Posts Tagged ‘pandemic’

Influenza Still Widespread in AZ

February 21st, 2014

A report out by the CDC this week found that people between 18 and 64 years old make up 61% of all flu-related hospitalizations so far this season in the US.   In normal years only about 35% of flu hospitalizations are from this age group. H1N1 (the flu strain we saw circulating in the 2009 flu pandemic) is still the main culprit.  H1N1 is included in this year’s vaccine, so people who got vaccinated will be protected from the flu in most cases.  People who’ve been vaccinated with the flu shot this year are 61% less likely to have to go to the doctor according to today’s report. 

Influenza is still widespread In Arizona.  If you haven’t been vaccinated yet, you may need to call around to find whether a healthcare provider or pharmacy near you still has vaccine in stock. Remember to get your shot early next season so you’re protected for the entire flu season. Visit to find a shot.


H7N9 Influenza

April 5th, 2013

This week the WHO announced that several people in eastern China are infected with a newly mutated bird influenza virus called H7N9. All are in critical condition and some have died… but importantly the cases don’t appear to be linked- meaning it’s probably not from human to human transmission (that’s good). The World Health Organization website has more detail including answers to some Frequently Asked Questions

Global Influenza surveillance is a key public health tool… because early warning gives the global public health system an opportunity to squelch the outbreak before it breaks loose and causes a pandemic. It also gives us a head start on interventions and planning.   BTW… in case you were wondering, the H stands for hemagglutinin and N stands for neuraminidase- which are proteins on the virus’s surface. The numbers stand for the kind of protein for each letter.


June 29th, 2012

Remember the 2009 H1N1 influenza pandemic?  That brand new virus that caused the pandemic was a combination of RNA from four different flu viruses – North American swine influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe.  The natural laboratories for new influenza viruses that end up causing pandemics (like the ’09 pandemic) are birds and pigs- so it’s important to pay attention to new viruses that emerge in these species so interventions can be implemented to manage outbreaks and potentially prevent human outbreaks or even pandemics. 

Last week Mexican veterinary authorities found a new strain of influenza virus called H7N3 that has been infecting and killing large numbers of poultry at several large commercial farms.  This is the first major outbreak in Mexican flocks since the country battled H5N2 influenza virus in the mid 1990s.  Luckily, there are no human cases and no suggestion yet that it is a kind of virus that can infect humans- but it’s still important to follow up on  Follow-up report No. 1 (25/06/2012)

By the way- the Influenza virus strains get their names from compounds called hemagglutinin and neuraminidase.  The H in the name refers to the kind Hemagglutinin on the virus and the N stands for the strain of Neuraminidase on the virus.


A Virus is Born

December 5th, 2011

The CDC confirmed the birth of a new influenza virus in this week’s MMWR Weekly Report.  The newborn is named “Swine-origin Triple Reassortant Influenza A (H3N2) (S-OtrH3N2)”.  The hybrid virus was found in a handful of school-age kids in Iowa recently- and luckily the kids recovered and none were hospitalized.  Nobody outside the initial cluster has been infected (a good thing) meaning it doesn’t look like the new virus is very good at moving person to person (yet).  The scientists think that the new virus is a new re-assortment of the RNA among the run-of-the-mill H3N2 and the 2009 H1H1 pandemic strains. The latest details are in this week’s CDC’s Weekly Report. All you virophiles can find a representation of the virus’s RNA on this special CDC website

Is this a new pandemic, you ask?  Probably not.

AZ’s New Pandemic Readiness Plan

September 16th, 2011

Remember our responses to the 2009-2010 H1N1 Pandemic?  One of the reasons why Arizona’s public health responses were so effective was that we had a well researched and tested pandemic readiness plan.  But… public health readiness isn’t a static process, and once the pandemic was finished we set out to revise our plan with lessons learned.  Over the last few months our public health preparedness team has put together a new and improved 2011 Pandemic Influenza Response Plan.  Hopefully we won’t need it in the near future- but as you might recall from the last influenza pandemic- novel viruses come at unexpected times and without warning… so it makes sense to stay on your toes.


September 9th, 2011

In all my years in public health this is the first crack I’ve taken at being a movie critic- so give me a little slack on this one.  I checked out the new movie called Contagion– and really liked it. I won’t give up too much information and spoil the film, but it’s basically a fictional drama that portrays CDC and other public health folks responding to a new disease outbreak that ends up causing a pandemic.  While I thought some of the human behavior and public policy decisions in the film were over the top- I was pleasantly surprised that the Director made good efforts to capture the essence of epidemiology, surveillance and disease control, public health interventions, and laboratory science and how they fit together as part of a public health response.

Ok, so you might wonder as you leave the theater- “Could this really happen?”  The answer is “yes” and it kind of already has.  The 2002-03 Severe Acute Respiratory Syndrome (SARS) epidemic was remarkably similar to the core of what happens in ContagionSARS– which was a easily transmitted and had a case-fatality rate of more than 10% – rapidly spread from Hong Kong to 37 countries.  Fortunately, a robust international public health response that included effective public health interventions was able to prevent the virus from becoming a devastating global pandemic.

Public health from around the world worked to identify and isolate the virus and good and swift public health interventions were able to limit the spread of the disease.  Because of the quick and robust initial public health response it was fully contained – but it won’t ever be eradicated because it could still live in an animal reservoir and spread to people.  By the way- civet cats were the likely intermediate host for direct transmission of SARS to humans, but bats, or some other host, are likely the natural reservoir for the virus.

The good news is that you should still be able to sleep after you watch the film because you’re aware that a global, national, state and local public health system is in place that’s designed to quickly identify emerging infectious diseases.  Plus, we get better every day at crafting and implementing public health interventions.  Here’s a website called Contagion and CDC which was created by the CDC Foundation to help separate fact from fiction and to highlight CDC’s role in preparedness and response… Contagion Movie:  Fact and Fiction in the film, a CDC website….and CDC 24/7 – which is a website that includes information you may find useful on how the public health system protects us from outbreaks.

By the way- all the locations in the movie that depict the CDC were all taken on their campus.  I recognized their Emergency Operations Center in the movie- and have even been in meetings in the conference room you’ll see in the movie.  The lab’s you see are actually the CDC labs too… as are the rooms you see where staff are talking about the outbreak.

ADHS Aces the 2010 Strategic National Stockpile Test

September 21st, 2010

The Strategic National Stockpile is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items which are stored in a few locations around the country. The stockpile is designed to supplement public health agencies in case there’s a national emergency anywhere and at anytime within the U.S. or its territories. At the beginning of the H1N1 pandemic, Arizona  received and distributed hundreds of thousands of treatment courses of antiviral medication and other hospital supplies.  We turned around our supplies and shipped everything to their final destinations at the local health departments within 36 hours.

Each year the CDC comes out to “grade” our readiness by reviewing our plans, exercises, our execution during actual events (e.g. H1N1) and our after action reports.  This week, our project officer gave us a final grade of A+ or 97%.

Well done Preparedness Team.

The reviewer gave us glowing commendations for factors including leadership support, effective coordination and collaboration with the state/local/private sectors (Scott Voss & Kaitlin Henslee), and development and implementation of a multi-year Training and Exercise Plan (Andrew Lawless).  We already knew we were ready because we smoked the H1N1 stockpile distribution, but it’s nice to know that we’re still in crackerjack shape.

Seasonal Flu News

August 9th, 2010

The FDA approved this year’s (2010-2011) flu vaccine for the US.  This year’s shot will protect folks from 3 strains of influenza including the pandemic strain from last year.  The technical terms for the strains in this year’s shot are the “A/California/7/09 (H1N1)-like virus (i.e. pandemic virus”; the “A/Perth /16/2009 (H3N2)-like virus”; and the “B/Brisbane/60/2008-like virus”.  For the first time, the CDC is recommending that everybody over 6 months old get a seasonal flu shot.  The supply of vaccine should be robust- as there are now 13 brand names and manufacturers for this year’s vaccine, so if there is a problem with one of the suppliers (as was the case in 2004) it’s unlikely to create a major supply disruption. You can read more in the  FDA’s announcement this week.


Last week, the CDC’s Advisory Committee on Immunization Practices recommended that doctors avoid using the flu vaccine made by CSL Biotherapies (an Australian company) for kids under 8 years old because of unexplained  fevers in kids that got the vaccine over the last several months in Australia and New Zealand.


The pandemic flu strain (A/California/7/09 (H1N1)-like virus) pretty much completely displaced the H3N2 strain last flu season in North America.  However, the flu outbreaks that have occurred this summer (at summer camps, day care centers and sports camps and the like) have mostly been the A/Perth/16/2009-like H3N2 virus.  Both strains are included in this year’s seasonal flu shot.

Pandemic Turns 1

April 29th, 2010

The H1N1 pandemic strain virus turns 1 this month.  The first indication that there may be a problem was published in an April 24, 2009 Morbidity & Mortality Weekly Report. The CDC announced the new virus in their usual low-key way, with an MMWR lead that said:

“On April 17, 2009, CDC determined that two cases of febrile respiratory illness occurring in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus. Although this is not a new subtype of influenza A in humans, concern exists that this new strain of swine influenza A (H1N1) is substantially different from human influenza A (H1N1) viruses, that a large proportion of the population might be susceptible to infection, and that the seasonal influenza vaccine H1N1 strain might not provide protection.”

And so, a pandemic was born.  The CDC news brief was followed quickly by reports from Mexico of hundreds, perhaps thousands of respiratory deaths, sparking perhaps the quickest and most comprehensive public health campaign in a decade.

The US public health system began tracking and reporting cases, hospitalizations and deaths, assessing the severity of the virus, and implementing public health interventions to slow the virus’s spread.  The strategic national stockpile assets (i.e. antivirals) were deployed, and a vaccine was developed, delivered, and a mass vaccination campaign took place.  Oh yeah- and it all happened in the middle of the biggest fiscal crisis that the state has ever seen.  Pretty busy year.

So where are we now? The best national estimate is that between 43 and 88 million people have gotten sick from the H1N1 virus.  There have been an estimated 192,000 & 398,000 H1N1-related hospitalizations, and between about 8,720 and 18,050 H1N1-related deaths so far.  These are the estimates from A paper in Emerging Infectious Diseases authored by CDC staff entitled “Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009”.  In the report, the authors concluded that every reported case of H1N1 represented an estimated 79 total cases, and every hospitalized case reported actually represented an average of 2.7 total hospitalized people.

We’re still putting together our weekly flu reports if you’re interested in the latest in AZ.  We’re still getting sporadic reports of cases… and we’ve recorded 149 deaths so far.  The pandemic strain almost totally displaced all other strains- and more than 98% of all sub-typed samples analyzed by our laboratory have been the pandemic strain.  There were virtually no H3N2 or B strains floating around.

The FDA’s Vaccines and Related Biological Products Advisory Committee has recommended that the 2010-2011 influenza vaccine be manufactured with the A/California/7/09 (H1N1)-like virus strain (i.e. the pandemic strain); an A/Perth /16/2009 (H3N2)-like virus; and the B/Brisbane/60/2008-like virus. The FDA recommendation is also consistent with the World Health Organization recommendation for the Northern Hemisphere’s 2010-2011 influenza season.

Pressing Ahead

February 19th, 2010

This is what I shared with ADHS staff earlier this week –

“Thanks again for all of your hard and creative work over the last year.  We’ve made a great deal of progress despite the complicated financial problems that the State has faced.  I’m not just saying that- I know it’s true and so do you.  If you don’t believe me, remind yourself by looking at the “Year of Progress” blog post a couple of weeks ago.

Because of our success together over the last year, the Governor nominated me to the post of Director a few weeks ago, and today the AZ State Senate voted to confirm the nomination- so I’m officially now serving as your Director.  The post from the Senate website is pasted at this link under Health Services:

We’re on a good course, so that’s where we’re going to stay.

  • In our Licensing programs, we’re going to continue to focus on our customer service and to continue to sharpen our efforts on the health and safety elements of our mission.  We’ll continue to do our time and effort studies to see where we can improve efficiency- and we’ll continue our efforts (with the help of IT) to deliver a paper-free licensing application- due for delivery later this spring.
  • In our Behavioral Health programs- we’re going to stay on course to evaluate the effectiveness system based on solid scientific criteria- looking to outcome measures to evaluate our effectiveness and to use that information and data to continue to drive the entire system toward the principles of Recovery.
  • At the Hospital- we’re going to keep on track with our efforts to get folks through Recovery- and we’ll continue to better integrate Security and our Clinical teams so that we’re using state-of-the-art information to develop and integrate a system that protects our staff while helping our patients and residents to recover and re-integrate into society.
  • In our Public Health Programs, we’re going to continue to help Arizonans with the tools they’ll need to improve their lifestyle- whether it’s nutritional guidance, help with physical activity goals, chronic disease prevention and tobacco cessation, and of course preventing folks from starting smoking in the first place.
  • We’re also going to continue to provide the public health system in Arizona with the data they need to drive good and targeted public health interventions.  We’ll also make sure that folks get their vital records when they need them, help the counties to do the same- all while ensuring that we’re protecting people’s identity and privacy.
  • In terms of Preparedness, we’re going to keep on track doing the things that we’ve always done- keep our surveillance system vigilant, react quickly when there’s a problem & implement swift and reasonable interventions, and ensure that all the pieces fit together with the local health departments, tribal partners, and our healthcare community so that we can enhance the system’s ability to prevent and respond to public health threats.
  • Our Operations team, including IT, Financial Services, Human Resources, Procurement, Auditing and Special Investigations and Administrative Counsel & Rules will continue to play a key role in helping our programs better integrate up-to-date technology, whether it’s IT infrastructure, business processes, policy development or employee relations.  After all- none of our programs would have accomplished anything without our crack Operations team.

OK…  let’s keep going…”