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Updated Guidance for Child Care and Early Childhood Programs

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Updated Guidance for Child Care and Early Childhood Programs

CDC has released new guidance to help decrease the spread of influenza (flu) among children in early childhood programs and early childhood providers during the 2009–2010 influenza season. The new guidance expands upon earlier guidance documents by providing a menu of tools that health officials and early childhood providers can choose from based on conditions in their area. The new guidance recommends actions to take now, during the 2009–2010 flu season; suggests additional strategies to consider if CDC determines that flu is becoming more severe; and provides a checklist for decision-making at the local level. Based on the severity of 2009 H1N1 flu-related illness thus far, this guidance recommends that children and early childhood providers with influenza-like illness remain home until 24 hours after resolution of fever without the use of fever-reducing medications.

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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 August 23-29, 2009, a review of these key indicators found that influenza activity increased in the United States. Below is a summary of the most recent key indicators:

  • Visits to doctors for influenza-like illness (ILI) were highest in February during the 2008-09 flu season, but rose again in April 2009 after the new 2009 H1N1 virus emerged. Current visits to doctors for influenza-like illness are down from April, but are higher than what is expected in the summer and have increased over the last two weeks.
  • Total influenza hospitalizationrates for adults and children are similar to or lower than seasonal influenza hospitalization rates depending on age group, but are higher than expected during this time of year.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) was low and within the bounds of what is expected in the summer.
  • Most state health officials are reporting regional or sporadic influenza activity. Six states (Alabama, Alaska, Florida, Georgia, Mississippi, and South Carolina) and Puerto Rico are reporting widespread influenza activity at this time. Any reports of widespread influenza activity in August are very unusual.
  • Almost all of the influenza viruses identified were the new 2009 H1N1 influenza A viruses. These 2009 H1N1 viruses remain similar to the viruses chosen for the 2009 H1N1 vaccine and remain susceptible to antiviral drugs (oseltamivir and zanamivir) with rare exception.

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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 

Total U.S. Novel H1N1 Flu Hospitalizations and Deaths 
Posted September 4, 2009, 11:00 AM ET 
Data reported to CDC by September 3, 2009, 9:00 AM ET
Reporting States and Territories*
Hospitalized Cases
53 states and territories 9,079 hospitalized cases 593 deaths

*Includes the District of Columbia, American Samoa, Guam, Puerto Rico and the U.S. Virgin Islands.

The number of hospitalized novel H1N1 cases and deaths presented in this table are an aggregate of reports received by CDC from U.S. states and territories and will be updated weekly each Friday at 11am. For state level information, refer to state health departments.

CDC discontinued reporting of individual confirmed and probable cases of novel H1N1 infection on July 24, 2009. CDC will report the total number of hospitalizations and deaths weekly, and continue to use its traditional surveillance systems to track the progress of the novel H1N1 flu outbreak. 
For more information about CDC’s novel H1N1 influenza surveillance system, see 
Questions & Answers About CDC's Novel H1N1 Influenza Surveillance.

International Human Cases of H1N1 Flu Infection 
World Health Organization.

For more information about the U.S. situation, see the CDC H1N1 Flu website.

International Situation Update

This situation report provides an update to the international situation as of August 28, 2009. As of August 23, the World Health Organization (WHO) regions have reported over 209,438 laboratory-confirmed cases of 2009 H1N1 influenza virus with at least 2,185 deaths. The laboratory-confirmed cases represent a substantial underestimation of total cases in the world as many countries focus surveillance and laboratory testing only in persons with severe illness. The 2009 H1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. Decreases in disease due to 2009 H1N1 continue to be reported from South America and parts of Australia. The United Kingdom is also reporting national decreases in disease due to 2009 H1N1. In contrast, disease associated with 2009 H1N1 influenza is continuing to increase in southern Africa, and more African countries have reported their first cases. In addition, 2009 H1N1 continues to circulate in tropical countries.

For more information, see the

International Situation Update >>

Recent Updates of Interest

Additional Updates on the CDC H1N1 Flu Website

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.



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