SCMS: Pandemic Flu Updates H1N1 Links Click on the icons below to visit these important H1N1 web sites! H1N1 Updates from Sangamon County Department of Public Health Please read these updates from the Director of the Sangamon County Public Health Department, James D. Stone, regarding the latest information from the CDC and/or the Illinois Department of Public Health. Letter from the Director of the Illinois Department of Public Health - November 19, 2009 When the initial H1N1 vaccine supplies were allocated in mid-October by the U.S. Centers for Disease Control and Prevention (CDC), the Illinois Department of Public Health (IDPH) sent those limited doses to providers who would be conducting clinics open to all members of the public, including the underinsured or uninsured, and health care workers. Among those receiving H1N1 vaccine were the state's 95 certified local health departments (LHDs) and hospitals outside the city of Chicago. CDC is shipping H1N1 vaccine for Chicago residents directly to the Chicago Department of Public Health. LHDs were chosen to ensure vaccine would be available at public clinics for all priority groups. Hospitals were selected so health care workers and their priority group patients could be vaccinated, which, in turn, protects other vulnerable hospitalized patients. Others receiving initial supplies of H1N1 vaccine were Federally Qualified Healthcare Centers and university health centers. IDPH began processing orders Wednesday, November 4, for direct shipment to private providers in high population areas who serve the targeted priority groups identified by CDC. By allocating H1N1 vaccine to these providers, including, but not limited to, obstetricians/gynecologists and pediatricians, the vaccine is now available in more locations and eases the demands on LHDs and hospitals. Contrary to rumors that have been circulating, IDPH has not yet supplied H1N1 vaccine to retail pharmacies. Only private providers who have signed provider agreements with IDPH are eligible to receive direct shipment of the H1N1 vaccine or to receive the transfer of vaccine from other authorized providers. A minimum of 100 doses must be ordered to receive a direct shipment. Private providers requesting less than 100 doses can contact their respective local health department to discuss the possible transfer of H1N1 vaccine. Although the overall H1N1 vaccine supply is improving, there is - and will continue to be - a difference in supply versus demand. To date, IDPH has been allocated 1.7 million doses of H1N1 vaccine for a population of more than 10 million people residing outside of Chicago. There simply is not enough vaccine available yet to meet the demands for all those requesting supply. As additional allocations of H1N1 vaccine are made available by CDC, IDPH will place orders for those providers previously mentioned, as well as expand the number of private providers who are sent supplies. As you might surmise, H1N1 vaccine distribution is a complex and time-consuming process. Staff must daily review the various allocations of H1N1 vaccine allocated to the state — live attenuated virus vaccine, multi-dose vials, pre-filled syringes, pediatric doses, thimerosal-free vaccine - and match those vaccine types with the orders previously submitted by thousands of providers across the state. Due to the limited H1N1 vaccine supply, IDPH can only fill partial orders. As the H1N1 vaccine supply situation improves, more people in the priority groups will be able to get vaccinated and do so with greater ease. Eventually, there will be enough H1N1 vaccine available for anyone who wants it. Thank you for your understanding, patience and assistance as we address this serious public health threat. If you have questions about H1N1 vaccine allocation and distribution or other H1N1-related questions, contact your local health department or IDPH at 217-785-1455. H1N1 Vaccination Program - November 9, 2009 We are continuing to take appointments for H1N1 vaccination of people who are in the CDC priority groups, which are as follows: 1. pregnant women; 2. household contacts and caregivers for children younger than six months; 3. healthcare and emergency medical services personnel; 4. all people from 6 months through 24 years of age; and 5. persons aged 25-64 years who have health conditions associated with higher risk of medical complications from influenza. We have decided to use appointments to ensure that individuals who are in the high risk groups are served initially, to reduce long lines, and to eliminate large group settings that could potentially expose high risk clients to influenza-like illness and inclement weather. We have recently encountered situations where some residents are presenting with or saying they have physician notes that are advising H1N1 vaccination. Until we are otherwise directed by the CDC and IDPH, we will only provide the vaccine to people who meet the priority criteria as listed above. We are hopeful that more vaccine will become available in the near future, which will allow all providers to open the H1N1 vaccination to anyone who wishes. Please feel free to contact me at 535-3100 or 789-2182 should you have any questions. We appreciate your patience and cooperation during this very unique time. www.AMAfluhelp.org — October 30, 2009 With the early onset of H1N1 influenza and the fast approaching seasonal flu this year, the American Medical Association continues its commitment to helping doctors help patients. Last week, the AMA launched a free, Web-based suite of decision support tools that allow physicians to connect with and monitor patients in response to H1N1 and seasonal flu. This site www.AMAfluhelp.org is a unique online practice management system offers private self-assessment tools authored and maintained by the AMA. It is an important resource will help your members. We encourage you to share this information with them. The AMA also has developed a Flu Resource Kit with access to a variety of patient oriented fact sheets and important information about how the AMAfluhelp.org resource can help physicians manage this flu season. This Flu Resource Kit is available online at www.ama-assn.org/go/flusource. Resources include: • Flu Care Poster for office waiting rooms or exam rooms • CDC Guidelines for Physicians • FAQ about www.AMAfluhelp.org • Bookmarks to share information about www.AMAfluhelp.org • A button for Web sites to help link to AMAfluhelp.org • Patient Information on a variety of topics ready to download AMAfluhelp.org walks patients through a series of questions to determine the severity of their flu symptoms based upon the latest Centers for Disease Control and Prevention guidelines. Patients can choose to share their information with their physician, as well as family members and loved ones. AMAfluhelp.org also provides a set of online tools to help physicians monitor their patients’ symptoms, facilitate care and treatment decisions, and efficiently manage their practices’ patient flow. With patient consent, aggregated, epidemiologic data will also be made available to public health agencies, in compliance with HIPAA standards. We encourage you to inform your members and colleagues about this new practice management flu care resource. Physicians can register for this program at www.AMAfluhelp.org or visit www.amaH1N1info.org for additional H1N1 resources. CDC Clinical Reminder: HealthCare Worker Vaccination Recommendations: October 23, 2009 In response to 2009 H1N1 Influenza, we would like to provide you with the following information. Please share this with other interested parties. If you have any questions on these or other clinical issues, please write to us at coca@cdc.gov. CLICK HERE --> Clinical Reminder - HealthCare Worker Vaccination Recommendations Protect your patients and yourself from influenza: Get Vaccinated! This year the CDC recommends seasonal and 2009 monovalent H1N1 influenza vaccination for all healthcare workers because of their critical role in the health care system and their increased risk of exposure to patients with influenza, as well as concern about transmission of the viruses to susceptible patients. The 2009 H1N1 monovalent influenza vaccine is made in the same way as seasonal flu vaccine, which has a very good safety track record. Preliminary data suggest that the immunogenicity and safety of these vaccines are similar to those of seasonal influenza vaccines. Seasonal influenza vaccination among healthcare personnel reduces the flu-related mortality risk among patients at highest risk of severe illness. Despite the documented benefits of healthcare worker vaccination, seasonal influenza vaccine coverage in past seasons among this group has remained low (<50%) nation-wide. Influenza outbreaks in hospitals and long-term care facilities have been associated with low vaccination rates among healthcare workers, while higher vaccination levels among staff are associated with a lower incidence of nosocomial influenza cases. More information on locating 2009 monovalent H1N1 and seasonal vaccine, priority groups for vaccination, and vaccine safety is located at www.flu.gov/ The most effective way to protect yourself and your patients from flu is to be vaccinated. It's up to you! CDC H1N1 Flu Situation Update, October 17, 2009 Vaccine Supply Status Nationwide distribution of the H1N1 (Swine) flu vaccine is underway to all states. Approximately 6 million doses have been shipped throughout the United States. A weekly update on the vaccine supply and shipment status, complete with state-by-state numbers, is now available on the CDC website. View the Vaccine Supply Status page Key Flu Indicators Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of October 4-10, 2009, a review of the key indicators found that influenza activity continued to increase in the United States from the previous week. Below is a summary of the most recent key indicators: • Visits to doctors for influenza-like illness (ILI) continued to increase in the United States, and overall, are higher than what is expected for this time of the year. ILI activity now is equal to or higher than what is seen at the peak of many regular flu seasons. • Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year. • The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and exceeds what is normally expected at this time of year. In addition, 11 flu-related pediatric deaths were reported this week; 10 of these deaths were confirmed 2009 H1N1, and one was influenza A virus, but unsubtyped. Since April 2009, there have been 86 confirmed pediatric 2009 H1N1 deaths; 39 of these have been reported to CDC since August 30, 2009. • Forty-one states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu. • Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. Learn more U.S. Situation Update Weekly Flu Activity Estimates U.S. Patient Visits Reported for Influenza-like Illness (ILI) U.S. Influenza-like Illness (ILI) Reported by Regions U.S. Influenza and Pneumonia-Associated Hospitalizations and Deaths from August 30 - October 10, 2009 Posted October 16, 2009, 11:00 AM ET Data reported to CDC by October 13, 2009, 12:00 AM ET Defined by   Hospitalizations   Deaths Influenza and Pneumonia Syndrome* 15,696 2,029 Influenza Laboratory-Tests** 4,958 292 *Reports can be based on syndromic, admission or discharge data, or a combination of data elements that could include laboratory-confirmed and influenza-like illness hospitalizations. **Laboratory confirmation includes any positive influenza test (rapid influenza tests, RT-PCR, DFA, IFA, or culture), whether or not typing was done. This table is based on data reported to CDC by U.S. states and territories from a new influenza and pneumonia hospitalizations and deaths web-based reporting system. This system will be used to monitor trends in activity for the 2009-10 influenza season. This is a cumulative count beginning August 30, 2009. The table shows aggregate reports of all influenza and pneumonia-associated hospitalizations and deaths (including 2009 H1N1 and seasonal flu) since August 30, 2009 received by CDC from U.S. states and territories. This table will be updated weekly each Friday at 11 a.m. For the 2009-2010 influenza season, states are reporting based on new case definitions for hospitalizations and deaths effective August 30, 2009. CDC will continue to use its traditional surveillance systems to track the progress of the 2009-2010 influenza season. For more information about influenza surveillance, including reporting of influenza-associated hospitalizations and deaths, see Questions and Answers: Monitoring Influenza Activity, Including 2009 H1N1 The number of 2009 H1N1 hospitalizations and deaths reported to CDC from April - August 2009 is available on the Past Situation Updates page. For state level information, refer to state health departments. International Human Cases of 2009 H1N1 Flu Infection See: World Health Organization For more information about the U.S. situation, see the CDC H1N1 Flu U.S. Situation Update page. International Situation Update This report provides anupdate to the international situation as of October 16, 2009. The World Health Organization (WHO) continues to report laboratory-confirmed 2009 H1N1 flu cases and deaths on its Web page. These laboratory-confirmed cases represent a substantial underestimation of total cases in the world, as many countries focus surveillance and laboratory testing only on people with severe illness. The 2009 H1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. Since April 19, 2009, over half of all influenza positive specimens reported to WHO were 2009 H1N1. In temperate regions of the Southern Hemisphere, disease due to 2009 H1N1 has returned to below baseline. In tropical regions of the Americas and Asia, influenza activity due to 2009 H1N1 remains variable. In temperate regions of the Northern Hemisphere, there is increased influenza-like illness (ILI) activity due to 2009 H1N1 in many areas, including Western Europe and Northern Asia, most of the United States, and parts of Mexico and Canada. For more information about the international situation, see the CDC H1N1 Flu International Situation Update page. CDC Experts Contributing to WebMD's Focus on Flu Blog Follow CDC Experts on WebMDs Flu Blog. In collaboration with WebMD, experts from the Centers for Disease Control and Prevention will be guest blogging and helping to answer questions on WebMD's Focus on Flu Blog. Launched on October 7th, Dr. Anthony Fiore (NCIRD) has since posted two blogs entries, October 7, 2009, "CDC Update on Flu and theH1N1 Vaccine" and October 14, "Flu Shot or Nasal Spray Vaccine?". The Focus on Flu blog is scheduled to run through the end of December. Recent Updates of Interest • Weekly FluView Map and Surveillance Report for Week Ending October 10, 2009 During week 40 (October 4-10, 2009), influenza activity remained stable in the United States; however, there were still higher levels of influenza-like illness than is normal for this time of year. • 2009-2010 Influenza Season Triage Algorithm for Children (18 years or Younger) With Influenza-Like Illness This algorithm was developed for use by physicians and those under their direct supervision to help in discussions and providing advice to parents or other caregivers of ill children regarding seeking medical care for an influenza-like illness. The algorithm can be used regardless of whether or not the child has been vaccinated for influenza. (Caregivers of children who may have potentially life threatening signs and symptoms, such as unresponsiveness, or respiratory distress and/or cyanosis [blue-colored skin], should be instructed to dial 911.) • Pediatric Supplement: Recommendations for use of antiviral medications for 2009 H1N1 influenza in children and adolescents This document provides clinician guidance regarding use of antiviral medications for the management of 2009 H1N1 influenza in children and adolescents. Questions and answers regarding high risk groups, considerations for antiviral therapy, pharmaceutical considerations, and considerations for post-exposure chemoprophylaxis. Additional resources are included. • Updated Recommendations on Antivirals Updates include: considerations for vaccinated persons, inclusion of the 2-week postpartum period as higher risk, oseltamivir dosing instructions for children younger than 1 year, and a review of antiviral indications and contraindications. • Translations: Public Service Announcement Scripts: Hygiene Habits to Fight Novel H1N1 Flu Translations for Arabic, Farsi, Kirundi, Somali, and Burmese. • 2009 H1N1 Flu: International Situation Update This report provides an update to the international situation as of October 16, 2009. The World Health Organization (WHO) continues to report updated 2009 H1N1 flu-associated laboratory-confirmed cases and deaths on its Web page. • 2009 H1N1 Influenza Vaccine Supply Status Every Friday, CDC will post updated 2009 H1N1 vaccine supply and distribution data. • U.S. Influenza and Pneumonia-Associated Hospitalizations and Deaths from October 4-10, 2009 During the week of October 4-10, 2009, influenza activity continued to increase in the United States. Flu activity is now widespread. Nationwide, visits to doctors for influenza-like-illness increased over last week and are higher than expected for this time of year. In addition, flu-related hospitalizations and deaths are increasing as well, and are higher than expected. • FLYER: 2009 H1N1 Flu Vaccine: It Takes Two (PDF - Spanish translation) Get your child a second 2009 H1N1 flu vaccine dose. • FLYER: 2009 H1N1 Flu Vaccine: It Takes Two (PDF) Get your child a second 2009 H1N1 flu vaccine dose. • Updated: 2009 H1N1 Influenza Vaccine Updated question and answer for 2009 H1N1 Influenza Vaccine. • 2009 H1N1 Flu and Seasonal Flu Information for Rheumatology Health Professionals This document provides clinician guidance regarding the rheumatologic patient population. Questions and answers regarding risk, vaccines and patient advice are available. Additional resources are included in this guidance as well. • 2009 H1N1 Flu and Seasonal Flu Information for People with Inflammatory Arthritis or Rheumatic Disease The purpose of this document is to provide guidance for people with inflammatory arthritis and rheumatic disease regarding seasonal and H1N1 flu. Important questions and answers are provided for this specific population. Additional resources are included in this guidance as well. • Allocation and Distribution Questions and Answers The purpose of this document is to provide information on plans for allocation and distribution of 2009 H1N1 vaccine. This document has been updated with additional information about the distribution process. • Questions and Answers about CDC's Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel How is this recommendation different from the previous 2009 H1N1 guidance for healthcare personnel?.... Who should use this guidance?.... • Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel Updated interim guidance on infection control measures to prevent transmission of 2009 H1N1 influenza in healthcare facilities. This updated guidance applies uniquely to the special circumstances of the current 2009 H1N1 pandemic and will be updated as necessary as new information becomes available throughout the course of this influenza season. • Questions and Answers Regarding Respiratory Protection For Preventing 2009 H1N1 Influenza Among Healthcare Personnel Questions and Answers which provide additional information intended to assist healthcare facilities in optimizing implementation of recommended respiratory protection practices in the context of shortages of respiratory protection equipment. • 2009 H1N1 and Seasonal Flu: What You Should Know About Flu Antiviral Drugs Antiviral drugs are prescription medicines that fight against the flu in your body. Additional Updates on the CDC H1N1 Flu To learn about other recent updates made to the CDC H1N1 Flu Website, please check the "What's New" page on the CDC H1N1 Flu website. H1N1 Update for Clinicians 10/13/09 Update - CLICK HERE H1N1 Update: Testing and Key Points for Clinicians Regarding H1N1 and Seasonal Influenza Health Alert - "Frequently Asked Questions" About Influenza Testing, 10/06/09 - CLICK HERE Novel H1N1 Seasonal Influenza Key Points - CLICK HERE H1N1 LAIV Vaccine and Provider Agreements Procedure for providing H1N1 vaccine to Other Community Providers - CLICK HERE H1N1 LAIV Vaccine - CLICK HERE "H1N1 - The Virus Formerly Known As Swine" Frequently Asked Questions by Donald R. Graham, M.D., F.A.C.P., Infectious Diseases, Springfield Clinic & Michael Sinha, MSIII, SIU School of Medicine Great resource for patients... CLICK HERE and copy What is H1N1? H1N1 is one of many variants of the influenza A virus, which is the most common cause of the flu. H1N1 appeared in late March of 2009 in Mexico, but spread quickly throughout the world. As with seasonal influenza, H1N1 is transmitted from human to human via aerosol, meaning that small particles from an infected person's cough or sneeze are inhaled by an unexposed person, and the virus in the sneeze droplet infects its new host. It can also be spread when people touch an infected surface and then touch their mouth, nose or eyes. Why has it been referred to as "swine flu"? It received the name swine flu because it is believed that the new variant developed as a result of a specialized genetic change called re-assortment after it was able to live in a pig's lung. The virus cannot be contracted from exposure to pigs or from consuming pork or other pig-derived food products. Additionally, the virus has not been found in any pigs in the United States. In fact, the current virus is a mixture of parts of viruses from several different sources. How do I know if I have H1N1? We commonly call the constellation of symptoms such as a cough, runny nose, fever, sore throat, body aches, chills, fatigue, and headache "the flu." Seasonal influenza A and its H1N1 variant have thus far caused a similar set of symptoms. Special testing of secretions in your nose will determine if you have influenza and if so which kind. During epidemic periods, diagnosis is often made based on symptoms alone, because testing of everyone is too costly and time consuming, leading to delays in treatment. Is H1N1 worse than the seasonal flu? Many people in the United States die from the seasonal flu every year, so all infections with the influenza A virus should be considered potentially serious. Those who are at higher risk of serious complications include children under 5 years of age, those over 65, pregnant women, those with other chronic medical conditions (especially lung disease), and the immunocompromised. Hospitalizations and deaths attributed to H1N1 have for the most part been in those higher-risk groups. To date, H1N1 has been less severe than seasonal flu, but the second wave may be more severe. Does H1N1 cause a different disease? H1N1 is different from seasonal flu in many ways, which is cause for concern. First, no vaccine has been developed yet and, if developed, will not be available until late 2009, when the annual flu season will have already begun. Additionally, new, more virulent strains of influenza A can seriously affect young adults of working age. For instance, during the influenza pandemic of 1918, the majority of patients were healthy young adults. The reasons for this are not fully understood, but may be due to the fact that younger populations have never been previously exposed to this particular variation of H1N1 influenza A. In fact, the Centers for Disease Control and Prevention (CDC) notes that people over 65 may be less susceptible to H1N1, because they may have been exposed to a similar variant at some point in their lives and have acquired immunity. The CDC notes that it is impossible to predict the exact effect of H1N1 worldwide. However, an overlap with the seasonal influenza A strains may result in a shortage of healthcare resources (including staff, vaccines, and antiviral medications). The CDC errs on the side of safety, encouraging all Americans to take precautions to help minimize the spread of the disease, thereby minimizing the impact of an H1N1 outbreak in the United States. Will a seasonal flu vaccine protect me against H1N1? Because the H1N1 influenza virus is significantly different from the strains that cause the seasonal flu, experts do not believe that the seasonal vaccine will provide full protection against H1N1. However, do not let this discourage you from getting a seasonal flu vaccine. Both types of flu may circulate this fall and winter. Even if your seasonal flu symptoms are mild, you risk infecting other people around you. Okay, so I need to take precautions. What can I do? Because no vaccine is yet available, hygiene is especially important. If you are in a public space, use alcohol sanitizing gels or wash your hands frequently. Keep in mind that influenza A can, in some cases, be transmitted via infected surfaces, including doorknobs, water faucets, and other areas frequently touched by others. The best thing to do is to stay home from work if you develop signs and symptoms of the seasonal flu, and to keep children home from school. CDC recommends that you stay home from the day you begin experiencing symptoms until 24 hours after your fever goes away. What do I do if I start to experience flu-like symptoms? To minimize the risk of spreading the virus, cough or sneeze into a clean tissue, discard it carefully, and wash your hands afterwards. The fever caused by the virus should resolve on its own, as do most respiratory viral infections in healthy individuals. The Illinois Department of Public Health has developed its "Three C's" for H1N1 prevention: (1) CLEAN - Clean your hands frequently, clean commonly used surfaces like doorknobs; (2) COVER - Cover your mouth and nose when coughing or sneezing, and dispose of tissues immediately; (3) CONTAIN - If you are experiencing flu-like symptoms, do not go to work. If your children are sick, do not send them to school. If you must go out in public, cover your mouth and nose with a mask to prevent getting others sick. Some patients benefit from treatment, especially in the early stages. Call your doctor. Even if you do not require treatment, the knowledge that the virus is spreading can be reported to the public health authorities to help them take steps to contain the virus. What should I avoid doing? If possible, avoid crowded environments. Do not give aspirin to children suffering from flu-like symptoms, as it may cause a severe life-threatening illness called Reye's Syndrome. CDC also warns against "flu parties," where a group of people gather with someone who has H1N1 in the hopes of acquiring the infection early, having the typical flu-like symptoms for a short period, and thereafter being immune. This is dangerous because it is not possible to predict how an individual's body will handle the H1N1 strain of influenza A, and it may have potentially serious and unanticipated outcomes. Taking antiviral medications to prevent becoming infected may help some people in selected cases of exposure, such as in families with sick young children. However, overuse of these medications may lead to drug-resistant strains that are even more dangerous than the original H1N1 virus. It may also result in a shortage of antiviral medications for those hospitalized patients who need them most. If you are healthy, you do not need to wear a face mask to protect yourself. The World Health Organization (WHO) warns that improper use of face masks could, in fact, increase your risk of exposure to the virus. Can flu be treated? Yes, seasonal flu can be treated with oseltamivir (Tamiflu®) by mouth and zanamivir (Relenza®) by inhaler. H1N1 can be treated with the same medications. Experimental studies of intravenous peramivir and intravenous zanamivir are in progress and are now being employed for certain hospitalized patients. Where can I go for more information? The CDC's H1N1 Flu web page has a number of resources. Go to http://www.cdc.gov/h1n1flu/ for more information. Also, your state http://www.idph.state.il.us/h1n1_flu/index.htm and county http://www.scdph.org public health departments have more information about H1N1. H1N1 Flu Update from IDPH: September 18, 2009 via Sangamon County Department of Public Health Please share this information with colleagues and staff IDPH Influenza Reporting Update - 9/15/09 This document contains information related to reporting of seasonal and 2009 H1N1 influenza. Physicians should report hospitalizations of more than 24 hours and deaths that are due to either confirmed or probable 2009 H1N1 influenza. Case definitions are provided in the document. Reporting should also include pediatric deaths with probable influenza, but includes deaths caused by either 2009 H1N1 or seasonal influenza. File case reports into the I-NEDSS database within 24 hours, or fax them to the Sangamon County Public Health Department. The document also contains a more detailed explanation on what is reportable and what isn't, and will continue to be updated as more information becomes available. Weekly reports on 2009 H1N1 hospitalizations and deaths in Illinois and other statistics are available here. Information regarding outpatient influenza like illness trends and virologic data in Illinois are available here. CDC case definitions for 2009 H1N1 influenza can be found here. IDPH Health Alert: Influenza Activity and Planning for Clinicians - 09/16/09 Though IDPH notes that the trajectory of influenza severity cannot be predicted with any certainty, this document provides clinicians with suggestions as to how to anticipate and prepare for the "potential for rapid spread and high demand on health care systems." The first page of the document contains several bulleted suggestions for clinicians and other health care providers, and the second and third pages provide information for patients as to when they should seek medical care for possible influenza, including 2009 H1N1 influenza. Update on Specimen Submission and Testing for H1N1 Influenza from IDPH Department of Laboratories - 09/14/09 An update of the document sent in the last e-mail update. An important change: "As of September 14, 2009, IDPH will only solicit and test specimens from hospitalized patients (inpatients) with acute febrile respiratory illness, and specimens approved by the local health department on a case by case basis (e.g. for outbreak management in a residential congregate facility)." A new IDPH Request for Respiratory/Influenza Testing form will be made available, and if specimens do not specify criteria or do not appear to meet criteria for approved testing, submitters will be contacted. These criteria for approved testing may be modified as theoutbreak of novel influenza A (H1N1) virus continues. Questions on IDPH laboratory testing may be directed to Bernard (Tom) Johnson, Chief, Division of Laboratories, at (217) 782-6562 or by e-mail.