel influenza A (H1N1). Approximately 82% of all influenza viruses being reported to CDC this week are novel influenza A (H1N1) viruses.
The increase in the percentage of specimens testing positive for influenza by WHO and NREVSS collaborating laboratories may be due in part to changes in testing practices by health care providers, triaging of specimens by public health laboratories, an increase in the number of specimens collected from outbreaks, and other factors.


<CENTER>
View WHO-NREVSS Regional Bar Charts| View Chart Data | View Full Screen </CENTER>Antigenic Characterization:

CDC has antigenically characterized 1,567 seasonal human influenza viruses [947 influenza A (H1), 162 influenza A (H3) and 458 influenza B viruses] collected by U.S. laboratories since October 1, 2008, and 84 novel influenza A (H1N1) viruses.
All 947 influenza seasonal A (H1) viruses are related to the influenza A (H1N1) component of the 2008-09 influenza vaccine (A/Brisbane/59/2007). All 162 influenza A (H3N2) viruses are related to the A (H3N2) vaccine component (A/Brisbane/10/2007).
All 84 novel influenza A (H1N1) viruses are related to the A/California/07/2009 (H1N1) reference virus selected by WHO as a potential candidate for novel influenza A (H1N1) vaccine.
Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Sixty-one influenza B viruses tested belong to the B/Yamagata lineage and are related to the vaccine strain (B/Florida/04/2006). The remaining 397 viruses belong to the B/Victoria lineage and are not related to the vaccine strain.
Data on antigenic characterization should be interpreted with caution given that antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.
Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza B viruses. Antigenic characterization of novel influenza A (H1N1) viruses indicates that these viruses are antigenically and genetically unrelated to seasonal influenza A (H1N1) viruses, suggesting that little to no protection would be expected from vaccination with seasonal influenza vaccine.
Antiviral Resistance:

Since October 1, 2008, 930 seasonal influenza A (H1N1), 172 influenza A (H3N2), and 491 influenza B viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). Nine hundred fifty-eight seasonal influenza A (H1N1) and 166 influenza A (H3N2) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). One hundred fifty-six novel influenza A (H1N1) viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). One hundred twenty-five novel influenza A (H1N1) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). The results of antiviral resistance testing performed on these viruses are summarized in the table below.
<TABLE class=table border=0 cellSpacing=0 cellPadding=3 align=center><TBODY><TR><TH width=160 align=left></TH><TH width=100 noWrap align=middle>Isolates tested (n)</TH><TH width=200 colSpan=2 noWrap align=middle>Resistant Viruses,
Number (%)</TH><TH width=100 noWrap align=middle>Isolates tested (n)</TH><TH width=120 noWrap align=middle>Resistant Viruses, Number (%)</TH></TR><TR><TH width=160 align=left></TH><TH width=100 noWrap align=middle></TH><TH width=100 noWrap align=middle>Oseltamivir</TH><TH width=100 noWrap align=middle>Zanamivir</TH><TH width=100 noWrap align=middle></TH><TH width=120 noWrap align=middle>Adamantanes</TH></TR><TR><TD width=160 noWrap align=left>Seasonal Influenza A (H1N1)</TD><TD width=100 noWrap align=middle>930</TD><TD width=100 noWrap align=middle>925 (99.5%)</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>958</TD><TD width=120 noWrap align=middle>5 (0.5%)</TD></TR><TR><TD width=160 noWrap align=left>Influenza A (H3N2)</TD><TD width=100 noWrap align=middle>172</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>166</TD><TD width=120 noWrap align=middle>166 (100%)</TD></TR><TR><TD width=160 noWrap align=left>Influenza B</TD><TD width=100 noWrap align=middle>491</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>N/A*</TD><TD width=120 noWrap align=middle>N/A*</TD></TR><TR><TD width=160 noWrap align=left>Novel Influenza A (H1N1)</TD><TD width=100 noWrap align=middle>156</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>0 (0)</TD><TD width=100 noWrap align=middle>125</TD><TD width=120 noWrap align=middle>125 (100%)</TD></TR></TBODY></TABLE> <SUP>*The adamantanes (amantadine and rimantadine) are not effective against influenza B viruses. </SUP>



Antiviral treatment with either oseltamivir or zanamivir is recommended for all patients with confirmed, probable or suspected cases of novel influenza A (H1N1) virus infection who are hospitalized or who are at higher risk for seasonal influenza complications. The novel influenza A (H1N1) virus is susceptible to both neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. It is resistant to the adamantane antiviral medications, amantadine and rimantadine. Additional information on antiviral recommendations for treatment and chemoprophylaxis of novel influenza A (H1N1) infection is available at http://www.cdc.gov/h1n1flu/recommendations.htm
In areas that continue to have seasonal influenza activity, especially those with circulation of oseltamivir-resistant seasonal human influenza A (H1N1) viruses, clinicians might prefer to use either zanamivir or a combination of oseltamivir and either rimantadine or amantadine to provide adequate empiric treatment or chemoprophylaxis for patients who might have seasonal human influenza A (H1N1) virus infection.
Pneumonia and Influenza (P&I) Mortality Surveillance

During week 21, 6.3% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage is below to the epidemic threshold of 7.1% for week 21.
<CENTER>
View Full Screen</CENTER>Influenza-Associated Pediatric Mortality

Five influenza-associated pediatric deaths were reported to CDC during week 21 (Arizona [2], California, Colorado, and Illinois). Three of these deaths were associated with confirmed infections with novel influenza A (H1N1) viruses; one was confirmed as seasonal influenza A (H1N1), and one was confirmed as an influenza A virus (subtype unknown). The deaths reported this week occurred between February 8, 2009 and May 26, 2009. Since September 28, 2008, CDC has received 67 reports of influenza-associated pediatric deaths that occurred during the current influenza season.
Of the 33 children who had specimens collected for bacterial culture from normally sterile sites, 14 (42.4%) were positive; Staphylococcus aureus was identified in nine (64.3%) of the 14 children. One of the three children with confirmed novel influenza A (H1N1) infection had a specimen collected from a normally sterile site; bacterial cultures were negative. Four of the S. aureus isolates were sensitive to methicillin and five were methicillin resistant. Twelve (85.7%) of the 14 children with bacterial coinfections were five years of age or older and 10 (71.4%) of the 14 children were 12 years of age or older. An increase in the number of influenza-associated pediatric deaths with bacterial coinfections was first recognized during the 2006-07 influenza season. In January 2008, interim testing and reporting recommendations were released regarding influenza and bacterial coinfections in children and are available at (http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00268).
<CENTER>
View Full Screen</CENTER>Influenza-Associated Hospitalizations

Laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the New Vaccine Surveillance Network (NVSN) and the Emerging Infections Program (EIP).
During October 12, 2008 to May 16, 2009, the preliminary laboratory-confirmed influenza-associated hospitalization rate for children 0-4 years old in the NVSN was 3.85 per 10,000. Because of case identification methods utilized in this study, there is a delay from the date of hospitalization to the date of report.
<CENTER>
View Full Screen</CENTER>

During April 15, 2009 ? May 30, 2009, the following preliminary laboratory-confirmed overall influenza associated hospitalization rates were reported by the EIP (rates include type A, type B, and confirmed Novel H1N1):
Rates for children aged 0-23 months, 2-4 years, 5-9 years, and 10-17 years were 0.5, 0.1, 0.1, and 0.1 per 10,000, respectively. Rates for adults aged 18-29 years, 30-49 years, and >= 50 years, the overall flu rates were 0.03, 0.04, and 0.1 per 10,000, respectively.
<CENTER>
<SUP>*This value represents an age group-specific average influenza rate from October 1 to April 30 from the 2005-06, 2006-07, and 2007-08 influenza seasons. </SUP>

View Full Screen</CENTER>Outpatient Illness Surveillance:

Nationwide during week 21, 2.0% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.4%.
<CENTER>
View ILINet Regional Charts | View Chart Data |View Full Screen
</CENTER>


On a regional level, the percentage of outpatient visits for ILI ranged from 0.6% to 6.0%. Three of the 10 surveillance regions reported an ILI percentage at or above their region specific baseline (Regions I, II and X). ILI increased during week 21 in six of 10 regions compared to week 20.
Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and novel influenza A (H1N1) viruses and does not measure the severity of influenza activity.

During week 21, the following influenza activity was reported:

• Widespread influenza activity was reported by five states (Arizona, Delaware, New Jersey, Pennsylvania, and Virginia).
• Regional influenza activity was reported by 10 states (Alabama, California, Connecticut, Hawaii, Illinois, Massachusetts, New York, South Carolina, Texas, and Utah).
• Local influenza activity was reported by the District of Columbia and 14 states (Georgia, Kansas, Maine, Maryland, Michigan, Minnesota, Nevada, North Carolina, Oklahoma, Oregon, Rhode Island, Tennessee, Washington, and Wyoming).
• Sporadic activity was reported by 21 states (Alaska, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Ohio, South Dakota, Vermont, West Virginia, and Wisconsin).

<OBJECT id=Banner classid=clsid27CDB6E-AE6D-11cf-96B8-444553540000 width=620 height=420>
























</OBJECT>
<SCRIPT type=text/javascript> var stamp = new Date() var movieurl = "/flu/weekly/smallmap/SmallFluActivity_v2.swf?c=FluMap&n=" + stamp.getTime(); var so = new SWFObject(movieurl, "Banner", "620", "420", "7"); so.write("flashALTcontent"); so.addParam("scale", "noorder"); so.addParam("allowScriptAccess","sameDomain"); so.addParam("wmode", "transparent"); so.addParam("quality", "best"); so.addParam("salign", "r"); so.addParam("type", "application/x-shockwave-flash"); </SCRIPT>

View Full Screen

--------------------------------------------------------------------------------
A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm

[Possibilities]

Re: Swine H1N1 Explosion in United States

Dr. Niman,

A federal health source was quoted as saying that the number is now 200,000. I think that's a gross underestimate and agree with yours, but at least they are saying that Novel A H1N1 has really increased from several weeks ago.

[HenryN]

Re: Swine H1N1 Explosion in United States

Dr. Niman,

A federal health source was quoted as saying that the number is now 200,000. I think that's a gross underestimate and agree with yours, but at least they are saying that Novel A H1N1 has really increased from several weeks ago.

To get close to an accuarte number, you can take the confirmed cases in the weekly report and add three zero's.

In the latest report, the number of confirmed swine H1N1 is almost 7,000, which would translate into 7 million cases in the US.

Like the earlier estimate of 100,000, the 200,000 estimate is a joke.

The nonsense numbers underplay the true spread and create "discussions" with those using the bogus numbers to make bogus points, like a decline in the infection rate.

[gsgs]

Re: Swine H1N1 Explosion in United States

of course, total, accumulated numbers do increase
(by definition)
the question is, whether the number of new cases (say-per week)
does increase.


hospitlization numbers should be useful - they can't stop
reporting hospitalization numbers, I assume.

[HenryN]

Re: Swine H1N1 Explosion in United States

of course, total, accumulated numbers do increase
(by definition)
the question is, whether the number of new cases (say-per week)
does increase.


hospitlization numbers should be useful - they can't stop
reporting hospitalization numbers, I assume.

The hospitalization numbers are easy underestimate because of false negatives. Three of the recent fatalities initially tested negative. The two in El Paso were only positive at autopsy, and the Detroit case tested negative 3X before going to a new hospital and testing positve prior to death.

[gsgs]

Re: Swine H1N1 Explosion in United States

CDC numbers for the US-states are here:

http://www.cdc.gov/h1n1flu/update.htm

you can check for more actual numbers for certain state here:

http://www.cdc.gov/h1n1flu/states.htm

and then e.g. Wisconsin, their last report is from week 20:

http://pandemic.wisconsin.gov/docview.asp?docid=16834&locid=106

[gsgs]

Re: Swine H1N1 Explosion in United States

7 million is a lot

Assume 1 week per disease and 30% of US-population infected
in this wave

look at the seasonal chart:

http://www.cdc.gov/flu/weekly/

about one eigth of the total positives per season are reported in the peak week.

that would give 56M infected in this wave or 19% !
_If_ we were already at the peak

and in many regions there is still almost nothing

[HenryN]

Re: Swine H1N1 Explosion in United States

CDC numbers for the US-states are here:

http://www.cdc.gov/h1n1flu/update.htm

you can check for more actual numbers for certain state here:

http://www.cdc.gov/h1n1flu/states.htm

and then e.g. Wisconsin, their last report is from week 20:
http://pandemic.wisconsin.gov/docvie...6834&locid=106

Wisconsin used to report daily numbers for each county. Those reports have stopped and none of the above links have any type of breakdown. Wisconsin, like all other states has a specific swine H1N1 page, which is in addition the to weekly surveillence report linked above.

The Wisconsin H1N1 site is here

http://pandemic.wisconsin.gov/

However, there are no longer any daily updates or distributions within counties.

The most current outbreak specifics are on this map through May 27

http://pandemic.wisconsin.gov/docview.asp?docid=16676&locid=106

which details the 1427 cases confirmed then. There is no data on the 790 cases confirmed since May 27.

[Diane Morin]

Re: Swine H1N1 Explosion in United States

Considering it was a question of Canada sometimes here, I allow myself to bring my observations. The progression of the cases depends on the provinces. Nova Scotia and the Colombia-British which knew fast rises at the beginning do not progress almost any more. On the other hand Ontario and Quebec progress constantly.

Butler-Jones probably had reason for Nova Scotia and the Colombia-British but it underestimated Ontario and Quebec. And now, the eyes are rivetted on the provinces of the Prairies (Alberta, Saskatchewan, Manitoba) like in the territories of North (Yukon, Territoires of the North-West and Nunavut)


<AREA shape=POLY alt=Yukon coords=57,112,53,101,4,162,59,194,59,186,52,174 href="http://www.hss.gov.yk.ca/programs/nursing/health_officer/swine_influenza/" ,128><AREA shape=POLY alt=Terre-Neuve-et-Labrador coords=291,189,311,221,298,228,309,247,350,223 href="http://www.health.gov.nl.ca/health/hsi/default.htm" ,231,350,261,376,254,393,251,400,224,351,213,323,2 08,307,197,289,181><AREA shape=POLY alt=Nunavut coords=194,237,228,248,223,211,228,182,280,182 href="http://www.gov.nu.ca/health/" ,157,278,138,245,113,209,96,204,61,212,23,185,21,1 57,41,114,62,100,86,92,102,99,123,96,142,118,169,1 46,183,144,214,169,216><AREA shape=POLY alt=Nouveau-Brunswick coords=323,294,332,299,339,284,332,269,318,276 href="http://www.gnb.ca/cnb/Promos/Flu/index-f.asp" ,281><AREA shape=POLY alt=&#206;le-du-Prince-&#201;douard coords=352,273,349,279,342,286,336,274,336,265 href="http://www.gov.pe.ca/health/index.php3" ,264><AREA shape=POLY alt=Alberta coords=74,201,112,213,95,296,76,293,59,248,66,229 href="http://www.health.alberta.ca/"><AREA shape=POLY alt=Manitoba coords=145,219,171,219,196,241,171,275,173,305 href="http://www.manitoba.ca" ,305><AREA shape=POLY alt=Nouvelle-&#201;cosse coords=355,300,371,294,370,277,357,267,355,283 href="http://www.gov.ns.ca/hpp/cdpc/swine-influenza.asp" ,291,342,298,339,307,345,310><AREA shape=POLY alt="Territoires du Nord-Ouest" coords=67,113,80,111,98,127,94,142,117,169,145,183 href="http://www.hlthss.gov.nt.ca/english/services/communicable_disease_control_program/human_swine_flu.htm" ,142,216,109,210,59,192,51,175,49,149,54,105><AREA shape=POLY alt=Colombie-Britannique coords=9,166,74,202,61,248,77,292,37,278,34,283 href="http://www.gov.bc.ca/govt/swine_flu.html" ,280,1,230><AREA shape=POLY alt=Saskatchewan coords=113,212,144,216,139,303,96,297,113,211 href="http://www.health.gov.sk.ca/influenza-monitor"><AREA shape=POLY alt=Ontario coords=217,249,231,250,252,276,262,312,293,313 href="http://www.health.gov.on.ca/indexf.html" ,342,251,353,251,328,232,314,210,310,194,312,178,3 06,176,274,200,242><AREA shape=POLY alt=Qu&#233;bec coords=252,274,260,308,290,310,292,313,308,306 href="http://www.msss.gouv.qc.ca/index.php" ,288,315,280,330,270,343,255,347,234,357,217,350,2 16,350,216,346,210,343,225,330,235,313,245,305,242 ,296,225,310,222,288,183,270,185,237,183,233,193,2 37,241>As of June 5, 2009, a total of 2,115 laboratory-confirmed cases of H1N1 flu virus have been reported in 9 provinces and 3 territories in Canada (see Table 1 below).
En date du 05 juin 2009, un total de 2 115 cas de virus H1N1 confirm&#233;s en laboratoire tel que signal&#233; par 9 provinces et 3 territoires au Canada (voir Tableau 1 ci-dessous).

http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php

<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p>Dated June 5, Ontario counts for half of the Canadian cases (1078/2115) and with Quebec these two provinces cumulate approximately 3/4 of the cases (1515/2115).</o:p>
<o:p></o:p>
<o:p></o:p>
<o:p></o:p>
<o:p>
</o:p><o:p>
Here the number of cases declared per day between on April 28 and on June 5 in Ontario.

4,3,1,4,2,2,15,12,13,0,6,14,0,34,3,6,36,32,0,0,0,0 ,85,12,10,0,0,58,19,124,0,131,0,0, 89,0,179,0,184 (total = 1078)


Week 17: 14=4+3+1+4+2
Week 18: 62=2+15+12+13+0+6+14
Week 19: 111=0+34+3+6+36+32+0
Week 20: 107=0+0+0+85+12+10+0
Week 21: 332= 0+58+19+124+0+131+0
Week 22: 452=0+89+0+179+0+184+0


Here the number of case declared per day enters the 1<SUP>er</SUP> May and on June 6 in Quebec.

1,1,1,0,1,6,1,4,0,0,1,9,1,12,9,24,0,16,12,7,15,22, 15,9,17,8,14,21,25,12,18,25,2,35,34,57,25 (total = 460)


Week 17: 2=1+1
Week 18: 13=1+0+1+6+1+4
Week 19: 56=0+1+9+1+12+9+24
Week 20: 87=0+16+12+7+15+22+15
Week 21: 106=9+17+8+14+21+25+12
Week 22: 196=18+25+2+35+34+57+25




15-05-09: Doctor Poirier also announced the modification of the management of the cases of Influenza A (H1N1), the passage of the individual approach to the populationnelle approach. This which means that only the people seized up who are hospitalized or allowed with the urgency since at least 24 hours will be the subject of an investigation by the authorities of public health. To see it official statement.

http://www.flutrackers.com/forum/showpost.php?p=233636&postcount=130


*********************************

Vu qu’il &#233;tait question du Canada parfois ici, je me permets d’apporter mes observations. La progression des cas d&#233;pend des provinces. La Nouvelle-&#201;cosse et la Colombie-Britannique qui ont connu des mont&#233;es rapides au d&#233;but ne progressent presque plus. Par contre l’Ontario et le Qu&#233;bec progressent constamment.


<o:p></o:p>
Butler-Jones avait probablement raison pour la Nouvelle-&#201;cosse et la Colombie-Britannique mais il a sous-estim&#233; l’Ontario et le Qu&#233;bec. Et maintenant, les yeux sont riv&#233;s sur les provinces des Prairies (Alberta, Saskatchewan, Manitoba) ainsi que dans les territoires du Nord (Yukon, Territoires du Nord-Ouest et Nunavut).


<o:p></o:p>

En date du 5 juin, l’Ontario compte pour la moiti&#233; des cas canadiens ( 1078/2115) et avec le Qu&#233;bec ces deux provinces cumulent environ 3/4 des cas (1515/2115).

<o:p></o:p>
Voici le nombre de cas d&#233;clar&#233;s par jour entre le 28 avril et le 5 juin en Ontario.

<o:p></o:p>
4,3,1,4,2,2,15,12,13,0,6,14,0,34,3,6,36,32,0,0,0,0 ,85,12,10,0,0,58,19,124,0,131,0,0, 89,0,179,0,184 (total = 1078)


Semaine 17: 14=4+3+1+4+2
Semaine 18: 62=2+15+12+13+0+6+14
Semaine 19: 111=0+34+3+6+36+32+0
Semaine 20: 107=0+0+0+85+12+10+0
Semaine 21: 332= 0+58+19+124+0+131+0
Semaine 22: 452=0+89+0+179+0+184+0


<o:p></o:p>
Voici le nombre de cas d&#233;clar&#233; par jour entre le 1<SUP>er</SUP> mai et le 6 juin au Qu&#233;bec.

<o:p></o:p>
1,1,1,0,1,6,1,4,0,0,1,9,1,12,9,24,0,16,12,7,15,22, 15,9,17,8,14,21,25,12,18,25,2,35,34,57,25 (total = 460)


Semaine 17: 2=1+1
Semaine 18: 13=1+0+1+6+1+4
Semaine 19: 56=0+1+9+1+12+9+24
Semaine 20: 87=0+16+12+7+15+22+15
Semaine 21: 106=9+17+8+14+21+25+12
Semaine 22: 196=18+25+2+35+34+57+25

15-05-09 : Le docteur Poirier a &#233;galement annonc&#233; la modification de la gestion des cas de Grippe A (H1N1), le passage de l’approche individuelle &#224; l’approche populationnelle. Ce qui signifie que seules les personnes gripp&#233;es qui sont hospitalis&#233;es ou admises &#224; l’urgence depuis au moins 24 heures feront l’objet d’une investigation par les autorit&#233;s de sant&#233; publique.Lire le communiqu&#233;.

<o:p></o:p>http://www.flutrackers.com/forum/showpost.php?p=233636&postcount=130
</o:p>

[gsgs]

Re: Swine H1N1 Explosion in United States

thanks, Muscade. Do you have the numbers for othr provinces/regions ?


7 day-average of new cases:



none of these two look anyhow declining

[HenryN]

Re: Swine H1N1 Explosion in United States

7 million is a lot

Assume 1 week per disease and 30% of US-population infected
in this wave

look at the seasonal chart:

http://www.cdc.gov/flu/weekly/

about one eigth of the total positives per season are reported in the peak week.

that would give 56M infected in this wave or 19% !
_If_ we were already at the peak

and in many regions there is still almost nothing

The numbers are really quite straight forward. US population is 300 million. 10% infected with flu in a year is about 30 million. Number of confirmed flu cases a year is about 30,000.

To get from confirmed to actual, just add three zero's.

[gsgs]

Re: Swine H1N1 Explosion in United States

well, we had increased testing this year.
And the positives rate is quite high for M**flu
and that would give the cumulated number of cases,
including the recovered ones

[Diane Morin]

Re: Swine H1N1 Explosion in United States



http://www.ijc.org/rel/boards/cde/finalreport/Carteavecvillesfra.jpg


I observed that there is much case around the Large-Lakes on the two sides of the border. Here two readings at one week of interval is on May 29 and on June 5, 2009. The increase is very substantial (over 50&#37

J’ai observ&#233; qu’il y a beaucoup de cas autour des Grands-Lacs des deux c&#244;t&#233;s de la fronti&#232;re. Voici deux lectures &#224; une semaine d’intervalle soit le 29 mai et le 5 juin 2009. L’augmentation est tr&#232;s substantielle (plus de 50%)

Case around the Large-Lakes (4,421 cases and 7 dead): data of May 29 2009


Cas autour des Grands-Lacs (4,421 cas et 7 morts): donn&#233;es du 29 mai 2009


&#201;TATS-UNIS:

Minnesota: 49 cas

Wisconsin: 1430 cas

Illinois: 1002 cas (2 morts)

Michigan: 229 cas

Indiana: 138 cas

Ohio: 18 cas

Pennsylvanie: 123 cas

New York: 553 cas (4 morts)


CANADA:

Ontario: 626 cas (1 mort)

Qu&#233;bec: 253 cas


<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p>Case around the Large-Lakes (6,834 cases and 16 dead): data of June 5, 2009</o:p>
<o:p>

</o:p>Cas autour des Grands-Lacs (6,834 cas et 16 morts): donn&#233;es du 5 juin 2009


&#201;TATS-UNIS:

Minnesota: 82 cas

Wisconsin: 2217 cas

Illinois: 1357 cas (5 morts)

Michigan: 298 cas (1 mort)

Indiana: 173 cas

Ohio: 35 cas

Pennsylvanie: 299 cas

New York: 858 cas (8 morts)


CANADA:

Ontario: 1078 cas (2 morts)

Qu&#233;bec: 437 cas

[gsgs]

Re: Swine H1N1 Explosion in United States

because of early introduction ?

A/CA/05/2009-03-30
A/Mexico/4008/2009-04-03

both had the "2 Northern Mutations" A1741C(3) and C1118T(5)