Emergency Medical Services and Non-Emergent (Medical) Transport Organizations
Pandemic Influenza Planning Checklist

This document provides broad-based Pandemic Influenza Guidelines for consideration by State and local emergency medical services agencies, the specifics of pandemic influenza preparation and response are unique to the configuration and resources of each State EMS system and local EMS agency.

Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current U.S. case count is provided below.

An investigation and response effort surrounding the outbreak of swine flu is ongoing.

CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support.

CDC activated its Emergency Operations Center to coordinate the agency’s response to this emerging health threat and yesterday the Secretary of the Department Homeland Security, Janet Napolitano, declared a public health emergency in the United States. This will allow funds to be released to support the public health response. CDC’s goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus. To this end, CDC has issued a number of interim guidance documents in the past 24 hours. In addition, CDC’s Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir. This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

Press Briefing on Swine Influenza with Department of Homeland Security, Centers for Disease Control and Prevention, and White House

Release Date: April 26, 2009

For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010

Secretary Napolitano, Department of Homeland Security
John Brennan, Assistant to the President for Homeland Security and Counterterrorism
Dr. Richard Besser, Acting Director, Centers for Disease Control and Prevention
Robert Gibbs, Press Secretary

Mr. Gibbs: Good afternoon, guys. Thank you for taking some time out of your Sunday afternoon. We wanted to bring together many of the people that have the primary governmental responsibility in dealing with the situation and to discuss the government’s capacity and capability to discuss the steps the government is taking to address this.

Three people we’ll hear from today and then we’ll take some questions: First, John Brennan, Assistant to the President for Homeland Security and Counterterrorism; Dr. Richard Besser, the Acting Director of the Centers for Disease Control and Prevention, and Janet Napolitano, the Secretary of Homeland Security.

So with that I’ll turn it over to Mr. Brennan. (click here for additional)

While the WHO provides up-to-date information on outbreaks, HealthMap takes it several steps further. HealthMap aggregates news feeds from the WHO, Google News, ProMED, and elsewhere to map out all of the disease outbreaks. It includes a heat index to understand how bad certain situations really are and the most recent health-related news items.

Tip: To check just for influenza-related news, check only the box that says “influenza” under “Diseases, last 30 days”.

US Public Health Emergency

WASHINGTON, DC — April 26, 2009 — The Centers for Disease Control and Prevention (CDC) report 20 laboratory-confirmed human cases of swine influenza A/H1N1. Human cases of swine influenza A/H1N1 virus infection also have been identified internationally.

All 20 US cases (8 in New York; 7 in California; 2 in Texas; 2 in Kansas; and 1 in Ohio) have had mild influenza-like illness with only 1 requiring brief hospitalization (age range, 7-54 years). The CDC has confirmed that some of US cases may have become infected after travel ling to Mexico. No deaths have been reported.

All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

Laboratory testing has found the swine influenza A/H1N1 virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. According to Anne Schuchat, MD, the CDC’s Interim Deputy Director for Science and Public Health Program, treatment should begin within 48 hours of onset. However, she stressed that 19 of the US cases recovered without treatment. Vaccine development is in process, but it will take several months to prepare a vaccine.

CDC has issued interim recommendations for diagnostic testing and antiviral use to US hospitals and emergency rooms, but local and state circumstances may vary and individual protocols may be put in place.

The CDC also has prepared interim guidance on how to care for people who are sick and interim guidance on the use of face masks in a community setting where spread of this swine flu virus has been detected. This is a rapidly evolving situation and CDC will provide new information as it becomes available.

The World Health Organization (WHO) reports that the government of Mexico also has reported several laboratory-confirmed cases of swine influenza A/H1N1. In a media briefing today, the CDC confirmed several swine influenza-related deaths as well. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspect clinical cases have been reported in 19 of the country’s 32 states.

Investigations are ongoing to determine the source of the infection and whether additional people have been infected with swine influenza viruses.

CDC is working very closely with officials in states where human cases of swine influenza A/H1N1 have been identified, as well as with health officials in Mexico, Canada, and WHO. This includes deploying staff domestically and internationally to provide guidance and technical support. CDC has activated its Emergency Operations Center to coordinate this investigation.

WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other Member States as they occur and are supporting field epidemiology activities, laboratory diagnosis and clinical management.

On Saturday, April 25, upon the advice of the Emergency Committee called under the rules of the International Health Regulations, the Director-General declared this event a Public Health Emergency of International Concern.

WHO is not recommending any travel or trade restrictions.

SOURCE: World Health Organization and Center for Disease Control and Prevention

26 April 2009 — WHO is coordinating the global response to human cases of swine influenza A (H1N1) and monitoring the corresponding threat of an influenza pandemic.

More on swine influenza

Read the Director-General’s statement on swine influenza

Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current U.S. case count is provided below.

Investigations are ongoing to determine the source of the infection and whether additional people have been infected with swine influenza viruses.

CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support. CDC has activated its Emergency Operations Center to coordinate this investigation.

Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir and has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses. CDC also has prepared interim guidance on how to care for people who are sick and interim guidance on the use of face masks in a community setting where spread of this swine flu virus has been detected. This is a rapidly evolving situation and CDC will provide new information as it becomes available.

There are everyday actions people can take to stay healthy.

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

* Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
* If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Human Swine Influenza Investigation

April 25, 2009 17:30 EDT

Human cases of swine influenza A (H1N1) virus infection have been identified in the U.S. in San Diego County and Imperial County, California as well as in San Antonio, Texas. Internationally, human cases of swine influenza A (H1N1) virus infection have been identified in Mexico.

Investigations are ongoing to determine the source of the infection and whether additional people have been infected with similar swine influenza viruses.

CDC Health Advisory

Investigation and Interim Recommendations:
Swine Influenza (H1N1)

CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.

The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.
CDC has also been working closely with public health officials in Mexico, Canada and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at: http://www.who.int/csr/don/2009_04_24/en/index.html