Tuesday, May 19, 2009

CDC Press Briefing

Spread of the virus continues in the US and more people continue to be hospitilized. Thus far 22 states have regional spread of H1N1 and there are cases in 48 states.

Given the differences in spread and clustering of cases, responses need to be localized, particularly in the school setting. It's appropriate to close schools if a lot of children or staff are ill and there's too much disruption to function properly. However, school closures are not appropriate to stop the spread of illness.

Aside from closing schools for a very long period of time, there are no interventions that will stop the spread of the virus in school environments. Even if schools are closed long-term, children will still interact with other children/adolescents, and are still at risk of getting the illness. Further, they can shed the virus a full day before becoming ill. Once they are ill, parents need to keep children home for at least 7 days.

Chronic Conditions = Higher Risk of Complications
Seasonal flu rates are highest in children and adolescents, and this seems to be similar for H1N1. Children with chronic health problems, like asthma and diabetes, are at increased risk for developing complications. The largest number of H1N1 cases thus far have been in people between the ages 5-24 (no deaths reported in this age group at this time); CDC wouldn't be surprised for rates of hospitalization and death to increase for children with underlying medical conditions.

CDC released an MMWR today reviewing 30 hospitlized cases. There is a wide range in severity in disease from these cases from short-term uncomplicated hospitilizations to long-term very complex cases. No one has died of these 30 cases, though some remain in the hospital.

About 2/3 of the patients in the series had underlying medical conditions:
  • chronic lung disease
  • conditions associated with immuno-suppression
  • pregnancy
  • obesity
  • heart disease
Clinical symptoms:
  • Seasonal flu symptoms
  • All (but 1) had fever
  • Vomitting was present in nearly all the cases

All hospitlized cases should be treated with antivirals, even if they come in more than 48 hours after onset of illness.

CDC: http://www.cdc.gov/h1n1flu/
MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0518a1.htm

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