Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus

Background

As part of the ongoing investigation into the outbreak of swine influenza A (H1N1) in the United States and Mexico, CDC today announced confirmation of an additional 19 human cases of infection with swine flu in the U.S., bringing the total number of cases to 40 so far. At this time, cases of swine influenza have been confirmed in California, Kansas, New York City, Ohio, and Texas. Based on the rapid spread of the virus thus far, public health officials believe that more cases will be identified over the next several weeks. Case counts are updated daily and available at http://www.cdc.gov/h1n1flu/.

On April 26, 2009, the Secretary of the Department of Homeland Security, Janet Napolitano, announced that the Department of Health and Human Services declared a public health emergency in the United States. This will allow funds to be released to support the public health response. CDC’s goals during this public health emergency are to reduce transmission and illness severity, and to provide information to assist health care providers, public health officials, and the public in addressing the challenges posed by this newly-identified influenza virus. Laboratory testing has found that the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir. CDC is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak.

Community mitigation actions are also recommended to prevent illness. Steps including home isolation of cases, school dismissals, and other social distancing interventions may be implemented by communities and families as part of a comprehensive program of infection control. Community mitigation strategies may be different for each state or community depending on the numbers of cases and spread of disease. As a result, CDC is issuing mitigation guidance that includes a range of interventions so that public health authorities can identify the most appropriate means to protect their counties, communities, and citizens.

CDC is recommending home isolation of ill persons. Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer. Persons who experience ILI and wish to seek medical care should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office, or hospital. Persons who have difficulty breathing or shortness of breath, or are believed to be severely ill, should seek immediate medical attention. Household contacts of persons with symptoms consistent with swine influenza should:remain home at the earliest sign of illness; minimize contact in the community to the extent possible; designate a single household family member as the ill person’s caregiver to minimize interactions with asymptomatic persons.

Communities should consider school dismissals and childcare facility closures. Dismissal of students should be strongly considered in schools with a confirmed or a suspected case epidemiologically linked to a confirmed case. Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of ILI in the community. If the school dismisses students or a childcare facility closes, they should also cancel all school or childcare-related gatherings and encourage parents and students to avoid congregating outside of the school. The duration of closings for school and childcare facilities should be for a time period to be determined based on ongoing epidemiological findings in their geographic area Schools and childcare facilities should consult with their local or state health departments for guidance on reopening. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.

Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure. This includes asking teachers, parents, and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

CDC recommends that other social distancing interventions be considered. Large gatherings linked to settings or institutions with laboratory-confirmed cases should be cancelled, for example a school event linked to a school with cases; other large gatherings in the community may not need to be cancelled at this time. Additional social distancing measures are currently not recommended. Persons with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings.

A more detailed list of Community Mitigation Guidelines can be found at http://www.cdc.gov/h1n1flu/mitigation.htm.

This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available. As public health officials in the United States learn more about this emerging virus, updated guidance will be issued in conjunction with our state, local, tribal, and territorial partners.

Additional public health recommendations can be found at the following CDC Web sites:

• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected
• MMWR: Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008 MMWR July 17, 2008 / 57(Early Release);1-60
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home For additional information about swine flu see www.cdc.gov/h1n1flu.

For information about the current swine flu investigation, see www.cdc.gov/h1n1flu/investigation.htm. You can access the same information by calling 1-800-CDC-INFO.

##This Message was distributed to State and Local Health Officers, Public Information Officers, Epidemiologists and HAN Coordinators as well as Clinician organizations##