Home
Patients & General Public

Swine Flu Update for Patients & General Public

Friday, June 19, 2009
The United States reports 21,449 cases of confirmed H1N1 virus and 87 deaths, including 8 in California. San Diego health officials reported the county�s first death this week of a 20-year-old woman in the Escondido area.

The woman worked at KFC in San Marcos. Her brother, who is hospitalized with flu symptoms, works at Pizza Hut in the same area.

It is important to remember that H1Ni is not usually a food-borne illness and everyone should continue to take everyday steps to protect their health and lessen the spread of this new virus.

Vaccines are a very important part of a response to pandemic influenza and the U.S. Government is aggressively taking early steps in the process to manufacture a novel H1N1 vaccine, working closely with manufacturers. CDC has isolated the new H1N1 virus, made a candidate vaccine virus that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary.

Tuesday, May 12
North County Health Services continues to see an increase in patients and more probable H1N1 cases. Assessments in the lobby are still being done at the San Marcos Health Center to determine which patients may have flu-like symptoms so they can be masked and directed to the appropriate area.

Today, 53 cases of the H1N1 virus have been confirmed in San Diego County. State health officials confirm 193 cases of the virus in California in the following counties: Alameda, 3; Amador 1; Calaveras 1; Contra Costa, 3; El Dorado 1; Imperial 24; Los Angeles 19; Marin 4; Monterey 5; Orange 4; Placer 1; Riverside 9; Sacramento 5; San Bernardino 24; San Diego 53; San Francisco 5; San Joaquin 4; San Luis Obispo 9; Santa Clara 11; Sonoma 2; Tulare 3; Ventura 2; and 202 probable cases in: Alameda 5; Contra Costa 16; El Dorado 4; Imperial 24; Los Angeles 14; Madera 1; Marin 3; Monterey 5; Orange 14; Riverside 9; San Benito, 1; San Bernardino 24; San Diego 47; San Francisco 1; San Joaquin 4; San Mateo 1; Santa Clara 13; Solano 3; Tulare 2; Ventura 11.

The CDC has reported 3,009 laboratory confirmed human cases in the United States, including three deaths (2 in Texas; 1 in Washington). Costa Rica reported the first swine flu death outside North America, bringing the global death toll to 53, including 48 in Mexico, three in the United States and one in Canada.

The World Health Organization (WHO) and CDC confirmed 5,251 cases of the H1N1 virus in 30 countries, including at least 2,059 in Mexico, 3,009 in the United States and 330 in Canada.

China confirmed its first case on mainland, a student who had been in U.S. Health authorities scramble to quarantine hundreds of passengers who flew with him on flight from Japan and a domestic flight. Japanese authorities are scrambling to limit contact with their country's first cases, and Australia and Norway joined the list of nations with confirmed cases of swine flu.

HRSA�s Office of Pharmacy Affairs has published information regarding use of the 340B Drug Pricing Program during a public health emergency. During emergencies and disasters, the 340B Drug Pricing Program has some limited flexibilities for entities already covered by the 340B Drug Pricing Program to dispense pharmaceuticals to displaced patients and HRSA can make it easier for eligible new entities (including DHHS grantees, DSH hospitals, and FQHC look-alikes) to register for the 340B Program in counties with federal major disaster declarations, federal emergency declarations, and federal public health emergency declarations.

As the need for daily updates decreases, we will provide new information when appropriate.

Friday, May 8, 4:00 p.m.
North County Health Services continues to see an increase in patients and more probable H1N1 cases. The San Marcos Health Center will continue to do assessments in the lobby next week to determine which patients may have flu-like symptoms so they can be masked and directed to the appropriate area.

Today the San Diego County Health and Human Services Agency (HHSA) reports that the Centers for Disease Control and Prevention (CDC) has confirmed 19 new cases of human infection with H1N1 Influenza in San Diego County residents, bringing the total number of cases to 51. All of those cases were moved from the probable list to the confirmed list.

In addition, the World Health Organization (WHO) reports more than 3,100 cases worldwide in 28 countries, including more than 1,100 in Mexico, at least 1,639 in the United States, and 214 in Canada.

There have been 45 H1N1 deaths in Mexico and two in the U.S., both in Texas. One of those who died in the U.S. was a toddler from Mexico. Canadian officials say an Alberta woman in her 30s with swine flu died April 28, but she had underlying medical conditions and it's unclear the disease played a role in her death.

The WHO reports that up to 2 billion people could be infected by swine flu if the outbreak turns into a pandemic over months or years, but admit that it's too early to tell how widespread or severe the outbreak will become.

The WHO reported two new human cases of bird flu on Wednesday. One patient is recovering in Egypt, while another died in Vietnam.

According to the CDC, only about 10 percent of Americans with the H1N1 virus are believed to have gotten it during trips to Mexico.

Today the CDC issued a revised Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting. For more information, visit: http://www.cdc.gov/h1n1flu/guidance/hemodialysis_centers.htm.

According to the CDC, persons at high-risk for complications of novel influenza (H1N1) virus infection as the same for seasonal influenza at this time. As more epidemiologic and clinical data become available, these risk groups might be revised.

� Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old.

� Adults 65 years of age and older.

Persons with the following conditions:

� Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus);

� Immunosuppression, including that caused by medications or by HIV;

� Pregnant women;

� Persons younger than 19 years of age who are receiving long-term aspirin therapy;

� Residents of nursing homes and other chronic-care facilities.

The novel H1N1 flu virus is causing illness in infected persons in the United States and countries around the world. CDC expects that illnesses may continue for some time. As a result, you or people around you may become ill. The CDC has updated its guidance to help people recognize the symptoms and know what to do:

Symptoms

The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this new H1N1 virus also have reported diarrhea and vomiting.

Avoid Contact with Others

If you are sick, you may be ill for a week or longer. You should stay home and avoid contact with other persons, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general, you should avoid contact with other people as much as possible to keep from spreading your illness. At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods.

Treatment is Available for Those Who Are Seriously III

It is expected that most people will recover without needing medical care. If you have severe illness or you are at high risk for flu complications, contact your healthcare provider or seek medical care. Your healthcare provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes wide-spread, there will be little need to continue testing people, so your healthcare provider may decide not to test for the flu virus.

Antiviral drugs can be given to treat those who become severely ill with influenza. These antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including H1N1 flu virus. These medications must be prescribed by a healthcare professional.

There are two influenza antiviral medications that are recommended for use against H1N1 flu. The drugs that are used for treating H1N1 flu are called oseltamivir (trade name Tamiflu �) and zanamivir (Relenza �). As the H1N1 flu spreads, these antiviral drugs may become in short supply. Therefore, the drugs will be given first to those people who have been hospitalized or are at high risk of complications. The drugs work best if given within 2 days of becoming ill, but may be given later if illness is severe or for those at a high risk for complications.

Aspirin or aspirin-containing products (e.g. bismuth subsalicylate � Pepto Bismol) should not be administered to any confirmed or suspected ill case of novel influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs. For more information about Reye�s syndrome, visit the National Institute of Health website.

o Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.

o Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol�) and ibuprofen (Advil�, Motrin�, Nuprin�), to relieve symptoms.

o Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.

Emergency Warning Signs

If you become ill and experience any of the following warning signs, seek emergency medical care:

In children emergency warning signs that need urgent medical attention include:

� Fast breathing or trouble breathing

� Bluish or gray skin color

� Not drinking enough fluids

� Severe or persistent vomiting

� Not waking up or not interacting

� Being so irritable that the child does not want to be held

� Flu-like symptoms improve but then return with fever and worse cough.

In adults, emergency warning signs that need urgent medical attention include:

� Difficulty breathing or shortness of breath

� Pain or pressure in the chest or abdomen

� Sudden dizziness

� Confusion

� Severe or persistent vomiting

� Flu-like symptoms improve but then return with fever and worse cough

Protect Yourself, Your Family, and Community

� Stay informed. Health officials will provide additional information as it becomes available. Visit the CDC H1N1 Flu website.

� 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 hand cleaners are also effective.

� Avoid touching your eyes, nose or mouth. Germs spread this way.

� Try to avoid close contact with sick people.

� If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Keep away from other household members as much as possible. This is to keep you from infecting others and spreading the virus further.

� Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.

World health officials have cautioned that what seems mild now could return with a vengeance when the flu season begins in the fall. Many will be looking to the Southern Hemisphere, which is entering flu season, as a potential early test.

Thursday, May 7, 5:00 p.m.
The San Diego County Health and Human Services Agency (HHSA) reports that the Centers for Disease Control and Prevention (CDC) has confirmed three new cases of human infection with H1N1 Influenza in San Diego County residents, bringing the total number of cases to 32. The three new cases are: An 8-year-old male, a 25-year-old female, and an 18-year-old male.

�We continue to stress the things the public can do to protect themselves: if you are sick, do not go to work, school or travel. Cover your mouth when coughing, sneezing or blowing your nose, and wash your hands frequently,� said Wilma Wooten, M.D., M. P.H., County Public Health Officer.

The CDC has also confirmed 106 cases of human infection with H1N1 Influenza in California, and 896 and 925 probable in the U.S. States with the most confirmed cases are Illinois (122 cases), New York (97), California (67), Texas (61), and Arizona (48).

Among patients with confirmed disease for whom data were available, 262 (90%) of 292 reported fever, 249 (84%) of 296 reported cough, 176 (61%) of 290 reported sore throat, 65 (26%) of 249 reported diarrhea, and 54 (24%) of 221 reported vomiting.

The H1N1 influenza virus has now sickened 2,350 people worldwide in 24 countries. The case counts in Canada and Spain continue to increase by large numbers.

Last night, the CDC issued new interim guidance for public gatherings, colleges and universities, and antiviral recommendations for patients with the H1N1 virus. To view this new guidance, please visit: http://www.cdc.gov/h1n1flu/whatsnew.htm.

CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has now distributed test kits to all states in the U.S. and Puerto Rico. The test kits are being shipped internationally as well. This will allow states and other countries to test for this new virus. This increase in testing capacity is likely to result in an increase in the number of reported confirmed cases in this country, which should provide a more accurate picture of the burden of disease in the United States.

� Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old.

� Adults 65 years of age and older.

Persons with the following conditions:

� Immunosuppression, including that caused by medications or by HIV;

� Pregnant women;

� Persons younger than 19 years of age who are receiving long-term aspirin therapy;

� Residents of nursing homes and other chronic-care facilities.

Symptoms

Avoid Contact with Others

Treatment is Available for Those Who Are Seriously III

o Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.

o Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol�) and ibuprofen (Advil�, Motrin�, Nuprin�), to relieve symptoms.

o Children younger than 4 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.

Emergency Warning Signs

If you become ill and experience any of the following warning signs, seek emergency medical care:

In children emergency warning signs that need urgent medical attention include:

� Fast breathing or trouble breathing

� Bluish or gray skin color

� Not drinking enough fluids

� Severe or persistent vomiting

� Not waking up or not interacting

� Being so irritable that the child does not want to be held

� Flu-like symptoms improve but then return with fever and worse cough.

In adults, emergency warning signs that need urgent medical attention include:

� Difficulty breathing or shortness of breath

� Pain or pressure in the chest or abdomen

� Sudden dizziness

� Confusion

� Severe or persistent vomiting

� Flu-like symptoms improve but then return with fever and worse cough

Protect Yourself, Your Family, and Community

� Stay informed. Health officials will provide additional information as it becomes available. Visit the CDC H1N1 Flu website.

� 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 hand cleaners are also effective.

� Avoid touching your eyes, nose or mouth. Germs spread this way.

� Try to avoid close contact with sick people.

� Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.

Wednesday, May 6, 5:00 p.m.
The CDC and county health officials report 29 confirmed cases of human infection with H1N1 Influenza in San Diego County residents, and 51 probable cases.

In California, there are 103 confirmed cases: (counties) El Dorado 1; Imperial 21; Los Angeles 11; Marin 4; Orange 2; Riverside 5; Sacramento 4; San Bernardino 4; San Diego 29; San Francisco 4; San Joaquin 1; San Luis Obispo 3; San Mateo 1; Santa Clara 7; Sonoma 1; Tulare 3; Ventura 2; and 163 probable: (counties) Alameda 2; Amador 1; Calaveras 1; El Dorado 2; Imperial 19; Los Angeles 6; Madera 1; Marin 1; Monterey 6; Orange 9; Riverside 7; San Bernardino 28; San Diego 51; San Francisco 2; San Joaquin 2; San Luis Obispo 5; San Mateo 1; Santa Clara 10; Solano 1; Tulare 3; Ventura 5.

The San Diego County Health and Human Services Agency and local school district officials re-opened three local high schools today where students were dismissed based on new recommendations from the CDC, including Mission Hills High School in San Marcos.

Walk-in patients are beginning to taper off a bit. Thursday, NCHS will move our outdoor triage area at the San Marcos Health Center to the lobby to process all patients going into the building. RNs and LVNs with bilingual Medical Assistants are assessing patients with flu-like symptoms and masking when appropriate and sent to the appropriate waiting area, or directly into an exam room. This triage area will remain functioning until at least the end of this week.

After receiving only adult doses of Tamiflu late last week, NCHS received a shipment of cherry syrup yesterday to compound adult formulation Tamiflu for pediatric use.

The World Health Organization reports 1893 cases in 23 countries, with Canada, Spain and the United Kingdom having the highest counts outside of the U.S. and Mexico.

The CDC is reports 850 probable cases and 642 confirmed cases of the H1N1 virus in the United States. The median age for cases is 16 years with a range of 3 months to 81 years. 58% of the cases in the U.S. are under 18 years of age. A total of two deaths and 35 hospitalizations have been confirmed, plus 17 hospitalizations that are probable. The median age of -- for hospitalized patients is 15 years. The age range for hospitalization is 8 months to 53 years.

�Looking at underlying disease for the 13 individuals for whom we have that detailed information,� explained Dr. Richard Besser, Acting Director of the CDC, �seven of them had known conditions that would put them at risk for more severe infection.�

�It's important that people have respect for this virus,� said Dr. Besser, �because it does cause severe disease, hospitalization and death. We don't know yet about issues of population immunity. We are not seeing as much disease in the elderly. This could be due to some underlying protection or it could be due to just the dynamic of it starting with the younger population before it traveled to the elderly. Everything we've seen to date leaves us with the understanding that we need to remain vigilant. We cannot let up on this and it's important that people understand that there's shared responsibility; that people need to continue to wash their hands, cover their coughs and most importantly, when they are sick, not send their children to school, not go to work when they are sick.�

U.S. health officials say it took only two weeks to identify the genetic characteristics of the strain, and they are in good position to quickly produce a vaccine if the flu takes a turn for the worse. They say there are still elements of the virus they don't understand.

Tuesday, May 5, 5:00 p.m.
The CDC has confirmed three new cases of human infection with H1N1 Influenza in San Diego County residents, bringing the total number of cases to 27. The new cases are a 1-year-old male and two military cases: a 33-year-old male and a 37-year-old male.

The first death of a United States resident with swine flu was reported in Texas. Few details have been released, but health officials say the patient was a woman in her 30s who lived near the Rio Grande and a popular border crossing. Officials said the woman had other, chronic health problems, but didn't offer specifics.

Last week, a boy from Mexico City died at a Houston hospital, marking the first swine flu death in the United States.

North County Health Services� outdoor triage area at the San Marcos Health Center is again processing all patients going into the building. RNs or LVNs with bilingual Medical Assistants conduct patient assessments so that patients with flu-like symptoms are masked before entering the building and sent to the appropriate waiting area, or directly into an exam room. This triage area will remain functioning until at least the end of this week.

If you have an appointment at the San Marcos Health Center, or have flu symptoms and plan to make a walk-in visit, please report to the canopy area east of the lobby entrance. Your temperature will be taken and you will be asked a few brief questions before entering the building.

The San Diego County Health and Human Services Agency (HHSA) is working with local school district officials to reopen three local high schools where students were dismissed, based on new recommendations from the CDC (see below). The schools are scheduled to reopen Wednesday.

�We received new guidelines on school closures this morning from the CDC and we are working closely with the education officials from the two school districts to open the schools to students once again,� said Wilma Wooten, M.D., M.P.H., and County Public Health Officer. �The new guidelines call for schools to remain open - with an emphasis on having students, teachers or staff who exhibit influenza-like illness stay home and not go to school or out into the community for at least seven days.�

The new guidelines call for student dismissals only when there is a large number of faculty or students absent and that interferes with a school�s ability to function, according to the CDC.

The schools where students were dismissed include San Diego School of Creative and Performing Arts and Kearny High School in the San Diego Unified School District and Mission Hills High School in the San Marcos Unified School District.

Area parents are also asked to refrain from bringing children to area emergency departments to be tested for H1N1 Influenza. �Our local emergency departments are being severely impacted with people bringing in children to be tested. Only those individuals that develop complications from Influenza-like illness should be evaluated by their primary care providers,� said Wooten.

Initial cases of the virus in the United States included school-aged students and were associated with travel to Mexico and school-based outbreaks. Early information from Mexico indicated that many previously healthy young adults were hospitalized with rapidly progressive pneumonia, frequently resulting in respiratory failure requiring mechanical ventilation and death. Based on this initial information, CDC recommended consideration of school closure as an option to lessen the risk of infection with this novel influenza virus in order to protect students, staff, parents and other caregivers from a potentially severe disease as well as limit spread into the community.

New information on disease severity warrants revision of the school closure guidance. Most U.S. cases have not been severe and are comparable in severity to seasonal influenza. CDC and local and state health officials will continue to closely monitor the severity and spread of this novel H1N1 influenza outbreak.

At this time, CDC recommends the primary means to reduce spread of influenza in schools focus on early identification of ill students and staff, staying home when ill, and good cough and hand hygiene etiquette. Decisions about school closure should be at the discretion of local authorities based on local considerations, including public concern and the impact of school absenteeism and staffing shortages. �But in a severe pandemic, the benefits of a school closure outweigh the risks,� said a CDC official in today�s press briefing.

In addition, the CDC has issued an interim guidance regarding mental and behavioral health issues. Feedback from the public suggests that most people understand the need for, and are willing to accept community mitigation interventions as a strategy for dealing with a pandemic. However, it is likely that use of these strategies may raise concerns and feelings of uncertainty. In some people these feelings may lead to increased tension, fear, anger, depression, and possibly grief. In some cases, these feelings can lead to aggressive and abusive behavior among household members or in community settings. The behavior may take the form of verbal, physical or emotional abuse. For CDC guidance recommendations, visit: http://www.cdc.gov/h1n1flu/guidance/mental-social.htm.

In a press briefing this morning, the CDC said it is bringing together scientists to begin development of vaccine for H1N1. �Acceleration is underway for seasonal flu production to clear the deck so that, if a decision is made to produce a vaccine for H1N1, we�re ready to go,� said a CDC official.

According to Dr. Richard Besser, Acting Director of the CDC, the median age of persons with a confirmed case of the H1N1 virus is 16 years old. Of the 35 confirmed hospitalizations, 62% are under the age of 18. �Given what we know from seasonal flu, we expect to see additional hospitalizations, and additional deaths. While we�re seeing some encouraging signs, this is a rapidly changing situation and we are still in a period of major uncertainty. We can look back at what�s taken place, but where it�s going to go is hard to say.�

Dr. Besser confirmed that the H1N1 virus does not contain factors associated with previous pandemics. We continue to gain information about the severity in this country, which seem to mimic the seasonal flu.

�We are seeing more cases in Mexico of a milder disease which helps us put this into perspective,� he said. The World Health Organization is looking to see a steady transmission of the diseases in other regions of the world that are similar to North America to determine if they will raise the alert level to six. �Given the number of countries with cases, we would think eventually that criteria will be met.�

Dr. Besser explained that much attention is being given to the southern hemisphere where the seasonal flu season is about to begin. �This is important as we think about what we want to do; whether resistance develops in the virus or whether it changes over time into something more severe.�

The CDC continues to stress personal responsibility in containing this virus. Hand washing, use of alcohol gels, and other precautions you would normally take to prevent viral infections should be vigilant now. Dr. Besser says to remember that if you�re sick and must stay home for 7 days, please keep your children home as well for 7 days.

The H1N1 influenza virus has now sickened 1,490 people worldwide and 433 people in the United States. World health officials have cautioned that what seems mild now could return with a vengeance when the flu season begins in the fall. Many will be looking to the Southern Hemisphere, which is entering flu season, as a potential early test.

Tuesday, May 5, 10:00 a.m.
San Diego County raised its infection count to 24 yesterday, with nine new cases and 24 probable ones. California reported 69 confirmed cases.

The H1N1 influenza virus has now sickened 1,447 people worldwide and 380 people in the United States. World health officials have cautioned that what seems mild now could return with a vengeance when the flu season begins in the fall. Many will be looking to the Southern Hemisphere, which is entering flu season, as a potential early test.

Mexico cancelled Cinco de Mayo celebrations today but will allow most businesses to reopen Wednesday and universities to reopen Thursday. This week, Mexico City will reopen cafes, museums and libraries. The U.S. Embassy in Beijing says four U.S. citizens were quarantined in China. A plane chartered by the Mexican government was sent to make several stops in China to bring 70 quarantined Mexican travelers home. And China sent its own plane to retrieve Chinese nationals stranded in Mexico.

Monday, May 4, 6:00 p.m.
The San Diego County Health and Human Services Agency (HHSA) reports that the Centers for Disease Control and Prevention (CDC) has confirmed nine new cases of human infection with H1N1 Influenza in San Diego County residents, bringing the total number of cases to 24 and 23 probable cases.

One of the new cases, an 18-year-old female was hospitalized, but has since recovered. Two of them have a travel history to Mexico.

The probable cases that led to the closures of San Diego School of Creative and Performing Arts in Paradise Hills, Kearny High School in Kearny Mesa and Mission Hills High School in San Marcos have all now been confirmed as H1N1 Influenza cases by the CDC.

Health officials report 1,085 in 21 countries. There are 286 confirmed cases of the N1H1 virus in 36 states in the U.S. In California, there are 69 confirmed: El Dorado 1; Imperial 11; Los Angeles 6; Marin 4; Orange 2; Sacramento 4; San Bernardino 4; San Diego 25; San Francisco 4; San Joaquin 1; San Luis Obispo 3; San Mateo 1; Tulare 1; Ventura 2; and 121 probable: Alameda 2; Amador 1; Calaveras 1; El Dorado 2; Imperial 27; Los Angeles 7; Monterey 5; Orange 9; Riverside 8; San Bernardino 18; San Diego 19; San Francisco 1; San Joaquin 2; San Luis Obispo 3; San Mateo 1; Santa Clara 9; Solano 1; Sonoma 1; Tulare 1; Ventura 3.

�We're seeing over 700 probable cases in a total of 44 states,� said Dr. Richard Besser, Acting Director of the CDC, in a press briefing today. �This likely represents an underestimation of the total number of cases taking place across the country. In order to be counted, you have to have your flu-like symptoms and see your doctor and be tested. And we know that for a lot of people, those steps do not take place. And because this is flu, the situation will change rapidly.� According to Dr. Besser, the median age of confirmed cases is 16 years with a range of 3 months to 81 years.

To handle a high-volume patient load, NCHS has set up an outdoor triage area at the San Marcos Health Center to register patients. RNs or LVNs with bilingual Medical Assistants conduct patient assessments so that patients with flu-like symptoms are masked before entering the building. San Diego Channel 10 news again visited the San Marcos Health Center to learn more about our triage process and the impact this outbreak has had on the organization.

Monitoring the Virus

The World Health Organization describes this H1N1 flu outbreak as a phase five alert level. To move to a phase six, which signifies a pandemic, the WHO is looking for sustained human-to-human transmission outside of more than one World Health Organization region. So, they are looking to see in another region, the pattern they currently see in our region, which includes Canada, the U.S. and Mexico. So far, they haven't seen that. They've had case reports in many countries around the world, but they have yet to see sustained human-to-human transmission. �Were that to occur -- and we anticipate at some point, it will, given that flu viruses spread easily from person to person, they would raise the alert level to indicate that we have met all the criteria for a pandemic,� said Dr. Bresser. �That would not change what we're doing in the United States. We continue to take aggressive action based on it being in our communities. And as we learn more, we continue to adapt and adjust our recommendations and our guidance so that they are appropriate for the situation that we're seeing.�

What�s Next?

Going forward, here are some important factors that will be monitored: What will happen during the flu season in the southern hemisphere? The WHO will be working very closely with the international community to understand what happens to this virus over the next few months as flu season begins in the southern hemisphere. That will reveal a lot about whether the virus is changing, whether it's becoming more severe and what measures might need to be taken in the fall.

�We know that each year with seasonal flu, people are hospitalized and people die, and unfortunately, we expect here that with a virus of this severity there will be ongoing hospitalizations and that there will be additional deaths,� said Dr. Bresser. �It's important that as we talk about the encouraging signs that people don't take that as an indication that they have to let up their guard. Personal responsibility, the things that we talk about every day about hand washing, about covering your cough with your sleeve and not with your hand, about staying home when you're sick, about keeping your children home when they're sick, those things are critically important.�

Face Masks

There has been a lot of confusion over whether the masks/respirators are beneficial. The CDC encourages the public, whenever possible, to try to stay at least 6 feet from people who might be ill, rather than relying on the use of face masks or respirators. When close contact with people who may be ill cannot be avoided, the use of face masks should be considered.

For persons at increased exposure risk, N95 (respirators) should be considered for use primarily by individuals for whom close contact with an infected person is unavoidable. This includes people caring for a person with symptoms at home. In areas where person-to-person transmission of the H1N1 virus has been confirmed, ill persons should wear a face mask when interacting with others. For further CDC guidance on face masks, visit www.cdc.gov/swineflu/masks.htm.

Heart Disease and Stroke

The CDC recently released Interim Guidance for people with heart disease, stroke or cardiovascular disease. Recommendations include:

� Maintain a two-week supply of your medications.

� Do not stop taking your medications without first consulting your health care provider, especially in the event of influenza or a respiratory infection.

� People with heart failure should be alert to changes in their breathing and should promptly report changes to their health care provider.

� It is especially important to wash your hands often with soap and water and follow other basic hygiene to avoid infection.

Visit http://www.cdc.gov/h1n1flu/heart.htm for further information. In addition, CDC guidance for pregnant women can be found at: http://www.cdc.gov/h1n1flu/guidance/pregnant.htm

Monday, May 4, 10:00 a.m.
This morning, health officials report 247 confirmed cases of the N1H1 virus in the U.S. in 35 states, and 1,038 in 20 countries. In California, there are 29 confirmed and 130 probable. The count remains 15 in San Diego.

North County Health Services has received 1,940 adult treatment courses of Tamiflu and 0 courses of pediatric treatment courses from government sources. Most local pharmacies do not have Tamiflu in stock. Our San Marcos pharmacy has a limited supply of pediatric Tamiflu that was purchased as the outbreak was just beginning to unfold and we will likely run out of this allotment in the next 48 hours. Our Oceanside pharmacy has 0 pediatric Tamiflu. Our sources at the County have told us today that we will be getting the pediatric formulation, but they have no date of delivery. In the interim, our two NCHS pharmacies will begin to compound Tamiflu for pediatric patients utilizing our adult Tamiflu as the source of the medicine. The rate limiting factor is obtaining a supply of proper diluents for the syrup. We have purchased cherry flavor syrup that should be delivered to our San Marcos and Oceanside pharmacies as soon as tomorrow.

Only prescriptions written by NCHS providers for NCHS patients will be filled at our pharmacy. Outside prescriptions for Tamiflu will not be recognized by our pharmacy staff..

To handle a high-volume patient load, NCHS has set up an outdoor assessment area at the San Marcos Health Center to register patients. RNs or LVNs with bilingual Medical Assistants conduct patient assessments so that patients with flu-like symptoms are masked before entering the building. Patients arriving for appointments in dental, women�s health or optometry who present without fever are directed to their respective department.

Staff give patients a color-coded card that designates where they go once inside the building. Colored tape on the floor will assist in directing patients to the correct waiting areas. At such time that demand has filled waiting rooms, symptomatic patients will be asked to use the outdoor waiting area.

The World Health Organization said slaughtering pigs is unnecessary because the virus is being spread through humans. The U.S. Meat Export Federation, which represents pork and beef interests abroad, estimates that U.S. pork exports have dropped about 10 percent since the swine flu scare started.

Visitation at all California prisons has been suspended after an ill inmate at Centinela State Prison in Imperial County is being tested for swine flu.

The CDC has released Interim Guidance for people with heart disease, stroke or cardiovascular disease. Recommendations include:

� Maintain a two week supply of your medications.

� Do not stop taking your medications without first consulting your health care provider, especially in the event of influenza or a respiratory infection.

� People with heart failure should be alert to changes in their breathing and should promptly report changes to their health care provider.

� It is especially important to wash your hands often with soap and water and follow other basic hygiene to avoid infection. .

Visit http://www.cdc.gov/h1n1flu/heart.htm for further information. In addition, CDC guidance for pregnant women can be found at: http://www.cdc.gov/h1n1flu/guidance/pregnant.htm

Sunday, May 3, 10:00 p.m.
North County Health Services developed plans today to handle a high-volume patient load beginning Monday morning at the San Marcos Health Center. An outdoor assessment area will be set up by 8:00 a.m. to register patients. RNs or LVNs with bilingual Medical Assistants will be prepared to conduct patient assessments so that patients with flu-like symptoms are masked before entering the building. Patients arriving for appointments in dental, women�s health or optometry who present without fever will be directed to their respective department.

Staff will give patients a color-coded card that designates where they go once inside the building. Colored tape on the floor will assist in directing patients to the correct waiting areas. At such time that demand has filled waiting rooms, symptomatic patients will be asked to use the outdoor waiting area.

According to the CDC, 18 countries have officially reported 898 cases of influenza H1N1 infection. The United States Government has reported 226 laboratory confirmed human cases of the virus.

Canadian officials announced yesterday that the N1H1 virus had infected about 200 pigs on a farm, the first evidence that it had jumped to another species. It was linked to a farm worker who recently returned from Mexico. Health officials have warned that crossing species could make the virus mutate further before crossing back into humans again, which could make the virus more deadly.

Sunday, May 3, 10:00 a.m.
To better meet the needs of our patients, North County Health Services� San Marcos Health Center will be open tomorrow, Sunday, May 3, from 9 a.m. to 1 p.m. Today, Dr. Kevin Ellis, Chief Medical Officer, told Channel 10 news that, in addition to being open to see pediatric patients on Sunday, we will be conducting more group visits. The group visit concept allows NCHS to address larger patient loads with more efficiency and provides an educational component utilizing health educators.

Today, the CDC confirmed 226 cases of 2009 H1N1 virus in 30 states. San DIego County has confirmed 15 cases today.

Worldwide, 872 cases of the virus have been confirmed: 506 in Mexico; 197 in U.S.; 85 in Canada; 40 in Spain; 16 in Britain; eight in Germany; four in New Zealand; two in Italy, France, Israel, and South Korea; one each in Colombia; Costa Rica, Ireland, Switzerland, Austria, Hong Kong, Denmark and the Netherlands.

In the U.S., confirmed cases have been reported in Alabama 1; Arizona 18; California 26, Colorado 4; Connecticut 2; Delaware 10; Florida 3; Illinois 3; Indiana 3; Iowa 1; Kansas 2; Kentucky 1; Massachusetts 7; Michigan 2; Minnesota 1; Missouri 1; Nebraska 1; Nevada 1; New Hampshire 1; New Jersey 7; New Mexico 1; New York 63; Ohio 3; Rhode Island 1; South Carolina 15; Tennessee 1; Texas 40; Utah 1; Virginia 3; Wisconsin 3.

Today, the CDC will complete deployment of 25 percent of the supplies in the Strategic National Stockpile (SNS) to all states in the continental United States. These supplies and medicines will help states and U.S. territories respond to the outbreak.

Saturday, Canada reported the identification of the H1N1 virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico who had exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time. There is also no risk of infection from this virus from consumption of well-cooked pork and pork products.

While daily updates show the number of confirmed cases rising, these numbers are outdated almost as soon as they are announced. Not only are more cases are being confirmed daily, but because health officials are recommending individuals with flu-like symptoms stay home, it is impossible to obtain an accurate number of H1N1 cases.

About one-third so far are people who had been to Mexico and probably picked up the infection there. Many newly infected people are getting the illness in the U.S., and the CDC says it probably still is spreading.

The CDC warns that, because this is a flu strain that is new and one that people do not have immunity to, they expect that there are going to be hospitalizations as well as more deaths.

As flu season in the Southern Hemisphere is about to begin, U.S. health officials will monitor spread of the swine flu there as the Federal Government and manufacturers begin the process of developing a vaccine against the H1N1 flu virus.

A big concern among health officials is whether the virus will return, perhaps stronger, when regular the influenza season begins here in the fall.

The California Department of Public Health (CDPH) has activated a toll-free H1N1 (swine flu) hotline in English and Spanish. Assistance in other languages is also available.

The phone number is 1-888-865-0564. CDPH�s H1N1 hotline is available Monday through Friday, from 7 a.m. to 6 p.m., and on weekends from 8 a.m. to 4 p.m.

What can I do to protect myself from getting sick?  

There is no vaccine available right now to protect against H1N1 flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

- 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 hand cleaners are also effective.

- Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

- Avoid touching your eyes, nose or mouth. Germs spread this way.

What should I do if I get sick?  

If you live in San Diego County and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care:

In children emergency warning signs that need urgent medical attention include:

- Fast breathing or trouble breathing

- Bluish skin color

- Not drinking enough fluids

- Not waking up or not interacting

- Being so irritable that the child does not want to be

- Flu-like symptoms improve but then return with fever and worse cough

- Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

- Difficulty breathing or shortness of breath

- Pain or pressure in the chest or abdomen

- Sudden dizziness

- Confusion

- Severe or persistent vomiting

Can I get swine influenza from eating or preparing pork?  

No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe. 

Is travel to Mexico restricted?  

At this time, the CDC recommends that U.S. travellers avoid all nonessential travel to Mexico.  

Is anything being done at the border?  

There is increased surveillance at the border. Customs and Border Patrol agents are instructed to send travelers who appear ill with flu-like symptoms to a secondary screening. Any decision to restrict travel at the border lies with the federal government.

Saturday, May 2, 4:00 p.m.
To better meet the needs of our patients, North County Health Services� San Marcos Health Center will be open tomorrow, Sunday, May 3, from 9 a.m. to 1 p.m. Today, Dr. Kevin Ellis, Chief Medical Officer, told Channel 10 news that, in addition to being open to see pediatric patients on Sunday, we will be conducting more group visits. The group visit concept allows NCHS to address larger patient loads with more efficiency and provides an educational component utilizing health educators.

In a news conference at the San Diego County Department of Health and Human Services Agency, health officials confirmed no new cases of the swine flu in San Diego, however they continue to prepare for a wave of illnesses that could break at any time.

According to Dr. Wilma Wooten, San Diego County�s public health officer, there are 11 cases confirmed and at least 19 others are likely to be infected in the county. �That number changes every day, as we get more cases added to our list,� said Dr. Wooten. �We are assuming they are going to be confirmed.�

Of the recent school closures in San Diego County, including the most recent at Mission Hills High School in San Marcos, Dr. Wooten said, �HHSA Public Health Services works closely with local school officials in making a decision about closing a school in accordance with guidelines from the Centers for Disease Control and Prevention. The closure of the school is a preventative measure to help prevent possible further infections.�

�We all know how elementary and high school students are,� Dr. Wooten said. �They have very close social networks and they interact a lot.� Dr. Wooten said that parents who cannot stay home from work to watch their children should work together with friends and neighbors to supervise the affected students. �Even if they do become ill, they are staying at home. They are not spreading the disease into the community,� she said.

Saturday, May 2, 10:00 a.m.
Today the CDC confirmed 160 cases of 2009 H1N1 virus in 21 states. According to Centers for Disease Control and Prevention, World Health Organization, and government officials, 16 deaths were confirmed in Mexico and one confirmed in U.S., a 21-month-old boy from Mexico who died in Texas.

Worldwide, 705 have been: 443 in Mexico; 161 in U.S.; 51 in Canada; 15 in Spain; 13 in Britain; six in Germany; four in New Zealand; two in Israel, France and South Korea; one each in Italy, Switzerland, Austria, Hong Kong, Denmark and the Netherlands.

In the U.S., confirmed cases have been reported in New York 50; Texas 28; California 17; South Carolina 16; New Jersey seven; Massachusetts six; Maine six; Arizona four; Delaware four; Indiana three; Illinois three; Kansas two; Colorado two; Virginia two; Michigan two; Florida two; Ohio one; Connecticut one; Kentucky one; Missouri one; Minnesota one; Nebraska one; Nevada one.

The U.S. Education Department said Friday that more than 430 schools had closed, affecting about 245,000 children in 18 states.

Yesterday, the San Diego County Health and Human Services Agency�s (HHSA) Public Health Services and the San Marcos Unified School District closed Mission Hills High School as a precaution after a student was diagnosed as a new probable H1N1 Influenza case.

�HHSA Public Health Services works closely with local school officials in making a decision about closing a school in accordance with guidelines from the Centers for Disease Control and Prevention,� said Wilma Wooten, M.D., M.P.H., San Diego County Public Health Officer. �The closure of the school is a preventative measure to help prevent possible further infections.�

�We know closing the school is a burden for the families affected, but it�s a necessary step to ensure the continued good health of our students and faculty,� said San Marcos Unified School District Superintendent Dr. Kevin Holt.

The CDC recommends that schools and childcare facilities deciding to close should dismiss students for a minimum of 14 days. Schools, in consultation with local and State public health officials, should evaluate daily the need for possible extension of the dismissal/closure based on local influenza surveillance information, and the occurrence of new infections and severity of illness in the community from this virus.

As part of CDPH's efforts to provide updated information to Californians on what they can do to protect themselves and their families from the swine flu outbreak, the California Department of Public Health (CDPH) has activated a toll-free H1N1 (swine flu) hotline in English and Spanish. Assistance in other languages is also available. The phone number is 1-888-865-0564. CDPH�s H1N1 (swine flu) hotline is available Monday through Friday, from 7 a.m. to 6 p.m., and on weekends from 8 a.m. to 4 p.m.

What Can You Do to Stay Healthy?

What is swine flu?  

Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses. Outbreaks of swine flu happen regularly in pigs. People do not normally get swine flu, but human infections can and do happen. Most commonly, human cases of swine flu happen in people who are around pigs but it�s possible for swine flu viruses to spread from person to person also.

Are humans infected with H1N1 flu in San Diego County?  

In late March and early April 2009, cases of human infection with H1N1 flu were first reported in Southern California and near San Antonio, Texas. At this time, human cases of H1N1 flu infection have been reported in San Diego County. CDC and local and state health agencies are working together to investigate this situation.

Are there going to be more cases?  

More cases are anticipated because health care providers have been put on alert and heightened surveillance to help identify patients with flu-like symptoms.

Is this flu virus contagious?  

CDC has determined that this virus is contagious and is spreading from human to human.

What if I got my seasonal flu shot?

This H1N1 influenza virus currently circulating has never been seen before and the vaccine you received for your seasonal flu shot will not protect you. Also, any vaccinations received for swine flu previously (there was an outbreak in 1976) would not provide immunity as this virus is a different strain. There is no vaccine currently available to protect against swine flu.

What are the signs and symptoms of H1N1 flu in people?  

The symptoms of H1N1 flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, H1N1 flu may cause a worsening of underlying chronic medical conditions.

How serious is H1N1 flu infection?  

Like seasonal flu, H1N1 flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

How do you catch swine flu?  

Spread of swine flu can occur in two ways: (1) Through contact with infected pigs or environments contaminated with swine flu viruses.(2) Through contact with a person with swine flu. Human-to-human spread of swine flu has been documented also and is thought to occur in the same way as seasonal flu. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

Are there medicines to treat swine flu?  

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread H1N1 flu to others?  

People with H1N1 influenza virus infection should be considered potentially contagious as long as they are symptomatic and possibly for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What can I do to protect myself from getting sick?  

- 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 hand cleaners are also effective.

- Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

- Avoid touching your eyes, nose or mouth. Germs spread this way.

What should I do if I get sick?  

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care:

In children emergency warning signs that need urgent medical attention include:

- Fast breathing or trouble breathing

- Bluish skin color

- Not drinking enough fluids

- Not waking up or not interacting

- Being so irritable that the child does not want to be

- Flu-like symptoms improve but then return with fever and worse cough

- Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

- Difficulty breathing or shortness of breath

- Pain or pressure in the chest or abdomen

- Sudden dizziness

- Confusion

- Severe or persistent vomiting

Can I get swine influenza from eating or preparing pork?  

Helpful Links

Swine Flu Update More