Interim CDC guidance for nonpharmaceutical community mitigation in response to human infections with swine influenza (H1N1) virus
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Interim CDC guidance for nonpharmaceutical community mitigation in response to human infections with swine influenza (H1N1) virus

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      Monday, April 27, 2009, 22:10 EDT (10:10 PM EDT


      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

      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.

      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.

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