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Military版 - 2009 H1N1 Pandemic Timeline
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话题: h1n1话题: cdc话题: influenza话题: 2009话题: vaccine
1 (共1页)
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发帖数: 13
1
https://www.cdc.gov/flu/pandemic-resources/2009-pandemic-timeline.html
April 15
First human infection with new influenza A H1N1 virus detected in California.
April 17
Second human infection with the new influenza A H1N1 virus detected in
California about 130 miles away from first infection, with no known
connection to previous patient.
April 18
First novel 2009 H1N1 flu infections were reported by CDC to the World
Health Organization (WHO) through the U.S. International Health Regulations
Program.
April 21
CDC publicly reported the first two U.S. infections with the new H1N1 virus.
CDC began working to develop a candidate vaccine virus.
April 22
CDC activated it’s Emergency Operations Center (EOC).
April 23
Two additional human infections with 2009 H1N1 were detected in Texas,
transforming the investigation into a multistate outbreak and response.
April 24
CDC uploaded complete gene sequences of new H1N1 2009 virus to a publically-
accessible international influenza database.
April 25
The World Health Organization (WHO) declared a public health emergency of
international concern.
April 26
The United States Government declared 2009 H1N1 a Public Health Emergency of
International Concern and CDC began releasing 25% of antiviral drugs needed
to treat this new influenza virus from the federal stockpile.
April 27
WHO Director-General raised the level of influenza pandemic alert from phase
3 to phase 4, based on data showing person-to-person spread and the ability
of the virus to cause community-level outbreaks.
April 28
The Food and Drug Administration (FDA) approved a new CDC test to detect
2009 H1N1 infections
CDC issued the first CDC Interim Guidance on Closing Schools and Childcare
Facilities, recommending a 7-day dismissal in affected schools and childcare
facilities with laboratory-confirmed cases of influenza A H1N1 virus.
April 29
WHO raised the level of influenza pandemic alert from phase 4 to phase 5,
signaling that a pandemic was imminent, and requested all countries to
immediately activate their pandemic preparedness plans and be on high alert
for unusual outbreaks of influenza-like illness and severe pneumonia.
May 1
Domestic and global shipments of new CDC test to detect 2009 H1N1 began.
CDC updated the CDC Interim Guidance on Closing Schools and Childcare
Facilities, recommending affected communities with lab-confirmed cases of
influenza A H1N1 consider adopting school dismissal and childcare closing
measures, including closing for up to 14 days depending on the extent and
severity of influenza illness.
May 4
CDC shifted from reporting confirmed cases of 2009 H1N1 to reporting both
confirmed and probable cases of 2009 H1N1.
May 5
Peak school dismissal day in the spring phase of the pandemic. 980 schools
were dismissed, affecting 607,778 students.
May 6
CDC distributed updated recommendations for the use of influenza antiviral
medicines to provide guidance for clinicians in prescribing antiviral
medicines for treatment and prevention (chemoprophylaxis) of 2009 H1N1
influenza.
May 8
CDC issued an MMWR updating the 2009 H1N1 influenza situations in Mexico,
the United States, and worldwide.
May 12
CDC reported early data on 2009 H1N1 illness among pregnant women in an MMWR.
June 11
The World Health Organization (WHO) declared a pandemic and raised the
worldwide pandemic alert level to phase 6, which means the virus was
spreading to other parts of the world.
CDC held its first press conference with new CDC Director Thomas Frieden, MD
, MPH. The press conference had 2,355 participants.
June 19
All 50 states, the District of Colombia, Puerto Rico and the U.S. Virgin
Islands had reported cases of 2009 H1N1 infection.
By late-June, more than 30 summer camps in the U.S. had reported outbreaks
of 2009 H1N1 influenza illness. CDC released guidance for day and
residential camps to reduce spread of influenza.
June 25
CDC estimated at least 1 million cases of 2009 H1N1 influenza had occurred
in the United States.
Early July
Reported cases of 2009 H1N1 nearly doubled since mid-June 2009.
Three 2009 H1N1 influenza viruses that were resistant to the antiviral drug,
oseltamivir, were detected in three countries.
July 10
CDC reported findings in an MMWR that indicated a large prevalence of
obesity in intensive care patients with confirmed 2009 H1N1 influenza
infection.
After mid-July, 2009 H1N1 influenza activity declined in most countries.
July 22
Clinical trials testing the 2009 H1N1 flu vaccine began.
August
Additional oseltamivir-resistant 2009 H1N1 viruses were detected by CDC.
August 3
CDC School Dismissal Monitoring System (SDMS) activated.
August 19
CDC Guidance for Businesses and accompanying toolkit posted to CDC.gov.
August 20
CDC Guidance for Institutions of Higher Education (IHE) and accompanying
toolkit posted to CDC.gov. Calls were conducted with Secretary Duncan and
Sebelius to explain guidance. Press briefings followed.
Second wave of 2009 H1N1 influenza activity began in the U.S.
August 30
New reporting season for the 2009-2010 influenza season began.
September 1
More than 1,000 test kits shipped to 120 domestic and 250 international
laboratories in 140 countries since May 1, 2009.
September 3
CDC published a study that analyzed data related to H1N1 influenza pediatric
deaths reported to CDC from April to August 2009 in MMWR. Data showed 477
deaths with lab-confirmed 2009 H1N1 flu in the U.S. had been reported to CDC
as of August 8, 2009.
September 10
HHS secretary and CDC Director joined the National Foundation for Infectious
Diseases (NFID) in a news conference to stress the importance of getting
vaccinated for the upcoming influenza season.
September 15
The FDA announced its approval of four 2009 H1N1 influenza vaccines.
September 30
U.S. states placed first orders of 2009 H1N1 vaccine.
October
National Influenza 2009 H1N1 vaccination campaign
October 5
First doses of H1N1 vaccine were given in the U.S.
October 24
Influenza activity reached its highest level in the reporting week ending
October 24, 2009, with 48 of 50 states reported widespread activity.
Late October
Second wave of H1N1 flu activity peaked in the U.S.
November 12
CDC released its first estimates official estimates of 2009 H1N1 cases,
hospitalization and deaths.
November 16
FDA announced its approval of a fifth 2009 H1N1 vaccine.
November 23
No school closures throughout United States; first time since 8/25/2009.
December
Results of trials conducted among adults were published in December, and the
data indicated that the immune response among vaccinated adults was
excellent.
December 4
CDC published preliminary safety results for the 2009 H1N1 vaccines for the
first months of reports received through the U.S. Vaccine Adverse Event
Reporting System (VAERSexternal icon).
December 18
First 100 million doses of 2009 H1N1 vaccine were available for ordering.
Late December
2009 H1N1 vaccination had been opened up to anyone who wanted it.
-----------------------------------------------------------------------------
2010
January
Activity declined to levels below baseline, but persisted for several more
months at lower levels.
January 10-16
President of the United States proclaimed National Influenza Vaccination
Week (NIVW) and encouraged all Americans to observe the week by getting
vaccinated with the 2009 H1N1 flu vaccine.
February
FDA’s VRBPAC selected 2009 H1N1 virus for inclusion in 2010-2011 seasonal
flu vaccine
February 18
WHO published recommendations for the composition of influenza virus
vaccines for the upcoming Northern Hemisphere influenza season. Components
included a 2009 H1N1-like virus.
April
Between April 2009 and April 2010, CDC held 60 related media events – 39
press briefings and 22 telebriefings – reaching more than 35,000
participants.
August 11
WHO announced the end of 2009 H1N1 influenza pandemic.
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发帖数: 13
2
速度还是可以的吧
April 15
First human infection with new influenza A H1N1 virus detected in California.
April 17
Second human infection with the new influenza A H1N1 virus detected in
California about 130 miles away from first infection, with no known
connection to previous patient.
April 18
First novel 2009 H1N1 flu infections were reported by CDC to the World
Health Organization (WHO) through the U.S. International Health Regulations
Program.
April 21
CDC publicly reported the first two U.S. infections with the new H1N1 virus.
CDC began working to develop a candidate vaccine virus.
April 22
CDC activated it’s Emergency Operations Center (EOC).
April 23
Two additional human infections with 2009 H1N1 were detected in Texas,
transforming the investigation into a multistate outbreak and response.
April 24
CDC uploaded complete gene sequences of new H1N1 2009 virus to a publically-
accessible international influenza database.
April 25
The World Health Organization (WHO) declared a public health emergency of
international concern.
April 26
The United States Government declared 2009 H1N1 a Public Health Emergency of
International Concern and CDC began releasing 25% of antiviral drugs needed
to treat this new influenza virus from the federal stockpile.
April 27
WHO Director-General raised the level of influenza pandemic alert from phase
3 to phase 4, based on data showing person-to-person spread and the ability
of the virus to cause community-level outbreaks.
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发帖数: 13
3
https://www.cdc.gov/h1n1flu/cdcresponse.htm
2009 H1N1 was first detected in the United States in April 2009. This virus
was a unique combination of influenza virus genes never previously
identified in either animals or people. The virus genes were a combination
of genes most closely related to North American swine-lineage H1N1 and
Eurasian lineage swine-origin H1N1 influenza viruses. Because of this,
initial reports referred to the virus as a swine origin influenza virus.
However, investigations of initial human cases did not identify exposures to
pigs and quickly it became apparent that this new virus was circulating
among humans and not among U.S. pig herds.
Infection with this new influenza A virus (then referred to as ‘swine
origin influenza A virus’) was first detected in a 10-year-old patient in
California on April 15, 2009, who was tested for influenza as part of a
clinical study. Laboratory testing at CDC confirmed that this virus was new
to humans. Two days later, CDC laboratory testing confirmed a second
infection with this virus in another patient, an 8-year-old living in
California about 130 miles away from the first patient who was tested as
part of an influenza surveillance project. There was no known connection
between the two patients. Laboratory analysis at CDC determined that the
viruses obtained from these two patients were very similar to each other,
and different from any other influenza viruses previously seen either in
humans or animals. Testing showed that these two viruses were resistant to
the two antiviral drugs amantadine and rimantadine, but susceptible to the
antiviral drugs oseltamivir and zanamivir. CDC began an immediate
investigation into the situation in coordination with state and local animal
and human health officials in California.
The cases of 2009 H1N1 flu in California occurred in the context of sporadic
reports of human infection with North American-lineage swine influenza
viruses in the United States, most often associated with close contact with
infected pigs. (During December 2005 – January 2009, 12 cases of human
infection with swine influenza were reported; five of these 12 cases
occurred in patients who had direct exposure to pigs, six patients reported
being near pigs, and the source of infection in one case was unknown). Human
-to-human spread swine influenza viruses had been rarely documented and had
not been known to result in widespread community outbreaks among people. In
mid-April of 2009, however, the detection of two patients infected with
swine origin flu viruses 130 miles apart, raised concern that a novel swine-
origin influenza virus had made its way into the human population and was
spreading among people.
CDC remained in close contact with the international health community as the
outbreak unfolded and on April 18, 2009, under the International Health
Regulations (IHR) the United States International Health Regulations Program
reported the 2009 H1N1 influenza cases to the World Health Organization (
WHO). The cases also were reported to the Pan American Health Organization (
PAHO), Canada and Mexico, as part of the Security and Prosperity Partnership
of North America.
Response Ramps Up
CDC worked closely with state and local animal and human health officials on
epidemiological investigations by tracing contacts of both patients to try
to determine the source of their infection and by examining whether there
was any link between the patients and pigs. Surveillance also was enhanced
to try to detect additional cases of human illness with this virus. Based on
the geographic location of the first cases, lack of contact between these
cases and swine, and data collected through contact tracing and laboratory
testing, CDC epidemiologists suspected that human-to-human transmission of
this virus had taken place. In an article entitled Swine Influenza A (H1N1)
Infection in Two Children --- Southern California, March-April 2009
published on April 21, 2009 in the Morbidity and Mortality Weekly Report (
MMWR), CDC described the cases and requested that state public health
laboratories send to CDC all influenza A specimens that could not be
subtyped. That same day CDC responded to media inquiries related to the MMWR
from medical reporters. Within a day, three additional samples of this new
virus were identified in San Diego County and Imperial County California
hospitals and sent to CDC for further testing. CDC laboratory testing
confirmed that these samples also were positive for the virus that would
come to be called “2009 H1N1.”
By April 21, 2009, CDC had begun working to develop a virus that could be
used to make vaccine to protect against this new virus (called a candidate
vaccine virus). There are many steps involved with producing a vaccine –
the first step is getting a good high yield vaccine virus. A high-yield
vaccine virus is a sample of the virus that is used to grow the virus in
mass quantities in chicken eggs. Once the virus is grown in mass quantities,
the virus particles are then purified to make vaccine. Recognizing that
2009 H1N1 was a new flu virus – and, like all flu viruses, unpredictable -
CDC simultaneously pursued multiple scientific methods to create a high-
yield virus. A virus isolated at CDC, (called A/California/07/2009) was
eventually chosen to be the vaccine virus used to make vaccine. CDC sent the
vaccine virus to vaccine manufacturing companies so that they could begin
vaccine production, in the event that the U.S. government should decide a
vaccine was necessary.
CDC activated its Emergency Operations Center (EOC) on April 22, 2009, to
coordinate the response to this emerging public health threat. Response
activities were organized into a team structure according to the National
Incident Management System (NIMS)External Web Site IconThese teams had
different areas of focus including but not limited to: surveillance,
laboratory issues, communications, at-risk populations, antiviral
medications, vaccine, and traveler’s health issues. As the outbreak
unfolded, team structures and staffing were periodically assessed for
functionality and utility.
On April 23, 2009, samples submitted by Texas revealed two additional cases
of human infections with 2009 H1N1, transforming the investigation into a
multistate outbreak and response. At the same time, CDC was testing 14
samples from Mexico, some of which had been collected from patients who were
ill before the first 2 U.S. (California) patients. Results from seven of
the samples were positive for 2009 H1N1 and similar findings were reported
for specimens submitted by Mexico to Canada. It had now become clear that
cases were occurring in multiple countries and human to human spread of the
virus appeared to be ongoing. That same day CDC held the first formal full
press briefing to inform the media and guide the public and health care
response to the rapidly evolving situation. CDC held nearly 60 press
briefings during the 2009 H1N1 response.
On April 24, 2009, CDC uploaded complete gene sequences of the 2009 H1N1
virus to a publicly-accessible international influenza database, which
enabled scientists around the world to use the sequences for public health
research and for comparison against influenza viruses collected elsewhere,
and an updated report on the outbreak was published online in the MMWR.
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发帖数: 13
4
World Braces for Possible Pandemic
On Saturday, April 25, 2009, under the rules of the International Health
Regulations, the Director-General of WHO declared the 2009 H1N1 outbreak a
Public Health Emergency of International ConcernExternal Web Site Icon and
recommended that countries intensify surveillance for unusual outbreaks of
influenza-like illness and severe pneumonia. Also on April 25, 2009, New
York City officials reported an investigation into a cluster of influenza-
like illness in a high school, and CDC testing confirmed two cases of 2009
H1N1 influenza infection in Kansas, and another case in Ohio shortly after.
On April 26, 2009, the United States Government determined that a public
health emergency existed nationwide; CDC’s Strategic National Stockpile (
SNS) began releasing 25% of the supplies in the stockpile that could be used
to protect and treat influenza. This included 11 million regimens of
antiviral drugs, and personal protective equipment including over 39 million
respiratory protection devices (masks and respirators), gowns, gloves and
face shields, to states (allocations were based on each state’s population).
As part of the nation’s pre-pandemic planning efforts, by April 2009 the
Federal Government had purchased 50 million treatment courses of antiviral
drugs – oseltamivir and zanamivir – for the SNS, and states had purchased
23 million antiviral regimens. After the determination of the public health
emergency, FDA also took action to expand possible usage of antiviral drugs
oseltamivir and zanamivir by issuing Emergency Use Authorizations (EUAs).
The EUAs allowed for use of the products in a manner different from what
they were FDA-approved for. This included allowing for off-label use of:
oseltamivir to treat children younger than 1 year of age and to help prevent
influenza in children 3 months to 1 year of age, and;
oseltamivir and zanamivir to treat patients who are symptomatic for more
than two days before initiation of treatment, or who had complicated illness
requiring hospitalization.
On April 27, the WHO Director-General raised the level of influenza pandemic
alert from phase 3 to phase 4External Web Site Icon, based primarily on
epidemiological data demonstrating human-to-human transmission and the
ability of the virus to cause community-level outbreaks. Based on reports of
widespread influenza-like-illness and many severe illnesses and deaths in
Mexico, CDC issued a travel health warning recommending that United States
travelers postpone all non-essential travel to Mexico. As in past influenza
seasons, CDC urged the public and especially those people at highest risk of
influenza-related complications, to protect themselves by taking antiviral
drugs early in their illness when recommended by their doctor; CDC also
advised that everyone take every day preventive actions like covering coughs
and sneezes and staying home from work and school when ill to help reduce
the spread of illness.
On April 29, 2009 WHO raised the influenza pandemic alert from phase 4 to
phase 5External Web Site Icon, signaling that a pandemic was imminent, and
requested that all countries immediately activate their pandemic
preparedness plans and be on high alert for unusual outbreaks of influenza-
like illness and severe pneumonia. The U.S. Government was already
implementing its pandemic response plan. CDC continued to post and update
guidance for states, clinicians, laboratories, schools, partners and the
public on topics ranging from the non-pharmaceutical measures communities
could take to limit spread of disease, to how to evaluate a patient for
possible infection with 2009 H1N1 influenza, to how to care for children who
might be sick with 2009 H1N1 influenza.
On April 30, 2009, CDC issued an MMWR Dispatch describing the initial
outbreak of 2009 H1N1 influenza in Mexico. Findings in Mexico indicated that
transmission in Mexico involved person-to-person spread with multiple
generations of transmission. CDC also issued an MMWR Dispatch on the
outbreak of 2009 H1N1 influenza infection in a high school in New York City,
that was, at the time, the largest reported cluster of 2009 H1N1 cases in
the United States. The Dispatch suggested that the high school age students
had respiratory and fever symptoms similar to those caused by a seasonal flu
, but in addition, about half had diarrhea, which is more than expected with
seasonal flu. As the details of the outbreak unfolded, the Federal response
continued in high gear. Also on April 30, 2009, HHS announced that the
Federal government would purchase an additional 13 million treatment courses
of antiviral drugs to help fight influenzaExternal Web Site Icon. The
additional treatment courses would be added to the SNS.
As the outbreak spread, CDC began receiving reports of school closures and
implementation of community-level social distancing measures meant to slow
the spread of disease. School administrators and public health officials
were following their pandemic plans and doing everything they could to slow
the spread of illness. (Social distancing measures are meant to increase
distance between people. Measures include staying home when ill unless to
seek medical care, avoiding large gatherings, telecommuting, and
implementing school closures).
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发帖数: 13
5
CDC Laboratories Bolster Nation’s Testing Capacity
While initial efforts were underway to develop a safe and effective vaccine
to protect people against 2009 H1N1, work also was being done at CDC to help
laboratories supporting health care professionals to more quickly identify
the 2009 H1N1 virus in samples from patients. The real-time PCR test
developed by CDC was cleared for use by diagnostic laboratories by FDA under
an Emergency Use Authorization (EUA) on April 28, 2009, less than two weeks
after identification of the new pandemic virus. Prior to the availability
of this EUA, public health laboratories had been able to identify whether
influenza A viruses were seasonal influenza viruses or were a novel strain,
but the new diagnostic kits allowed labs to confirm a virus as 2009 H1N1. On
May 1, 2009, CDC test kits began shipping to domestic and international
public health laboratories. (Each test kit contained reagents to test 1,000
clinical specimens). From May 1 through September 1, 2009, more than 1,000
kits were shipped to 120 domestic and 250 international laboratories in 140
countries. Once labs had the test kits and verified that their testing was
running properly, they were able to identify new cases more quickly than
before and no longer needed to send samples to CDC for lab confirmation. The
transition away from CDC lab confirmation testing didn’t happen overnight
though - between April 23 and May 31, 2009, CDC influenza laboratory
analyzed about 5,000 influenza virus samples, five times the number that
were processed in a similar timeframe in 2008, and more than during any
previous influenza season. By May 18, 2009, 40 states had been validated to
conduct their own 2009 H1N1 testing, with eight states having multiple
laboratories able to do their own testing. CDC alerted the public that the
expansion in testing capacity would likely result in a jump in the number of
2009 H1N1 cases, but that this would actually present a more accurate
picture of the true scope of 2009 H1N1 influenza in the United States.
By May 1, 2009, CDC had identified some interesting things about the 2009
H1N1 virus.
Researchers had confirmed earlier testing that the 2009 H1N1 influenza virus
was a quadruple-reassortant virus, meaning that it contained virus genes
that originated from four different influenza virus sources. Some of the
gene segments originated from North American swine influenza viruses, some
gene segments originated from North American avian influenza viruses, one
gene segment originated from a human influenza virus, and two gene segments
were normally found in swine influenza viruses from Asia and in Europe.
Testing of a number of the virus samples submitted to CDC showed that they
were very similar, which means they likely originated from the same source.
Laboratory testing showed that the 2009 H1N1 influenza virus did not have
any 1918-like markers that had been associated with increased risk of severe
disease.
Testing also did not find genetic markers that were previously associated
with high death rates in people infected with the avian influenza A (H5N1)
virus in other countries.
On May 4, 2009, CDC shifted from reporting confirmed cases of 2009 H1N1 to
reporting both confirmed and probable cases of 2009 H1N1. At that point,
more than 98% of “probable” flu virus samples were testing positive for
2009 H1N1, indicating the ever-growing scale of the outbreak. Probable cases
were reported to CDC by state health departments and occurred in people who
tested positive for influenza A and negative for seasonal influenza A(H1N1)
and A(H3N2) subtypes at their state health department laboratory, but whose
samples had not had confirmatory testing for the 2009 H1N1 influenza virus.
top of page
CDC Shares Personnel, Guidance, Early Results of Studies
CDC deployed a large number of staff to the field to support the outbreak
response; by May 1, 2009, 50 staff people were deployed, and that number
climbed to more than 100 by May 11, 2009, before gradually declining as
field teams returned from deployment to complete studies, analyze collected
data, and help inform policy decisions for the prevention and control of
2009 H1N1 influenza. Over the course of the outbreak, more than 3,300 people
from throughout CDC would support the response.
On May 6, 2009, CDC distributed recommendations for the use of influenza
antiviral medicines to provide guidance for clinicians in prescribing
antiviral medicines for treatment and prevention (chemoprophylaxis) of 2009
H1N1 influenza. CDC recommended that testing and antiviral treatment be
prioritized for people with severe respiratory illness and people at high
risk of complications from seasonal influenza. This included children
younger than 5 years old, pregnant women, people with chronic medical
conditions, and people 65 years and older.
On May 8, 2009, CDC issued an MMWR updating the situations in Mexico, the
United States, and worldwide, and on May 15, 2009, CDC’s Travel Health
Warning recommending against non-essential travel to Mexico, in effect since
April 27, 2009, was downgraded to a Travel Health Precaution for Mexico.
By this point in the outbreak, about half of all influenza viruses being
detected through laboratory surveillance were 2009 H1N1 viruses, with the
other half being regular seasonal influenza viruses, including seasonal
influenza A H1N1, influenza A H3N2 and type B viruses. Surveillance reports
indicated that the largest number of 2009 H1N1 influenza confirmed and
probable cases (about 57% of cases) were occurring among people between 5
years and 24 years of age, and 41% of the hospitalizations were occurring
among older children and young adults. The highest rates of hospitalization
were among children younger than 5 years of age; the next highest
hospitalization rate was in people 5 years to 24 years of age. Based on data
from previous influenza pandemics and seasonal influenza, pregnant women
had been recognized as a high-risk group early in the outbreak. Early data
on 2009 H1N1 illness among pregnant women was reported in an article
published as an MMWR Dispatch on May 12, 2009. This article emphasized the
importance of empiric treatment (treatment without confirmatory testing) of
pregnant women suspected to have 2009 H1N1. People with other previously
recognized medical conditions that placed them at high risk of complications
from seasonal influenza also appeared to be at increased risk of
complications from 2009 H1N1 influenza. In this report, seventy-one percent
(71%) of hospitalized patients had one or more underlying chronic medical
conditions. Reported deaths had occurred in people ranging in age from 22
months old to 57 years old. Also, only 13% of hospitalizations had occurred
in people 50 years and older, and there were few cases and no deaths in
people older than 65 years, which was unusual when compared with seasonal
flu.
Early results of an antibody study conducted by CDC indicated that children
had no existing cross-reactive antibody to the 2009 H1N1 influenza virus,
while about one-third of adults older than 60 years of age had cross-
reactive antibody against the 2009 H1N1 flu virus. One possible explanation
for this pre-existing antibody in older adults was that they may have had
previous exposure, either through infection or vaccination, to an influenza
A H1N1 virus that was more closely related to the 2009 H1N1 flu virus than
contemporary seasonal influenza A (H1N1) viruses are. Data from a similar
study suggested that seasonal influenza vaccine would not provide any
significant protection against 2009 H1N1 influenza virus.
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发帖数: 13
6
A Pandemic is Declared
On June 11, 2009, WHO signaled that a global pandemic of 2009 H1N1 influenza
was underwayExternal Web Site Icon by further raising the worldwide
pandemic alert level to Phase 6External Web Site IconExternal Web Site Icon.
That day, CDC held its first press conference with the new CDC Director
Thomas Frieden, MD, MPH. The press conference had a total of 2,355
participants. At the time, more than 70 countries had reported cases of 2009
H1N1 infection, and community level outbreaks of 2009 H1N1 were ongoing in
multiple parts of the world. The WHO decision to raise the pandemic alert
level to Phase 6 was a reflection of spread of the virus in other parts of
the world and not a reflection of any change in the 2009 H1N1 influenza
virus or associated illness. To date, most people in the United States who
had become ill with 2009 H1N1 influenza had not become seriously ill and had
recovered without hospitalization.
After the WHO declaration of a pandemic on June 11, the 2009 H1N1 virus
continued to spread and the number of countries reporting cases of 2009 H1N1
nearly doubled from mid-June 2009 to early July 2009. Significant levels of
2009 H1N1 illness continued, with localized and in some cases intense
outbreaks occurring. By June 19, 2009, all 50 states in the United States,
the District of Columbia, Puerto Rico, and the U.S. Virgin Islands had
reported cases of 2009 H1N1 infection. The United States continued to report
the largest number of 2009 H1N1 cases of any country worldwide, although
most people who became ill recovered without requiring medical treatment. By
late June more than 30 summer camps in the U.S. had reported outbreaks of
2009 H1N1 influenza illness, and CDC released guidance for day and
residential camps to reduce the spread of influenza. At the June 25, 2009
Advisory Committee on Immunization Practices Meeting Adobe PDF file, CDC
estimated that at least 1 million cases of 2009 H1N1 influenza had occurred
in the United States.
In early July, 2009, three 2009 H1N1 influenza viruses that were resistant
to the antiviral drug oseltamivir were detected in three countries. (
Antiviral resistance is when a virus changes in such a way that the
antiviral drug is less effective in treating or preventing illnesses caused
by the virus.) CDC and WHO partners continued to conduct surveillance for
antiviral resistance, although instances of antiviral resistance continued
to be detected very rarely.
Also in July 2009, CDC reported findings in the MMWR that indicated a
striking prevalence of obesity in intensive care patients who were confirmed
to have 2009 H1N1 influenza. Throughout the pandemic, CDC would continue to
examine the relationship between 2009 H1N1 influenza, obesity, severe
disease and other underlying risk factors.
CDC continued to work with the Council of State and Territorial
Epidemiologists (CSTE) to enhance surveillance for 2009 H1N1 influenza. As
2009 H1N1 cases continued to occur through the spring and summer, the task
of counting cases became increasingly difficult. On May 12, 2009, CDC
transitioned from reporting individual confirmed and probable cases of 2009
H1N1 influenza to reporting aggregate counts of 2009 H1N1 lab confirmed and
probable cases, hospitalizations and deaths with the launch of an aggregate
reporting web site. Once the numbers of cases increased beyond the point
where counting of individual cases was practical, on July 23, 2009, CDC
reported the number of 2009 cases for the last time. Reporting of 2009 H1N1
hospitalizations and deaths continued. In addition, CDC continued using its
traditional surveillance systems to track the progress of the 2009 H1N1
influenza outbreak. Traditional surveillance systems do not count individual
cases, but instead monitor activity levels and virus characteristics
through a nationwide surveillance system.
CDC worked closely with countries in the Southern Hemisphere to monitor and
enhance surveillance for influenza viruses throughout the summer months. The
Southern Hemisphere’s influenza season began in May 2009 and countries
there reported that 2009 H1N1 virus was spreading and causing illness along
with regular seasonal influenza viruses. After mid-JulyExternal Web Site
Icon, disease activity in most countries decreased, and by November,
temperate regions of the Southern Hemisphere were reporting very little 2009
H1N1 disease activity. In general, the experience of the Southern
Hemisphere with the 2009 H1N1 virus was similar to what is usually seen
during a regular influenza season and did not seem to excessively impact the
health care systems in the Southern Hemisphere. Also, surveillance systems
did not find significant changes in the 2009 H1N1 influenza viruses
circulating in the Southern Hemisphere as compared to viruses isolated from
people in the Northern Hemisphere. These findings provided the U.S. with
valuable clues related to what the 2009-2010 influenza season in the United
States might be like. Importantly, the lack of significant changes in the
virus indicated that the 2009 H1N1 vaccine being manufactured would closely
match the currently circulating 2009 H1N1 viruses and likely provide people
with good protection against 2009 H1N1 influenza.
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7
Ongoing Surveillance & Response
2009 H1N1 influenza summer activity peaked in the United States during May
and June and declined during July and early August. However, levels of
influenza activity would remain above normal throughout the summer months
with localized outbreaks. During the last two weeks of August, 2009 H1N1
influenza activity again began to increase United States.
In August 2009, CDC reported an additional two instances of oseltamivir-
resistant virus infection in two immunosuppressed patients in Seattle,
Washington. Later, in mid-September, CDC reported two additional cases of
oseltamivir-resistant 2009 H1N1 influenza in two summer campers in North
Carolina. CDC and partners continued to carefully track 2009 H1N1 influenza
antiviral resistance. As of June 2010 the 2009 H1N1 virus remains
susceptible to the antiviral drugs oseltamivir and zanamivir, with rare
exception. Cases of antiviral resistance are carefully tracked and updated
numbers are posted each week as part of the CDC publication FluView.
In late August, CDC began working with the commercial supply chain (
manufacturers, distributors, retailers) for certain influenza
countermeasures to monitor national inventory levels of critical supplies (
antivirals and respiratory protective equipment) on a weekly basis. This
visibility provided important data to guide SNS decision-making leading to
the release of additional SNS countermeasures.
FDA and the manufacturer of the antiviral drug Tamiflu® (oseltamivir)
recognized that commercial and stockpiled supplies of Tamiflu® oral
suspension (liquid formulation meant for children) were limited in October
2009. CDC worked with partners to reach pharmacists with background
information, updates on antiviral drug supplies, and instructions on how to
compound oral suspension from Tamiflu® capsules meant for adults (
Compounding is the mixing of drugs by a health care professional to fit the
unique needs of the patient). CDC also provided instructions for parents and
caregivers on how to make a medicine mixture for their child using adult
Tamiflu® capsules and thick, sweetened liquid. CDC also analyzed
related surveillance data and based on the analysis over 500,000 bottles of
pediatric oral suspension were distributed from the CDC SNS to states to
fill production gaps and meet the increasing demand for the formulation.
On October 23rd, 2009, FDA issued an Emergency Use Authorization (EUA) for
Peramivir IV. Peramivir IV is an investigational intravenous antiviral drug
used to treat people who have been hospitalized due to severe flu illness.
This drug was held in the Strategic National Stockpile (SNS) and distributed
by CDC under an EUA. Licensed clinicians were able to request this product
through the CDC website electronic request system, and product was delivered
directly to hospital facilities. Also in October, HHS authorized the
release of an additional 59.5 million N95 respirators.
CDC closed out reports of 2009 H1N1 hospitalizations and deaths for the 2008
-09 season in late August. On August 30, 2009, reporting modifications were
implemented to allow states to report hospitalizations and deaths associated
with any influenza or to report hospitalizations and deaths using a
pneumonia and influenza syndromic case definition through the Aggregate
Hospitalizations and Deaths Reporting Activity (AHDRA). This change in
reporting was implemented in order to provide a fuller picture of the burden
of serious flu illness and deaths during the pandemic. The new reporting
season for the 2009-2010 flu season began on August 30, 2009, and the first
new numbers for the 2009-2010 season were reported in the September 11, 2009
issue of FluView.
Over the course of the pandemic, CDC refined and revised its surveillance
methods, eventually developing a methodology based on surveillance data to
estimate the range of 2009 H1N1 cases, hospitalizations and deaths in the
United States. CDC released its first official estimates for 2009 H1N1 cases
, hospitalizations and deaths on November 12, 2009, and updated these on
December 10, 2009, January 15, 2010, February 12, 2010, March 12, 2010,
April 19, 2010 and for the final time on May 14, 2010.
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8
2009 H1N1 Vaccination
The emergence and spread of the 2009 H1N1 virus resulted in extraordinary
influenza-like illness activity in the United States throughout the summer
and fall months of 2009. During this period, influenza activity reached its
highest level in the reporting week ending October 24, 2009, with 49 of 50
states reporting geographically widespread disease. A cornerstone of the U.S
. Government response to the 2009 H1N1 pandemic was the launch of the
national influenza 2009 H1N1 vaccination campaign that began in October.
Much activity led up to the launch of the vaccination campaign.
Starting in early June 2009, weekly calls were held to provide state and
local planners with vaccine-related updates, and on July 8, 2009, CDC issued
guidance for state and local public health departments to assist them in
planning for the 2009 H1N1 influenza vaccination campaign. On July 9, 2009,
the Department of Health and Human Services, the Department of Homeland
Security, the Department of Education, and the White House held an influenza
preparedness summit for federal, state, local and tribal officials to
discuss existing pandemic plans, lessons learned, and preparedness
priorities. At the summitExternal Web Site Icon, the Federal government
announced the availability of $350 million in supplemental funding for use
by state, local and territorial health departments to bolster their response
activities to the 2009 H1N1 influenza pandemic and strongly encouraged
state, tribal and local partners to be ready to begin a 2009 H1N1 influenza
immunization program by mid-October 2009.
The 2009 National Influenza Vaccine Summit, a partnership of public and
private stakeholders committed to achieving the Healthy People 2010 goals
for influenza vaccine, convened on June 29. During the 2009 Summit,
attendees were provided updates by experts in several professional fields,
including private medicine, public health, health communication, vaccine
manufacturing, vaccine distribution, and vaccine-related policy. CDC has
been a cosponsor of this event, along with the American Medical Association,
since 2001.
In preparation for the 2009 H1N1 influenza immunization program, on July 22,
2009, the National Institutes of Health (NIH) announced the start of a
series of clinical trialsExternal Web Site Icon to test pilot lots of two
manufacturers’ versions of 2009 H1N1 influenza vaccine in healthy people,
as well as people with underlying health conditions like asthma and HIV.
Preliminary results from the clinical trials were announced publicly.
On July 23, 2009, FDA’s Vaccines and Related Biological Advisory
CommitteeExternal Web Site Icon indicated support of FDA’s proposed plan to
license monovalent 2009 H1N1 vaccines via a “strain change” pathway,
similar to how seasonal influenza vaccines are licensed. This meant the 2009
H1N1 vaccine would be made in the same way using the same standards already
in place for seasonal vaccines; it also allowed licensure to proceed more
quickly since it did not require immunogenicity data or additional safety (
except for the live attenuated vaccine) data for licensure.
On July 29, 2009, the Advisory Committee for Immunization Practices (ACIP)
met to make recommendations for 2009 H1N1 vaccine. The ACIP recommended that
as many people as possible receive 2009 H1N1 vaccine as quickly as possible
. Certain groups of people were targeted to receive initially limited
supplies of the 2009 H1N1 vaccine based on epidemiologic and virologic data
indicating they were at higher risk for infection or for severe influenza
complications. The initial target groups for vaccination were estimated to
consist of about 159 million people and included: pregnant women, people who
live with or care for infants younger than 6 months of age, health care and
emergency medical services personnel, infants 6 months through young adults
24 years of age, and adults 25 through 64 years of age who are at higher
risk for 2009 H1N1 complications because of chronic health disorders or
compromised immune systems. The ACIP also recommended that local public
health authorities and health care practitioners have flexibility to
determine at the local level how quickly and when to expand vaccination to
other groups because vaccine availability and demand would likely vary by
area.
CDC convened three public engagement sessions in mid-August in ten regions
of the United States with the purpose of soliciting citizen input into
vaccination planning. The public provided opinions to CDC regarding how
vaccine should be provided in the U.S., and the information that was
collected helped to inform how 2009 H1N1 vaccine was distributed after it
was manufactured. Ultimately, it was decided that vaccine should be
distributed as soon as it was ready so that people could be protected
against influenza as soon as possible, versus waiting to distribute vaccine
until large quantities were prepared.
In late August, CDC published a study in the MMWR that summarized an
investigation of laboratory-confirmed cases of 2009 H1N1 influenza
identified during April 24-July 25, 2009 in Chicago, Illinois. The study
found that the overall attack rate was highest among children aged 5-14
years (147 per 100,000 population), which was 14 times higher than for
adults older than 60 years of age. A total of 205 (13%) patients were
hospitalized, with the highest rate observed among children aged 0-4 years (
25 per 100,000), followed by children aged 5-14 years (11 per 100,000).
These findings would also provide input into vaccination strategy.
By the end of August 2009, prototype vaccines to prevent 2009 H1N1 virus had
been developed but were not yet licensed. Production of the enormous
quantities of vaccine necessary to protect the entire U.S. population was
underway. CDC expanded its contract for the childhood Vaccine for Children
program in the United States (McKesson Specialty Distribution), to provide
centralized distribution of 2009 H1N1 vaccine. Available vaccine supplies
were allocated to states proportional to their total populations and shipped
to public and private provider vaccination sites based on orders placed by
the states. Participating providers were asked to sign a Provider Agreement
assuring they intended to meet state requirements for administering vaccine.
On September 3, 2009, CDC published in the MMWR a study that had analyzed
data related to 2009 H1N1 influenza pediatric deaths reported to CDC from
April to August, 2009. Data showed that as of August 8, 2009, 477 deaths
with laboratory confirmed 2009 H1N1 flu in the United States had been
reported to CDC, including 36 children younger than 18 years of age. Sixty-
seven percent (67%) of children who died with 2009 H1N1 influenza had at
least one high-risk medical condition. CDC continued to urge parents to
recognize 2009 H1N1 in their children early and to seek medical attention
when needed. CDC also reiterated that all children 6 months or older and
caregivers of children younger than 6 months should receive the 2009 H1N1
vaccine when it became available.
On September 10, 2009, the HHS Secretary and CDC Director joined the
National Foundation for Infectious Diseases (NFID) in a news conference to
stress vigilance against seasonal influenza in an unusual season and urged
Americans to get their seasonal flu vaccine early. In addition to NFID, HHS
and CDC, the news conference was held in collaboration with the American
Medical Association (AMA), American Academy of Pediatrics (AAP), American
College of Physicians (ACP), AARP, and the National Influenza Vaccine Summit.
top of page
On September 15, 2009, the Food and Drug Administration (FDA) announced its
approval of four 2009 H1N1 influenza vaccinesExternal Web Site Icon, and
later, on November 16, FDA announced its approval of a fifth 2009 H1N1
vaccineExternal Web Site Icon to protect against the 2009 H1N1 flu virus.
The NIH announced on September 21, 2009, that early results from clinical
trialsExternal Web Site Icon of 2009 H1N1 influenza vaccine in children
looked promising. Preliminary analysis indicated that the vaccines were safe
, and that only one dose of 2009 H1N1 vaccine for the majority of 10 to 17
year olds would be needed to generate a sufficient immune response to be
protective against 2009 H1N1 influenza virus, but younger children generally
had a less robust early response to the vaccine. CDC recommended that
children younger than 10 years receive two doses of 2009 H1N1 influenza
vaccine. Results of trials conducted among adultsExternal Web Site Icon were
later published in December, and the data indicated that the immune
response among vaccinated adults was excellent. The safety data from these
trials also indicated that vaccine side effects were similar to those seen
with the seasonal flu vaccines.
On September 30, 2009, states were able to place their first orders for the
2009 H1N1 vaccine; forty-seven states placed orders on that day, and by
October 9, 2009, all states and the District of Columbia had placed orders
for vaccine. The first doses were administered on October 5, 2009.
Because initial supplies of vaccine were limited, most state and local
health departments requested that vaccine be given only to those in the
initial target groups, and many restricted use to those in sub
prioritization groups that had also been outlined by ACIP. The first six
weeks after vaccines were initially released where characterized by high
demand for vaccine and limited availability. On October 23, the ACIP
discussed pandemic vaccine issues, including suitability of the initial
target groups developed in July 2009, and concluded that the July guidance
remained appropriate. The ACIP continued to emphasize the role of local
decision-making in determining when to begin offering vaccine to persons
outside initial target groups.
As vaccine supply increased, by late November and early December most states
had begun easing restrictions for 2009 H1N1 vaccine use, and by late
December vaccination had been opened up to anyone who wanted it. Also
beginning in December 2009, the HHS Center for Faith-Based Neighborhood
Partnerships partnered with the HHS Regional Offices to host eleven
teleconferences to engage community and faith-based organizations in the
2009 H1N1 flu response. Since most states were easing vaccination
restrictions, these calls presented an opportunity to remind key partners
that they should check with their local health departments to determine
availability of vaccine. By the week of December 22, distribution of 2009
H1N1 vaccine had been opened up to retail pharmacies so that they could
place orders for vaccine directly, thereby expanding the reach and
availability of vaccine.
In December 2009, CDC published in the MMWR preliminary safety results for
the 2009 H1N1 vaccines from the first months of reports received through the
U.S. Vaccine Adverse Event Reporting System (VAERS), a national voluntary
reporting surveillance system and data from the Vaccine Safety Datalink.
Results indicated that the vast majority (95%) of adverse events reported to
VAERS after receipt of the 2009 H1N1 vaccine were not serious (e.g.,
soreness at the vaccine injection site). Of the 3,783 reports, 204 (5%) were
reports that involved what would be coded as serious health events (defined
as life threatening or resulting in death, major disability, abnormal
conditions at birth, hospitalization, or extension of an existing
hospitalization). The percentage of reports involving what would be
considered serious health events was not substantially different between
2009 H1N1 and seasonal influenza vaccines.
The 2009 H1N1 influenza vaccine was manufactured in several formulations,
using the same manufacturers and the same manufacturing practices used to
produce seasonal influenza vaccine. Monitoring the safety of the flu vaccine
continues to be a top priority. CDC and the Food and Drug Administration (
FDA) worked with other agencies to establish and enhance existing
surveillance systems to rapidly detect any unexpected adverse events among
persons who are vaccinated and to adjust the vaccination program, if
necessary, to minimize risks and maximize benefits from vaccination. Two
important systems used to monitor vaccine safety that have been active for
20 years, are the Vaccine Adverse Events Reporting System (VAERS)External
Web Site Icon, jointly operated between CDC and FDA, and the Vaccine Safety
Datalink (VSD) , a collaborative project between the CDC and eight managed
care organizations covering more than nine million members(about 3% of the
US population). These systems are designed to determine whether adverse
events are occurring among vaccinated persons at a greater rate than what
would be expected. CDC worked with FDA and other partners to strengthen
these vaccine safety monitoring systems and develop new ways to monitor
vaccine safety. In addition, based on the recommendation of the National
Vaccine Advisory CommitteeExternal Web Site Icon (NVAC), HHS established the
H1N1 Vaccine Safety Risk Assessment Working Group to review 2009 H1N1
vaccine safety data as it accumulates. This working group of outside experts
conducts regular, rapid reviews of available data from the federal safety
monitoring systems and presents them to NVAC and federal leadership for
appropriate policy action and follow-up.
Also in December 2009, HHS joined with the Ad Council to launch a new
nationwide Public Service Announcements campaign called Together We Can
Fight the Flu that encouraged Americans to get vaccinated against the 2009
H1N1 virus. The week of December 18, 2009 marked the first 100 million doses
of 2009 H1N1 vaccine available for ordering.
The year 2010 began with the National Influenza Vaccination Week (NIVW).
NIVW is a national observance that was established to highlight the
importance of continuing influenza vaccination after the holiday season into
January and beyond. The President of the United States proclaimed the week
of January 10-16, 2010, National Influenza Vaccination Week, and encouraged
all Americans to observe the week by getting the 2009 H1N1 flu vaccine and
by asking their families, friends and coworkers to do the same. CDC and HHS
- in conjunction with the states and many other partners, both public and
private - launched a comprehensive NIVW campaign with the objective of
raising vaccination awareness, providing educational opportunities, free
resources, as well as vaccination clinics. Every year, certain days during
NIVW are designated to highlight the importance for certain groups; this
year’s Week was dedicated to highlighting the importance of vaccination for
the general public and health care workers, people with chronic health
conditions that put them at high risk of serious influenza-related
complications, children, pregnant women, and caregivers of infants less than
6 months old, young adults 19 through 24 years old, and people 65 years and
older. For example, the events on Tuesday, January 12 centered on people
with chronic medical conditions that put them at higher risk of serious
influenza-related complications. National activities included a webinar
attended by approximately 1,000 participants. This joint effort was hosted
by HHS, CDC, the American Cancer Society, the American Diabetes Association,
and the American Lung Association. In addition, Secretary Sebelius
participated in two press conference calls announcing new public service
announcements (PSAs) tailored to African American and Native American
audiences. The Director of the Indian Health Service joined the Secretary in
stressing the importance and benefits of vaccination.
On January 15, 2010, CDC published an article in the MMWR on influenza A (
H1N1) 2009 monovalent vaccination coverage in the United States between
October and December 2009. Results of the study indicated that efforts to
get available vaccine to target groups had largely succeeded. Early on
during the 3-month period, 85% of available vaccine reached people within
those initial target populations. By the end of December, with many programs
expanding their vaccine efforts to all populations, 74% of all vaccine
given during the program had gone to people in the initial priority groups.
On February 18, 2010, the World Health Organization (WHO) published
recommendations for the composition of influenza virus vaccines for the
upcoming season in the Northern Hemisphere (November 2010-April 2011). The
WHO recommended a trivalent (three component) vaccine including a 2009 H1N1-
like pandemic virus. In February of 2010, the components of the 2010-2011
influenza vaccine were announced. The 2010-2011 flu vaccine will protect
against a 2009 H1N1-like virus in addition to an influenza A H3N2 virus and
an influenza B virus.
The United States experienced its second wave of 2009 H1N1 activity in the
fall with activity peaking during the second week in October. After that,
activity declined quickly to below baseline levels in January, but persisted
for several more months at lower levels. However, by May, influenza
activity levels in the United States were low across key flu indicators.
Reporting for the 2009-2010 influenza season was finalized on May 28, 2010.
Even as flu activity reached normal summer-time levels in the U.S., CDC
continued to recommend influenza vaccination, particularly for high risk
persons, because of reports of ongoing sporadic cases of 2009 H1N1, ongoing
spread of 2009 H1N1 in the Southern Hemisphere and the possibility that 2009
H1N1 viruses might circulate early during the upcoming flu season.
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9
CDC Communication Activities During the 2009 H1N1 Pandemic
The CDC response to the 2009 H1N1 pandemic was led by science and
continually evolved to meet the nation’s needs as events unfolded and as
more information became available. However, a consistent underlying
communications strategy underscored the entire CDC response. The strategy is
based on the emergency risk communications principles of quickly,
proactively and transparently communicating accurate information to the
public and to partners. This strategy included CDC clearly stating its goals
and actions in response to the evolving situation and acknowledging what
was not known, as well as what was known. Another important part of the
strategy was CDC setting the expectation that information and advice would
change rapidly as the situation evolved. From the earliest days of the
pandemic, CDC regularly articulated its goals to “reduce transmission and
illness severity, and provide information to help health care providers,
public health officials and the public address the challenges posed by the
new virus.” Throughout the response, in an effort to provide the most
helpful information in the most effective ways possible, CDC drew on
existing knowledge but also worked with partners to conduct ongoing
scientific research and evaluation of people’s knowledge, attitudes and
practices related to a number of topics including 2009 H1N1 flu, infection
control guidance, and vaccine.
Especially during the early days of the outbreak, the release of information
from CDC and exchange of information with partners was conducted on a 24-
hour cycle. This included frequent updates to media and the public, the
consistent use of a core group of spokespersons, daily information outreach
to partners, and rapid establishment and ongoing maintenance of an extensive
Web site dedicated specifically to the emergency response for 2009 H1N1 flu
. The goal was not only to be as transparent as possible in all activities
related to managing the public health response, but also to maintain
credibility and continue to be a trusted source of information for the
public and for partners.
Beginning early in the response and continuing throughout the year and into
2010, special care was taken to keep state and local public health partners
informed of CDC’s activities. Key messages were regularly provided to help
maintain consistent, clear communication across the response. Special care
also was taken to regularly collect feedback from state and local public
health partners to help ensure that CDC recommendations were finely tuned to
what was happening in the field. Regularly scheduled conference calls with
the Association of State and Territorial Health Officials, the National
Association of City and County Health Officials, and the National Public
Health Information Coalition proved to be an effective way to share
information. In addition, on April 24, 2009, CDC held the first of more than
30 Clinician Outreach and Communication Activity (COCA) calls presented on
a variety of 2009 H1N1-related topics. COCA is designed to reach a diverse
group of health care providers and provide a system through which clinicians
can communicate their educational needs to CDC and receive answers to
questions about related emerging diseases. At the peak of the 2009 H1N1
response, COCA had more than 41,100 listserv subscribers.
CDC also worked hard to keep the policy community informed. CDC provided
responses to congressional requests for information and briefings on 2009
H1N1-related issues, and also provided email and web-based informational
updates as the pandemic unfolded. In all, CDC participated in 14 hearings,
provided technical assistance in another 12 hearings, issued over three
dozen 2009 H1N1 newsletters to policymakers, arranged for over 40
congressional briefings or speaking engagements and fielded over 350
congressional inquiries during the pandemic.
There was a concerted effort to get information out as soon as possible and
to keep the public and partners aware of developments as they unfolded, even
as guidance was changing quickly. For example, when relatively few cases of
human infection with this virus were lab confirmed and severity of the
pandemic was not known, on April 28, 2009, CDC posted guidance for schools
and advised that they close if they had a suspected or actual case of the
flu in order to lessen the risk of spreading 2009 H1N1 into their
communities. As more information became available suggesting a lower risk of
severe illness and death from 2009 H1N1, six days later the recommendation
was changed to recommend against school closure for community mitigation
purposes.
The development of CDC guidance is an example of the collaborative
communication and sharing of information that took place between CDC, HHS,
other federal agencies, and external partners. Development of appropriate
guidance often relied on CDC communication with many external partners
several times a week, with the goal of achieving consensus on what the best
practice would be given the best science currently available. For example,
CDC worked with representatives from a number of organizations including but
not limited to Council of State and Territorial Epidemiologists (CSTE),
External Web Site Icon National Association of County and City Health
Officials (NAACHO), External Web Site IconAmerican Academy of Pediatrics (
AAP)External Web Site Icon, American Academy of Family Physicians (AAFP)
External Web Site Icon, American College of Obstetricians and Gynecologists
(ACOG), External Web Site IconAssociation of State and Territorial Health
Officials (ASTHO)External Web Site Icon, American College of Physicians (ACP
)External Web Site Icon, Infectious Diseases Society of America (ISDA)
External Web Site Icon, American Academy of Pediatrics (AAP)External Web
Site Icon, Food and Drug Administration (FDA) External Web Site Iconand
World Health Organization (WHO)External Web Site Icon, during the
development of guidance related to everything from surveillance systems to
the appropriate use of antiviral drugs during the pandemic. On the topic of
vaccination, these discussions helped inform decision-making by the Advisory
Committee on Immunization Practices (ACIP).
Apart from ongoing collaboration between CDC and its external partners, the
communications response for 2009 H1N1 flu also was characterized by ongoing,
close coordination between CDC’s communicators and its scientists to
ensure that messages stayed scientifically accurate. Also, CDC communicators
took time to regularly analyze feedback from a variety of external sources,
including polls and surveys, in order to ensure that CDC's messages were
clear.
CDC provided a steady stream of information to audiences across the spectrum
and countries around the globe. Information provided by CDC reached a myriad
of audiences through a variety of channels including but not limited to: a
24-hour information hotline, press briefings for the media, dissemination
through health alert networks, daily postings (including video and audio
podcasts) to the CDC 2009 H1N1 web site, regular updates on Facebook and
Twitter, and further outreach by partners and partner organizations to their
own audiences, just to name a few channels. For example, in November 2009,
CDC kicked off a national travelers’ health public awareness campaign and
urged travelers to plan ahead and stay informed about what to do if they got
sick while they were away from home. The campaign used a variety of media,
including informational posters distributed at over 300 ports of entry in
the United States, national radio and print advertising, and social media
and online outreach, which culminated in over 80 million exposures. CDC
also coordinated with HHS and the Flu.gov web site and posted communication
toolkits for the 2009-2010 influenza season for businesses, employers,
childcare groups and institutions of higher education.
The CDC 2009 H1N1 influenza and seasonal influenza vaccination campaign was
made up of multiple outreach efforts including placement of articles geared
to numerous audiences like parents and young adults, in high-profile media
outlets. Article placements led to nearly 403 million overall impressions.
Other national outreach efforts made via social media tools, radio ads, two
television public service announcements (PSAs), online media banners, and
city bus ads. Numerous print materials in multiple languages were made for
partners to distribute and were downloaded tens of thousands of times.
Special audiences identified for additional print materials included Native
Americans, African Americans, Hispanics, pregnant women, young adults, first
responders, and health care workers.
In addition to materials provided for the 2009 H1N1 and seasonal influenza
vaccination campaign, CDC provided other key materials in multiple languages
. For example, the entire English-language 2009 H1N1 web site was mirrored
in Spanish. In addition, key tools and resources were created in Chinese,
Vietnamese, Korean, French, German, Arabic, Russian, Amharic, Farsi, Somali,
Karen, Burmese, Cambodian, and Kirundi.
In all, between April 2009 when 2009 H1N1 flu first emerged and April 2010,
CDC held 60 related media events – 39 press briefings and 22 telebriefings
– for a total of more than 35,000 participants. CDC also hosted its first
ever two-day workshop for the news media on the subjects of both 2009 H1N1
influenza and seasonal influenza in late August. Originally conceived to
include 12 members of the news media, the attendance grew to over 40
journalists from national, regional and local news outlets representing
radio, television, newspapers, magazines, and online news media. Speakers at
the event included the Secretary of Health and Human Services, the CDC
Director, influenza experts, vaccine safety experts, and laboratory experts.
The CDC hotline (1-800-CDC-INFO) responded to more than 211,000 related
inquiries from the general public and health care providers, and the CDC
2009 H1N1 web site had more than 219,595,000 page views. Also, the number of
CDC Facebook fans rose to more than 55,000 fans and the CDC emergency
profile on Twitter was tracked by more than 1,200,000 followers.
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10
MMWR
Influenza Activity --- United States, 2009--10 Season
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5929a2.htm?s_cid=mm5929a2_w
1 (共1页)
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h1n1,挂1万多关于下一步舆论斗争的指示
美国CDC公布的2014年流感数据17年前的SARS详细数据,何时公开?
当年H1N1是怎么结束的?Bill Gates: Coronavirus may be ‘once-in-a-century pathogen we’ve been worried about’
美国上次发生大规模传染病疫情是什么时候?flu season, flu shots in US
相关话题的讨论汇总
话题: h1n1话题: cdc话题: influenza话题: 2009话题: vaccine