Weekly Report on Novel H1N1 Influenza (swine flu) as of July 16, 2009.

This Week’s Developments:

This week, DPH announced two additional deaths related to H1N1 influenza(swine flu) in our state.  These deaths are a sad reminder of how serious flu can be for some people -- both residents had underlying health conditions which put them at greater risk for complications from the flu.  We have now identified 6 deaths in Massachusetts related to H1N1 flu. 

We continue to focus our preparations on the upcoming flu season.  Today, the Boston Globe reportedon one element of our response planning: increasing our state stockpile of antiviral treatments.  Antivirals can be an important part of an overall response, however they are only one piece of a much larger effort that will be needed to prepare for the fall.  There is always a concern that flu viruses will develop resistance to antiviral treatment, and while there have been some reports of resistance with the new H1N1 flu the resistance is not believed to be widespread.

The upcoming week will be a very busy one for DPH as we meet with a variety of government and health care partners to strategize about the fall flu season planning. 

Update on Massachusetts:
There was a slight decline in doctor office visits for flu-like illness in Massachusetts last week, however the levels of flu we are detecting through surveillance are far below the peak that we saw last month.  Visits to emergency rooms that we monitor for flu-like illness have also dropped slightly from last week.  

The CDC report on flu activity throughout the nation can be found here.  The New England region is "Region One" and is described at "normal" flu activity levels as is every region throughout the country at this point.  While the flu-like illness levels have dropped significantly, we continue to see elevated influenza-like illness activity for this time of year.  Click below to see an update of our flu surveillance charts.

The chart above shows the percentage of visits for influenza-like-illness reported by health care providers in our flu surveillance network over the past 3 flu seasons.  The dotted lines show activity during the previous 2 flu seasons, and the red line shows flu activity for this year.  As you can see, the activity has dropped over the past month, but is still higher than normal.  (Click on the chart for a better view)  To compare it to last week's chart, click here.

   

The two charts above track visits to a number of emergency roomsacross the state for influenza-like illness over the past several years.  The blue area of the charts represents the amount of flu-related visits to ERs that we would expect to see at a given time during the year. When the black line on the charts reaches the red area, that indicates flu activity higher than we would expect to see.  (Click on the charts for a better view)

Cases:

• There are now 1,335 confirmed cases of H1N1 flu in Massachusetts (14 more than our last update).
• There have been 164 people hospitalized since the outbreak began (12 more than our last update.)
• There have been 6 reported deaths in Massachusetts since the outbreak began.

Age breakdown on confirmed cases:
0-4            197       
5-24          762        
25-64        360       
65+           14       
Unknown   2 

The median age of confirmed cases is still 14 years-old, and 64% of confirmed cases are 18 years-old or younger.               

Flu outbreaks evolve in unpredictable ways -- some severe cases, including additional deaths, may occur during this outbreak.  Risk of complications is especially high in people with underlying risk factors (see list below). 

Guidance for the Public:
Preventing the Flu:  Because there is no vaccine for H1N1 influenza, public health officials remind all Massachusetts residents to continue taking simple steps to keep themselves and others healthy.

• Wash your hands frequently with soap and warm water or use an alcohol-based hand sanitizer.
• Cover your cough with a tissue or cough into your inner elbow and not into your hands.
• If you are sick stay home from work and if your child is sick keep them home from school for 7 days, or 24 hours after your symptoms go away—whichever is longer.
• Stay informed about the latest developments on the H1N1 flu.

Treating the Flu:  Most people that get the H1N1 flu do not need to be tested or seen by a doctor.  They can simply stay home, get plenty of rest, and take over-the-counter medication for their fever, aches and pains.  Although the H1N1 flu doesn’t seem to be more severe than the seasonal flu, certain groups of people may be at greater risk for complications from any flu – whether seasonal or H1N1. 

Get medical care right away if the sick person at home:

• Has difficulty breathing or chest pain
• Has purple or blue discoloration of the lips
• Is vomiting and unable to keep liquids down
• Has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• Has seizures (for example, uncontrolled convulsions), is less responsive than normal or becomes confused

Anyone in the groups listed below who has a fever, along with a cough, sore throat or runny nose, should contact their doctor to talk with them about treatment with antivirals.  Antivirals work best if they are taken within 2 days of when symptoms start, so even people with mild illness should call their doctor right away if they have any of these conditions.

• Children less than 2 years old
• People age 65 years or older
• Pregnant women
• People who have chronic health problems like heart disease, asthma or diabetes
• Children and teens who are on long-term aspirin therapy who might be at risk for experiencing Reye’s syndrome after influenza virus infection
• Adults and children who have compromised immune systems caused by medications or by HIV infection

Comments

[Ricardo Rodriguez Cid]

1 year later: Pandemic is over, but H1N1 flu remains active

Now come key questions, she says. "What have we learned? What did we do right? What can we do better in the future?"

Ricardo Rodríguez Cid. MD PhD MPH

[ricardo rodriguez cid]

It is likely that most families all over the World will be touched by H1N1 influenza this year. Fortunately, many will experience mild illness. Others will endure unspeakable tragedy. The benefits of preventing serious consequences from infection with the 2009 H1N1 influenza virus far outweigh the risks associated with vaccination. All Americans, and especially pregnant women and others at high risk of severe influenza infection, should seriously consider the recommendation for vaccination to help protect themselves and their loved ones.
Ricardo Rodriguez Cid MD PhD MPH

[Steffie]

Where is the report for week ending July 24? We would like to know how many new cases during the week -- and deaths and hospitalizations.

Please update this valuable information. People are not seeing any written activity so everyone thinks the threat is over and it seems people, esp. kids are getting careless because of this. If you keep reporting people may keep washing their hands like they were and thus prevent further spread.......unless of course there is no more here in Massachusetts. I did see the map from the CDC and we are now considered local but we still need mass.gov input.

Thank you

[ricardo rodriguez cid MD MPH]

The new H1N1 influenza virus that emerged in Mexico in April 2009 ignited outbreaks as far away as the U.K. and Japan. Though H1N1 was neither as virulent nor as lethal as first suspected, the quick-mutating influenza virus should never be underestimated. Three Bloomberg School experts share their thoughts on what might happen, and what should happen, this summer

ricardo rodriguez cid MD PhD MPH