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Utah public health gives CDC fall severity estimate

AlaskaDenise

In Memoriam
Tea PMed me a link to this part of the current Utah public health swine flu information release.

http://health.utah.gov/epi/h1n1flu/sitrep062409.pdf

o CDC is now estimating that the novel H1N1 virus will be “Category 2” in severity. They are closely watching the situation in the Southern Hemisphere for validation of this estimate.
 A category 2 pandemic has the following characteristics:
• Case fatality ratio of 0.1 percent to less than 0.5 percent.
• Between 90,000 and 450,000 deaths in the U.S. (compared with estimated 36,000 deaths during a typical influenza season).
• Excess death rate of between 30 to less than 150 per 100,000 people.
• Illness rate of between 20 and 40 percent.
• Similar to 1957 pandemic.

I don't want to post this unless we see it come from CDC. Is it possible that utah is doing a little speculating?

I couldn't find it in a CDC search.

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Re: CDC category 2???

Re: CDC category 2???

This should be posted - It is already in the public domain and it will only be a few hours before someone else posts it.

If it is true, the sooner people realize the potential severity the better. If it is false, then let the CDC tells why it will only be a mild flu season in the coming months.
 
Re: Utah public health gives CDC fall severity estimate

I don't want to post this unless we see it come from CDC. Is it possible that utah is doing a little speculating?
.

I've seen it referenced in several stories - go for it. And speculation - yeah, I'd like to see the supporting data. Utah or New York would probably have best guess though. They must be sitting on mounds of data.
 
Re: Utah public health gives CDC fall severity estimate

Utah could be biased by their own data, they are less likely
to look at the national picture.
We often saw such things in the past.
 
Re: Utah public health gives CDC fall severity estimate

They implied the source was CDC, so perhaps there is some relevent similar CDC news about to be released.

My concern is that the information presents the top death count as 450,000 for the US alone. Given that 1957 had 2 million worldwide, are they saying the death rate will exceed 1957? (while adjusting for population increase)

Also that top number is about 12 times the seasonal rate. It's not just the deaths, but also the impact on health services, businesses, etc. at a time when the global economy is already sick itself. If they're convinced this will occur in the 2009/2010 northern hemisphere flu season, that gives the north no more than 5 months to prepare - manufacturing more antivirals, etc.

Which season are they projecting this increase to hit? This coming one, or the following year? When those changes become widespread determines the timeframe for preparation and impact.

.
 
Re: Utah public health gives CDC fall severity estimate

The projection assumes the absence of an effective vaccine, right?

It's hard to say, since this isn't an offical CDC release (yet).

The vaccine answer may depend on which mutations it makes.

Even if there is an effective vaccine, will there be sufficient supply, and will it be available in time?

Maybe all of the above is why there is such a large difference in the numbers - from 90,000 to 450,000 in the US alone.

.
 
Re: Utah public health gives CDC fall severity estimate

Now that they've cried wolf over H5N1 and the early novel H/H1N1 outbreak news, I wonder how the public will react to the new information.

added later: I was referring to the public's perception as being that authories have cried wolf.
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Re: Utah public health gives CDC fall severity estimate

But we continue to lack of information about real case-fatality rate.

We may calculate a raw estimate of current CFR based on WHO data - grossly understimate - but the value is not predictive: 4 per 1,000 laboratory-confirmed cases.

The CFR of a future 2nd or 3rd wave may be influenced by actual number of people who have been infected during this first wave.

So a correct estimate of the incidence of novel H1N1v in USA during the last three months should provide some indications about a possible partial immunologic protection of these people against future waves.
 
Re: Utah public health gives CDC fall severity estimate

IOH:

Do you feel confident that the virus will not mutate fast enough to remove that immunity acquired by early infections?

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Re: Utah public health gives CDC fall severity estimate

IOH:

Do you feel confident that the virus will not mutate fast enough to remove that immunity acquired by early infections?

.

We cannot speculate about possible mutations.

But if the first ''pass'' has elicited a robust immune response, then it may provide some protection about future drift variants; enough to save a life, perhaps.

Obviously, if we would have a new subtype (such as an H5, H9, H7, H3...) the problem could be much worse.

I think that the first ''pass'' plus the background previous human H1N1 viruses derived immunity could protect better against drift variants.

The problem is how to measure this immune protection: is it feasible? Is it valuable the HI titers in ferrets studies?

Clearly, these studies are eagerly awaited.
 
Re: Utah public health gives CDC fall severity estimate

But we continue to lack of information about real case-fatality rate.

We may calculate a raw estimate of current CFR based on WHO data - grossly understimate - but the value is not predictive: 4 per 1,000 laboratory-confirmed cases.

The CFR of a future 2nd or 3rd wave may be influenced by actual number of people who have been infected during this first wave.

So a correct estimate of the incidence of novel H1N1v in USA during the last three months should provide some indications about a possible partial immunologic protection of these people against future waves.

I agree.

We can be happy to see that the vast majority of cases is cured, with antivirals of cured by themselves.

At the moment for me it would be important to know more about the serious cases. We don't have sufficient information on these.

At one hand we seem to have patients with "underlying" health problems , like asthma, diabetes, obesitas, heart problems.

On the other hand we read scaring stories on apparently healthy young adults and children, who are very ill or even die.

A low or very low CFR is hardly relevant if it is your child .
 
Re: Utah public health gives CDC fall severity estimate

Maybe the underlying assumption is Tamiflu resistance. That alone, perhaps, could account for a much higher CFR
 
Re: Utah public health gives CDC fall severity estimate

the best example which we have so far is New York.

An estimated 1M people infected, ~50 deaths (per wave)
CFR=0.005% , 1/200 that of seasonal flu (per year)
 
Re: Utah public health gives CDC fall severity estimate

Here is another link from the Academy of Family Physicians that quotes from a CDC source that we are now at category 2 pandemic. I believe that the CDC is now sending out private reports to the health authorities only, not listing this information on their website in in order to control the amount of information that we can easily access.

The information is listed in bold below.


http://www.aafp.org/online/en/home/...inical-care-research/20090612h1n1-pandem.html

WHO Declares Pandemic, But Little Else Changes

Switch Reflects Spread of Virus, Not Severity or Mutation
By David Mitchell
6/12/2009

The World Health Organization, or WHO, raised its influenza pandemic alert to its highest level -- phase six -- on June 11, but the distinction is not expected to have much immediate impact on how public health officials, physicians and others deal with the novel H1N1 influenza virus in the United States. Still, says one Academy leader, it offers FPs an opportunity to examine their practices' current pandemic readiness levels.

"This just reminds us that practices need to review their pandemic flu plans," said Herbert Young, M.D., director of the AAFP Scientific Activities Division. "Members may wish to access the documents in the AAFP Resources section of the H1N1 Flu page."

The WHO's move comes as no surprise to federal health officials.

"We've been reacting as though we're in a pandemic already in terms of the intensity of our efforts to prepare as individuals and respond as a nation," said Anne Schuchat, M.D., interim deputy director for the CDC's Science and Public Health Program, in a June 11 news conference.

Schuchat said there are more than 13,000 probable and confirmed cases of infection attributed to the H1N1 virus in the United States, with more than 1,000 hospitalizations and 27 deaths.

During the news conference, CDC Director Thomas Frieden, M.D., M.P.H, stressed that the change in the WHO's pandemic level does not reflect any change in the illness itself.

"This doesn't mean there's any difference in the level of severity of the flu," Frieden said. "This is not, at this point, a flu that's anywhere near as severe as the 1918 pandemic, for example."

It also doesn't mean that the virus has mutated, he added, and the CDC has not changed any of its physician guidance on identifying and treating H1N1-infected patients based on the WHO's announcement.

Frieden said the WHO changed the pandemic level because this H1N1 strain is a new virus that people have little or no immunity to that has demonstrated sustained person-to-person transmission on multiple continents.

On June 10, WHO officials reported that there were 27,737 laboratory-confirmed cases, including 141 deaths, in 74 countries.

More than 21,000 of the confirmed cases were in North America, while Chile (1,694), Australia (1,224) and the United Kingdom (666) had the highest concentrations of confirmed cases elsewhere.

WHO Director-General Margaret Chan, M.D., said in a June 11 WHO news conference (8-page PDF; About PDFs) that the numbers don't tell the whole story.

"This is only part of the picture," she said. "With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place."

Chan also said in a June 11 statement that the H1N1 pandemic currently is considered moderate according to the WHO's three-tiered system of ranking pandemics as mild, moderate or severe, but she noted that situation could change.

The CDC uses a five-level pandemic severity index based on case-to-fatality ratio. The agency says the current situation ranks as a category two, with a 0.1 to <0.5 case-fatality ratio.

Schuchat said in the June 11 CDC news conference that most states are reporting a decrease in flu-like illness, with only two regions -- New England and New York-New Jersey -- above baseline for this time of year. She also reiterated that the CDC is monitoring how the virus is behaving in the Southern Hemisphere, which is at the beginning of its flu season, in preparation for the fall flu season in the Northern Hemisphere.
 
Re: Utah public health gives CDC fall severity estimate

Switch Reflects Spread of Virus, Not Severity or Mutation
By David Mitchell
6/12/2009

The World Health Organization, or WHO, raised its influenza pandemic alert to its highest level -- phase six -- on June 11

So we started out as a category 2.
 
Re: Utah public health gives CDC fall severity estimate

From the transcript of the June 12 call with businesses:

http://www.cdc.gov/H1N1flu/business/pdf/transcript6_12_09call_with_business.pdf

Stuart Brindley: Thank you again for the brief today. My question was regarding the three scale severity question. So essentially I think you have answered it but I would like to emphasize this would be very, very helpful for us moving forward if industry is going to be nimble and flexible as you have indicated. The use of a severity type index would be very, very helpful. So thanks for that consideration.

Lisa Koonin: Surely. And just let me point you to the fact that CDC did publish a severity index in 2007 when we published our Community Mitigation Guide. That is called the Pandemic Severity Index. It is based on only one parameter though and that is case fatality ratio which is the likelihood of people dying from disease.

Our scale is similar to a hurricane scale and it ranges from category one to category five with category one being least severe and category five being most severe.

So at the current time, if you wanted to look at our scale, we would estimate that the pandemic situation is equivalent to a pandemic severity index of two and this is, as Doctor Fiori said, is most similar to the 1957 influenza pandemic.

And so if you want a parameter to plan for using a scale that CDC developed, you can find that. It is on www.pandemicflu.gov and that can be something that you use as part of your planning as well.

Also see http://www.pandemicflu.gov/plan/community/commitigation.html
 
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