Background On April 15 and April 17, 2009, novel swine-origininfluenza A (H1N1) virus (S-OIV) was identified in specimensobtained from two epidemiologically unlinked patients in theUnited States. The same strain of the virus was identified inMexico, Canada, and elsewhere. We describe 642 confirmed casesof human S-OIV infection identified from the rapidly evolvingU.S. outbreak.
Methods Enhanced surveillance was implemented in the UnitedStates for human infection with influenza A viruses that couldnot be subtyped. Specimens were sent to the Centers for DiseaseControl and Prevention for real-time reverse-transcriptase–polymerase-chain-reactionconfirmatory testing for S-OIV.
Results From April 15 through May 5, a total of 642 confirmedcases of S-OIV infection were identified in 41 states. The agesof patients ranged from 3 months to 81 years; 60% of patientswere 18 years of age or younger. Of patients with availabledata, 18% had recently traveled to Mexico, and 16% were identifiedfrom school outbreaks of S-OIV infection. The most common presentingsymptoms were fever (94% of patients), cough (92%), and sorethroat (66%); 25% of patients had diarrhea, and 25% had vomiting.Of the 399 patients for whom hospitalization status was known,36 (9%) required hospitalization. Of 22 hospitalized patientswith available data, 12 had characteristics that conferred anincreased risk of severe seasonal influenza, 11 had pneumonia,8 required admission to an intensive care unit, 4 had respiratoryfailure, and 2 died. The S-OIV was determined to have a uniquegenome composition that had not been identified previously.
Conclusions A novel swine-origin influenza A virus was identifiedas the cause of outbreaks of febrile respiratory infection rangingfrom self-limited to severe illness. It is likely that the numberof confirmed cases underestimates the number of cases that haveoccurred.
Source Information
The members of the writing group (Fatimah S. Dawood, M.D., Epidemic Intelligence Service, Office of Workforce and Career Development; and Seema Jain, M.D., Lyn Finelli, Dr.P.H., Michael W. Shaw, Ph.D., Stephen Lindstrom, Ph.D., Rebecca J. Garten, Ph.D., Larisa V. Gubareva, M.D., Ph.D., Xiyan Xu, M.D., Carolyn B. Bridges, M.D., and Timothy M. Uyeki, M.D., M.P.H, M.P.P., Influenza Division, National Center for Immunization and Respiratory Diseases — all at the Centers for Disease Control and Prevention, Atlanta) assume responsibility for the overall content and integrity of the article. This article (10.1056/NEJMoa0903810) was published on May 7, 2009, and was last updated on June 3, 2009, at NEJM.org.
Address reprint requests to Dr. Dawood at the Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS A-32, Atlanta, GA 30333, or at fdawood{at}cdc.gov; or to Dr. Shaw at the Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS G-16, Atlanta, GA 30333, or at mshaw1{at}cdc.gov.
Agarwal, P. P., Cinti, S., Kazerooni, E. A.
(2009). Chest Radiographic and CT Findings in Novel Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection. Am. J. Roentgenol.
193: 1488-1493
[Abstract][Full Text]
Louie, R. F., Kitano, T., Brock, T. K., Derlet, R., Kost, G. J.
(2009). Point-of-Care Testing for Pandemic Influenza and Biothreats. dmphp
3: S193-S202
[Abstract][Full Text]
Soto-Abraham, M. V., Soriano-Rosas, J., Diaz-Quinonez, A., Silva-Pereyra, J., Vazquez-Hernandez, P., Torres-Lopez, O., Roldan, A., Cruz-Gordillo, A., Alonso-Viveros, P., Navarro-Reynoso, F.
(2009). Pathological Changes Associated with the 2009 H1N1 Virus. NEJM
361: 2001-2003
[Full Text]
Hancock, K., Veguilla, V., Lu, X., Zhong, W., Butler, E. N., Sun, H., Liu, F., Dong, L., DeVos, J. R., Gargiullo, P. M., Brammer, T. L., Cox, N. J., Tumpey, T. M., Katz, J. M.
(2009). Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus. NEJM
361: 1945-1952
[Abstract][Full Text]
The ANZIC Influenza Investigators,
(2009). Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand. NEJM
361: 1925-1934
[Abstract][Full Text]
Jain, S., Kamimoto, L., Bramley, A. M., Schmitz, A. M., Benoit, S. R., Louie, J., Sugerman, D. E., Druckenmiller, J. K., Ritger, K. A., Chugh, R., Jasuja, S., Deutscher, M., Chen, S., Walker, J. D., Duchin, J. S., Lett, S., Soliva, S., Wells, E. V., Swerdlow, D., Uyeki, T. M., Fiore, A. E., Olsen, S. J., Fry, A. M., Bridges, C. B., Finelli, L., the 2009 Pandemic Influenza A (H1N1) Virus Hospita,
(2009). Hospitalized Patients with 2009 H1N1 Influenza in the United States, April-June 2009. NEJM
361: 1935-1944
[Abstract][Full Text]
Shih, S.-R., Horng, J.-T., Poon, L. L. M., Chen, T.-C., Yeh, J.-Y., Hsieh, H.-P., Tseng, S.-N., Chiang, C., Li, W.-L., Chao, Y.-S., Hsu, J. T.-A.
(2009). BPR2-D2 targeting viral ribonucleoprotein complex-associated function inhibits oseltamivir-resistant influenza viruses. J Antimicrob Chemother
0: dkp393v2-dkp393
[Abstract][Full Text]
Louie, J. K., Acosta, M., Winter, K., Jean, C., Gavali, S., Schechter, R., Vugia, D., Harriman, K., Matyas, B., Glaser, C. A., Samuel, M. C., Rosenberg, J., Talarico, J., Hatch, D., for the California Pandemic (H1N1) Working Group,
(2009). Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California. JAMA
302: 1896-1902
[Abstract][Full Text]
Loeb, M., Dafoe, N., Mahony, J., John, M., Sarabia, A., Glavin, V., Webby, R., Smieja, M., Earn, D. J. D., Chong, S., Webb, A., Walter, S. D.
(2009). Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial. JAMA
302: 1865-1871
[Abstract][Full Text]
Dominguez-Cherit, G., Lapinsky, S. E., Macias, A. E., Pinto, R., Espinosa-Perez, L., de la Torre, A., Poblano-Morales, M., Baltazar-Torres, J. A., Bautista, E., Martinez, A., Martinez, M. A., Rivero, E., Valdez, R., Ruiz-Palacios, G., Hernandez, M., Stewart, T. E., Fowler, R. A.
(2009). Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico. JAMA
302: 1880-1887
[Abstract][Full Text]
Kumar, A., Zarychanski, R., Pinto, R., Cook, D. J., Marshall, J., Lacroix, J., Stelfox, T., Bagshaw, S., Choong, K., Lamontagne, F., Turgeon, A. F., Lapinsky, S., Ahern, S. P., Smith, O., Siddiqui, F., Jouvet, P., Khwaja, K., McIntyre, L., Menon, K., Hutchison, J., Hornstein, D., Joffe, A., Lauzier, F., Singh, J., Karachi, T., Wiebe, K., Olafson, K., Ramsey, C., Sharma, S., Dodek, P., Meade, M., Hall, R., Fowler, R. A., for the Canadian Critical Care Trials Group H1N1 C,
(2009). Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada. JAMA
302: 1872-1879
[Abstract][Full Text]
The Australia and New Zealand Extracorporeal Membr,
(2009). Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA
302: 1888-1895
[Abstract][Full Text]
Koyama, K., Takahashi, M., Oitate, M., Nakai, N., Takakusa, H., Miura, S.-i., Okazaki, O.
(2009). CS-8958, a Prodrug of the Novel Neuraminidase Inhibitor R-125489, Demonstrates a Favorable Long-Retention Profile in the Mouse Respiratory Tract. Antimicrob. Agents Chemother.
53: 4845-4851
[Abstract][Full Text]
Pabbaraju, K., Wong, S., Wong, A. A., Appleyard, G. D., Chui, L., Pang, X.-L., Yanow, S. K., Fonseca, K., Lee, B. E., Fox, J. D., Preiksaitis, J. K.
(2009). Design and Validation of Real-Time Reverse Transcription-PCR Assays for Detection of Pandemic (H1N1) 2009 Virus. J. Clin. Microbiol.
47: 3454-3460
[Abstract][Full Text]
Peacey, M., Hall, R. J., Bocacao, J., Huang, Q. S.
(2009). Diagnostic Assay Recommended by the World Health Organization for Swine Origin Influenza A (H1N1) Virus Cross-Reacts with H5N1 Influenza Virus. J. Clin. Microbiol.
47: 3789-3790
[Full Text]
Riquelme, A, Alvarez-Lobos, M, Pavez, C, Hasbun, P, Dabanch, J, Cofre, C, Jimenez, J, Calvo, M
(2009). Gastrointestinal manifestations among Chilean patients infected with novel influenza A (H1N1) 2009 virus. Gut
58: 1567-1568
[Full Text]
Khazeni, N., Bravata, D. M., Holty, J.-E. C., Uyeki, T. M., Stave, C. D., Gould, M. K.
(2009). Systematic Review: Safety and Efficacy of Extended-Duration Antiviral Chemoprophylaxis Against Pandemic and Seasonal Influenza. ANN INTERN MED
151: 464-473
[Abstract][Full Text]
Khazeni, N., Hutton, D. W., Garber, A. M., Hupert, N., Owens, D. K.
(2009). Effectiveness and Cost-Effectiveness of Vaccination Against Pandemic Influenza (H1N1) 2009. ANN INTERN MED
0: 0000605-200912150-00157v1-E-157
[Abstract][Full Text]
Medlock, J., Galvani, A. P.
(2009). Optimizing Influenza Vaccine Distribution. Science
325: 1705-1708
[Abstract][Full Text]
Ware, L. B.
(2009). Clinical Year in Review I: Interstitial Lung Disease, Pulmonary Vascular Disease, Pulmonary Infections, and Cardiopulmonary Exercise Testing and Pulmonary Rehabilitation. Proc Am Thorac Soc
6: 487-493
[Full Text]
Clark, T. W., Pareek, M., Hoschler, K., Dillon, H., Nicholson, K. G., Groth, N., Stephenson, I.
(2009). Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine -- Preliminary Report. NEJM
0: NEJMoa0907650v1-1
[Abstract][Full Text]
Lu, Q., Zhang, X.-Q., Pond, S. L. K., Reed, S., Schooley, R. T., Liu, Y.-T.
(2009). Detection in 2009 of the Swine Origin Influenza A (H1N1) Virus by a Subtyping Microarray. J. Clin. Microbiol.
47: 3060-3061
[Full Text]
Vinikoor, M., Stevens, J., Nawrocki, J., Singh, K.
(2009). Influenza A Virus Subtyping: Paradigm Shift in Influenza Diagnosis. J. Clin. Microbiol.
47: 3055-3056
[Full Text]
Bose, M. E., Beck, E. T., Ledeboer, N., Kehl, S. C., Jurgens, L. A., Patitucci, T., Witt, L., LaGue, E., Darga, P., He, J., Fan, J., Kumar, S., Henrickson, K. J.
(2009). Rapid Semiautomated Subtyping of Influenza Virus Species during the 2009 Swine Origin Influenza A H1N1 Virus Epidemic in Milwaukee, Wisconsin. J. Clin. Microbiol.
47: 2779-2786
[Abstract][Full Text]
He, J., Bose, M. E., Beck, E. T., Fan, J., Tiwari, S., Metallo, J., Jurgens, L. A., Kehl, S. C., Ledeboer, N., Kumar, S., Weisburg, W., Henrickson, K. J.
(2009). Rapid Multiplex Reverse Transcription-PCR Typing of Influenza A and B Virus, and Subtyping of Influenza A Virus into H1, 2, 3, 5, 7, 9, N1 (Human), N1 (Animal), N2, and N7, Including Typing of Novel Swine Origin Influenza A (H1N1) Virus, during the 2009 Outbreak in Milwaukee, Wisconsin. J. Clin. Microbiol.
47: 2772-2778
[Abstract][Full Text]
Perez-Padilla, R., de la Rosa-Zamboni, D., Ponce de Leon, S., Hernandez, M., Quinones-Falconi, F., Bautista, E., Ramirez-Venegas, A., Rojas-Serrano, J., Ormsby, C. E., Corrales, A., Higuera, A., Mondragon, E., Cordova-Villalobos, J. A., the INER Working Group on Influenza,
(2009). Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico. NEJM
361: 680-689
[Abstract][Full Text]
Cutler, J., Schleihauf, E., Hatchette, T. F., Billard, B., Watson-Creed, G., Davidson, R., Li, Y., Bastien, N., Sarwal, S., the Nova Scotia Human Swine Influenza Investigatio,
(2009). Investigation of the first cases of human-to-human infection with the new swine-origin influenza A (H1N1) virus in Canada. CMAJ
181: 159-163
[Abstract][Full Text]
Munster, V. J., de Wit, E., van den Brand, J. M. A., Herfst, S., Schrauwen, E. J. A., Bestebroer, T. M., van de Vijver, D., Boucher, C. A., Koopmans, M., Rimmelzwaan, G. F., Kuiken, T., Osterhaus, A. D. M. E., Fouchier, R. A. M.
(2009). Pathogenesis and Transmission of Swine-Origin 2009 A(H1N1) Influenza Virus in Ferrets. Science
325: 481-483
[Abstract][Full Text]
Zimmer, S. M., Burke, D. S.
(2009). Historical Perspective -- Emergence of Influenza A (H1N1) Viruses. NEJM
361: 279-285
[Full Text]
Garske, T., Legrand, J., Donnelly, C. A, Ward, H., Cauchemez, S., Fraser, C., Ferguson, N. M, Ghani, A. C
(2009). Assessing the severity of the novel influenza A/H1N1 pandemic. BMJ
339: b2840-b2840
[Full Text]
Garten, R. J., Davis, C. T., Russell, C. A., Shu, B., Lindstrom, S., Balish, A., Sessions, W. M., Xu, X., Skepner, E., Deyde, V., Okomo-Adhiambo, M., Gubareva, L., Barnes, J., Smith, C. B., Emery, S. L., Hillman, M. J., Rivailler, P., Smagala, J., de Graaf, M., Burke, D. F., Fouchier, R. A. M., Pappas, C., Alpuche-Aranda, C. M., Lopez-Gatell, H., Olivera, H., Lopez, I., Myers, C. A., Faix, D., Blair, P. J., Yu, C., Keene, K. M., Dotson, P. D. Jr., Boxrud, D., Sambol, A. R., Abid, S. H., St. George, K., Bannerman, T., Moore, A. L., Stringer, D. J., Blevins, P., Demmler-Harrison, G. J., Ginsberg, M., Kriner, P., Waterman, S., Smole, S., Guevara, H. F., Belongia, E. A., Clark, P. A., Beatrice, S. T., Donis, R., Katz, J., Finelli, L., Bridges, C. B., Shaw, M., Jernigan, D. B., Uyeki, T. M., Smith, D. J., Klimov, A. I., Cox, N. J.
(2009). Antigenic and Genetic Characteristics of Swine-Origin 2009 A(H1N1) Influenza Viruses Circulating in Humans. Science
325: 197-201
[Abstract][Full Text]
Trifonov, V., Khiabanian, H., Rabadan, R.
(2009). Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus. NEJM
361: 115-119
[Full Text]
Fraser, C., Donnelly, C. A., Cauchemez, S., Hanage, W. P., Van Kerkhove, M. D., Hollingsworth, T. D., Griffin, J., Baggaley, R. F., Jenkins, H. E., Lyons, E. J., Jombart, T., Hinsley, W. R., Grassly, N. C., Balloux, F., Ghani, A. C., Ferguson, N. M., Rambaut, A., Pybus, O. G., Lopez-Gatell, H., Alpuche-Aranda, C. M., Chapela, I. B., Zavala, E. P., Guevara, D. Ma. E., Checchi, F., Garcia, E., Hugonnet, S., Roth, C., The WHO Rapid Pandemic Assessment Collaboration,
(2009). Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings. Science
324: 1557-1561
[Abstract][Full Text]
Belshe, R. B.
(2009). Implications of the Emergence of a Novel H1 Influenza Virus. NEJM
360: 2667-2668
[Full Text]
A correction has been published: N Engl J Med 2009;361(1):102.
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