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Seasonal and Pandemic (H1N1) 2009 Influenza Report
San Mateo County Health System, Public Health
Week 40 (October 4-10, 2009)
www.smhealth.org/flu· www.smhealth.org/swineflu · Provider Reporting: 650.573.2346 · 650.573.2919 (fax)
Volume 2, Issue 1 (Issue date Oct. 16, 2009)
Karen Relucio MD, Assistant Health Officer · Suvas Patel, MPH, Epidemiologist · Scott Morrow MD, MPH, Health Officer
Current Influenza Activity
San Mateo County
Disease week 40 (ending 10/10/09) marked the start of the 2009-10
influenza season. Influenza activity continued to fluctuate in the latter
weeks of the 2008-09 influenza season. Week 40 of the current 2009-10
season had the greatest number of specimens that tested positive for
influenza, all of which have been influenza A, compared to week 40 in
previous seasons (Figures 1 and 2).
Based on lab reports from seven reporting county and hospital laborato-
ries*, there were 30 influenza positives (30 influenza A, 0 influenza B),
and 1 RSV positive for week 40.
A summary of the 2008-09 season: from week 40 of 2008 (ending
10/4/08) to week 39 of 2009 (ending 10/3/09), a total of 5,511 speci-
mens were tested for influenza, of which 1,221 (22%) were positive. A
total of 1,413 specimens were tested for RSV, of which 452 (32%) were
positive.
For week 40 (ending 10/10/09) of the current 2009-10 influenza season,
a total of 203 specimens were tested for influenza, of which 30 (15%)
were positive. A total of 8 specimens were tested for RSV, of which 1
(13%) was positive. All seven laboratories reported data for week 40.
Figure three summarizes the trend in percent influenza and RSV posi-
tives observed by week, weighted by the number of laboratories report-
ing data each week.
Of the 30 specimens that tested positive for influenza, all 30 (100%)
were influenza A positive. Figure four summarizes the trend in percent of
influenza specimens that tested positive by type and week for the 2008-
09 influenza season. Currently all influenza activity continues to be type
A within the current 2009-10 season. Note: data for the current 2009-10
season will be included in Figure 4 starting week 41.
California
California flu activity is at widespread level: outbreaks of influenza or
increases in influenza-like-illness and recent lab confirmed influenza in
at least half of the regions in the State. Lab detections and reports of ILI
from sentinel providers remain high.
As of 10/12/09, 250 severe pediatric influenza cases have been re-
ported in California, of which 176 (70%) have been confirmed/probable
H1N1.
CDPH has received 2,748 reports of hospitalized and/or fatal cases to
date. Of these, 646 (24%) are severe cases (admitted to ICU). The
statewide incidence rate of reported 2009 H1N1 hospitalizations and
fatalities is 7.1 per 100,000.
United States
During week 39, influenza activity increased in the United States.
Ninety-nine percent of all subtyped influenza A viruses being reported to
CDC were pandemic (H1N1) 2009.
Two thousand, nine hundred sixty-eight (27%) 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.
Nineteen influenza-associated pediatric deaths were reported and six-
teen (84%) of these deaths were associated with an H1N1 virus infec-
tion.
Thirty-seven states reported geographically widespread influenza activ-
ity; Guam and 11 states reported regional influenza activity; two states,
the District of Columbia, and Puerto Rico reported local influenza activ-
ity.
*Our reported numbers do not represent all cases of influenza within SMC, but are intended to demonstrate trends in influenza
activity
Sources: SMC: Kaiser, San Mateo Medical Center, Sequoia Hospital, Peninsula Hospital, San Mateo County Public Health Lab;
CA: California Influenza Surveillance Project: http://www.cdph.ca.gov/programs/vrdl/Pages/
CaliforniaInfluenzaSurveillanceProject.aspx ; US: CDC Flu Activity and Surveillance: http://www.cdc.gov/flu/weekly/fluactivity.htm;
“CD Brief-Week 40”, Division of Communicable Disease Control, California Department of Public Health.
Seasonal and Pandemic (H1N1) 2009 Influenza Report
San Mateo County Health System, Public Health
Week 40 (October 4-10, 2009)
FLU REPORT UPDATES UPDATED GUIDANCES
Novel H1N1 Situational Update
H1N1 Vaccination Updates New treatment guidance and patient information have been posted
in the Healthcare Providers section at www.smhealth.org/swineflu.
Updated Guidances
The following documents can be accessed by clicking the blue
text, which are direct hyperlinks.
NOVEL H1N1 SITUATIONAL UPDATE
Updated San Mateo County Guidance
As of October 16, 2009, the World Health Organization (WHO) re-
Summary of Antiviral Treatment and Chemoprophylaxis Guid-
gions have reported more than 399,232 laboratory-confirmed cases
ance
of 2009 H1N1 influenza virus with over 4,735 deaths. CDC started
a new system of reporting H1N1 cases based on new case defini- Pediatric Management Guidance for Clinicians
tions from hospitalized cases. From October 4 to 11, the CDC re- Pregnancy Management Guidance for Clinicians
ported 15,696 hospitalized cases of influenza and pneumonia syn- For Patients: H1N1 and Seasonal Flu Vaccine: Who should get
drome in the United States, with 2029 deaths. In California, there what and when?
are 3051 hospitalized cases and 219 deaths. H1N1 (swine) influenza
remains the predominant circulating influenza virus in California. Updated CDC Guidance: Infection Control Measures
Thirty one isolates of oseltamivir-resistant novel H1N1 have been This guidance was released on 10/14/09. The following information
identified worldwide, 12 have been identified within the US, and one below highlights changes from earlier guidance. To read the full
isolate has been identified in California. guidance, click here.
Recommended time away from work for healthcare personnel
H1N1 VACCINE UPDATE has been changed from 7 days from symptom onset or until
the resolution of symptoms to 24 hours after resolution of
The San Mateo County Health System (SMCHS) has been reviewing fever without use of antipyretics.
vaccine allocations for clinics and hospitals. In mid to late Octo- Expansion of information on the hierarchy of controls which
ber, San Mateo County will expect deliveries of 86,000 ranks preventive interventions in the following order of prefer-
doses of novel H1N1 (swine) vaccine in the form of Flumist ence:
and three different types of injectable vaccine. A weekly ○ Elimination of exposures (e.g. exclude visitors with ILI)
Public Health Fax Advisory from the Health Officer is being emailed ○ Engineering controls (e.g. sneeze barriers)
and faxed to vaccine registrants to provide updates and instruc- ○ Administrative controls (e.g. promote vaccination, exclude ill
tions, which is posted on our website. employees)
ACIP Recommendations for Prioritization ○ Personal protective equipment
The ACIP recommendations are used to determine high-priority Changes to guidance on use of respiratory protection.
groups for vaccination, and as a guide to determine which clinics ○ Minimize number of individuals who need to use respiratory
will be prioritized for vaccine. For a summary of ACIP recommenda- protection through the use of engineering and administra-
tions, click here. tive controls
○ Use alternatives to disposable N95 respirators where feasi-
Where can I refer people for H1N1 vaccination? ble
Most of the flu vaccine clinics from pharmacies, retail stores, and ○ Extend the use, and consider reuse of disposable N95
SMCHS will be posted on www.flucliniclocator.org. Please refer respirators
patients to this website to look for places that offer seasonal and ○ Prioritize the use of N95 respirators for those personnel at
H1N1 vaccine. Hotline information for SMCHS flu clinic schedules highest risk of exposure
are available at (650) 573-3927.
Updated CDPH Guidance:
New outbreak definitions are updated in page 2 of the CDPH
PLEASE REPORT TO COMMUNICABLE DISEASE Health Alert.
CONTROL Guidelines for reporting novel H1N1 influenza cause of death
on death certificates is available here.
Report hospitalized or deceased cases with severe febrile respira-
tory illness and any type of influenza (seasonal H1 or H3, novel
H1N1, or influenza B viruses) by calling (650) 573-2346 or by submit-
ting a Confidential Morbidity Report (CMR) and faxing it to (650) 573-
2919. Those cases will be prioritized for expedient PCR testing at the San STAY INFORMED AND BE PREPARED!
Mateo County Public Health Laboratory Check out our new, improved website
See updates on pandemic H1N1 (2009) influenza through our newly integrated
website: www.smhealth.org/flu
Report severe pediatric influenza cases and pediatric influenza-
related deaths. Case definitions, updated case report forms, and instruc- Subscribe to the Flu Report
tions are available at www.smhealth.org/flu To receive the Seasonal and Pandemic (H1N1) 2009 Flu Report , email epidemiol-
ogy@co.sanmateo.ca.us.
Immediately report any respiratory outbreaks in your facility to Com- Sign up for California Health Alert Network (CAHAN)
municable Disease Control by calling (650) 573-2346. CAHAN provides rapid notification to our community partners in the event of a
countywide emergency. To sign up for CAHAN, contact Theresa Smith at
THSmith@co.sanmateo.ca.us or call (650)573-3782.
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