Update 5: June 14, 2009
On Thursday, June 11, 2009, the World Health Organization (WHO) officially raised the influenza pandemic alert level from 5 to 6. Level 6, by definition, means that the novel H1N1 virus is causing sustained human-to-human transmission in more than one WHO global region.
Implications of WHO action
The definition of pandemic does not include any criteria relating to severity. In fact, disease caused by the current strain, thus far, has been moderate and comparable in severity to seasonal flu. WHO’s elevation of the pandemic threat level does not indicate any change in severity.
At this point in time, neither the WHO or the CDC is recommending any extraordinary mitigation measures, beyond what is normally recommended for seasonal flu. There are no restrictions on travel, however some countries are closely monitoring incoming passengers for signs of possible illness.
Implications for Moravian College
The H1N1 Flu committee will continue to review guidelines from the WHO, CDC, state, and local public health authorities, as well as the situation here at the College. At this point in time, no changes are planned for any activities within the institution. Given the evolving nature of the current outbreak, this recommendations may change. Please continue to monitor this website or the AMOS site for updates.
The CDC recommends that, in communities where the novel H1N1 influenza virus is circulating (which now includes the Lehigh Valley, see below), persons at increased risk of complications should consider staying away from such gatherings (http://www.cdc.gov/h1n1flu/guidance/guidelines_colleges.htm).
Individuals with flu symptoms (described below) should remain at home. Students at the College with flu symptoms should follow the instructions, below, under “Seeking Help.” Everyone should implement the prevention practices listed below.
What does raising the pandemic alert level accomplish?
By declaring that there is a global outbreak of a novel influenza virus, the WHO has signaled to the entire global community a need to mobilize and direct resources toward this outbreak. The pandemic response includes close monitoring of possible cases and sharing of information, enhanced efforts to develop and stockpile vaccine and anti-viral agents, and implementation of contingency plans for health care systems and public infrastructure which could be overwhelmed by a severe outbreak.
Although the current outbreak is only moderate in severity, there are some reasons for concern. First, influenza pandemics, historically, have occurred in waves which may vary in severity. While the current outbreak has not caused high mortality, no one knows how second wave might behave. Severity may also vary with location and particular populations. Countries where malnutrition is common and regions where large segments of the population have been displaced by violent conflict are of particular concern.
Second, although, overall, the mortality caused by the novel influenza strain is comparable to seasonal flu, the pattern of deaths has been somewhat different. Where seasonal flu typically is hardest on the elderly and very young, the pattern of deaths from the novel influenza virus seems to include a higher proportion of previously healthy young persons and pregnant women. If this pattern continues, it may suggest changes in approach to containing and controlling the disease.
Third, all influenza viruses have genetic characteristics which make possible rapid changes in properties such as severity and host range. As the novel influenza virus spreads in southern hemisphere countries at a time when the seasonal influenza strains normally circulate, it is impossible to predict what, if any, changes the new virus might undergo. Hence the need for close monitoring.
Background: Current case reporting
Globally, the latest WHO report (Friday, June 12) showed nearly 30,000 confirmed cases in 74 countries. This underestimates the actual number of cases since many countries lack the health care infrastructure required to test individuals with influenza-like illnesses unless the case is life-threatening. Thus, many mild cases go unreported. Large numbers of confirmed cases have been reported in only a handful of countries.
In the United States, where the novel influenza virus has been spreading since late April and where testing is widespread, the CDC has reported (as of Friday, June 12) nearly 18,000 cases involving all 50 states, the District of Columbia, and Puerto Rico. However, despite the media attention on influenza deaths, the case fatality rate has actually been quite low (comparable to seasonal influenza).
In Pennsylvania, more than 800 cases (confirmed + probable) have been reported (Thursday, June 11), involving approximately half the counties in the state. The Lehigh Valley and all adjacent counties have reported cases.
- Florence Kimball for the H1N1 Flu committee
