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Seasonal Influenza (Flu)

Seasonal Influenza (Flu)
2010-2011
Seasonal Influenza
Flu Season
Vaccine Updates
Questions & Answers Reconstruction of the 1918 Influenza On this Page
Pandemic Virus Background on the
Influenza:
Key Facts The
About
Disease Research
Seasonal Flu Questions & Answers Biosafety Precautions
People at High Risk CDC researchers and their colleagues have successfully
from Flu reconstructed the influenza virus that caused the 1918-19 flu Biosecurity Issues
pandemic, which killed as many as 50 million people worldwide.
Influenza
Types ofViruses
Influenza A report of their work, "Characterization of the Reconstructed
Viruses
1918 Spanish Influenza Pandemic Virus," was published in the October 7 issue of Science. The
How the Flu Virus Can work is a collaboration among scientists from CDC, Mount Sinai School of Medicine, the Armed
Change Forces Institute of Pathology, and Southeast Poultry Research Laboratory. The following
Influenza in Animals questions and answers describe this important research and related issues.

Background on the Research

Symptoms & Severity What research does the Science article describe? Why is it important?
How Flu Spreads This report describes the successful reconstruction of the influenza A (H1N1) virus responsible for
the 1918 "Spanish flu" pandemic and provides novel information about the properties that
Flu Season contributed to its exceptional virulence. This information is critical to evaluating the effectiveness
Questions
Influenza:& The
Answers
Disease of current and future public health interventions, which could be used in the event that a 1918-like
strain reemerges, either naturally or through deliberate release. The knowledge from this work
Estimating Deaths may also shed light on the pathogenesis of contemporary human influenza viruses with pandemic
Types of Flu Viruses potential. The natural emergence of another pandemic virus is considered highly likely by many
experts, and therefore novel insights into pathogenic mechanisms could contribute to the
Cold vs. Flu development of prophylactic and therapeutic interventions needed to control pandemic viruses.
Flu & Staph Infection
What are the reasons for doing these experiments?
Flu & Other The influenza pandemic of 1918-19 killed an estimated 20 to 50 million people worldwide, many
Respiratory Viruses more than the subsequent pandemics of the 20th century. The biological properties that confer
U.S. Hospitalizations virulence to pandemic influenza viruses were poorly understood. Research to better understand
how the individual genes of the1918 pandemic influenza virus contribute to the disease process
Influenza Research could provide important insights into the basis of virulence. This kind of information will enable us
Diagnosing Flu to devise appropriate strategies for early diagnosis, treatment, and prevention, should a similar
pandemic virus emerge. Additionally, such research will provide us with general principles with
2010–2011 Seasonal
Flu Vaccine Selection which we can better design antiviral drugs and other interventions against all influenza viruses
with enhanced virulence.
2009–10 Flu Season
Who funded the work described in this article?
Work with the reconstructed 1918 virus was conducted at and supported by CDC. The U.S.
Department of Agriculture (USDA), the National Institutes of Health (NIH), and the Armed Forces
Institute of Pathology (AFIP) all provided support for many other aspects of this research.
Preventing
Vaccination
Vaccine Safety
Flu
Situation Update: When did CDC begin research on the 1918 virus?
Summary of Weekly CDC studies of the 1918 influenza virus were begun in 2004 with the initiation of testing of viruses
FluView containing subsets of the eight genes of the 1918 virus. Previous articles describing the properties
of such viruses were published before 2005. Reconstruction of the entire 1918 virus was begun in
General Q&A
August 2005.
Q&A on Thimerosal
What are the next steps for research on the 1918 pandemic influenza strain at CDC?
Q&A on Guillain-Barré CDC will evaluate the biological properties of the other individual genes that make up this virus
syndrome (CDC has examined four of the virus' eight genes so far). Scientists will continue to study the
Q&A on Febrile hemagglutinin (HA) gene for potential treatments and other interventions for use against this
 Seizures virus. Researchers also want to gain a better understanding of the role of HA in causing
Q&A on Monitoring inflammation of the lung, a factor that may contribute to the overall increased levels of illness and
Systems death associated with this virus.
What's new about the Could a 1918-like H1N1 virus re-emerge and cause a pandemic again?
flu vaccine It is impossible to predict with certainly, but the probability of the 1918 virus re-emerging from a
Fluzone High-Dose natural source appears to be remote. Influenza experts believe that a pandemic is most likely to
Seasonal Influenza be caused by an influenza subtype to which there is little, or no, preexisting immunity in the
Vaccine human population. There is evidence that some residual immunity to the 1918 virus, or a similar
virus, is present in at least a portion of the human population. Since contemporary H1N1 viruses
Key Facts About circulate widely and the current annual influenza vaccines contain an H1N1 component, a 1918-like
Seasonal Flu Vaccine
H1N1 virus would not fit the current criteria for a new pandemic strain.
Children, the Flu, and
the Flu Vaccine Are current antivirals and vaccines effective against the 1918 virus?
Yes. Two types of antiviral drugs, rimantadine (Flumadine) and oseltamivir (Tamiflu), have been
Caregivers of Children shown to be effective against influenza viruses similar to the 1918 virus. Vaccines containing the
Less Than 6 Months
Old 1918 HA or other subtype H1 HA proteins were effective in protecting mice against the 1918 virus.
In fact, the current influenza vaccine provided some level of protection against the 1918 virus in
Seasonal Flu Vaccine mice.
Safety and Pregnant
Women Are new prophylactics and therapeutics against the 1918 virus under way?
The reconstruction of the 1918 virus will enable CDC to pursue development of a vaccine
candidate reference virus that would provide optimal protection against this or similar viruses.
Good
Key Health
Facts About
HabitsGood
Health Habits for Have these findings validated the current preparedness strategies? Will there be changes to
Preventing Seasonal the pandemic preparedness plan in light of these findings?
Flu Many experts believe that the next pandemic strain will be related to emergence of an avian
Cover Your Cough influenza strain. The research reported in Science further validates that theory and suggests that
we are headed in the right direction in our preparedness plans. The 1918 virus gene sequences
The Flu: A Guide for are related more closely to avian H1N1 viruses than are any of the other known mammalian
Parents influenza H1N1 strains. The results of this research will be taken into account as part of the
Stopping the Spread ongoing pandemic preparedness planning process.
of Germs at Home,
Work & School Will the 1918 virus strain used during these experiments at CDC be made available to other
research institutions?
Smoking & Influenza CDC currently has no plans to distribute this virus. If other individual scientists desire to work with
the agent, consideration will be given to hosting them at CDC.
Antiviral
Key FactsDrugs
About Biosafety Precautions
Antiviral Drugs and
Seasonal Flu Is the public at risk from the experiments being done on this virus?
The work described in this report was done using stringent biosafety and biosecurity precautions
Summary of Side that are designed to protect workers and the public from possible exposure to this virus (for
Effects example, from accidental release of the virus into the environment).
Antiviral Drugs for
Seasonal Flu: What biosafety and biosecurity precautions for protecting laboratory workers and the public
Additional Links and were in place while this work was being done?
Resources Before the experiments were begun, two tiers of internal CDC approval were conducted: an
Institutional Biosafety Committee review and an Animal Care and Use Committee review. All
Mixing Tamiflu viruses containing one or more gene segments from the 1918 influenza virus were generated and
Capsules
handled in accordance with biosafety guidelines of the Interim CDC-NIH Recommendation for
What You Should Raising the Biosafety Level Laboratory Work Involving Noncontemporary Human Influenza
Know About Flu Viruses. Although the 1918 virus was not designated as a select agent at the time this work was
Antiviral Drugs performed, all procedures were carried out using the heightened biosecurity elements mandated
by CDC's Select Agent program. The Intra-governmental Select Agents and Toxins Technical
Advisory Committee recommended that the reconstructed 1918 influenza virus be added to the list
Flu
Staying
Prevention
homeToolkit
when of HHS select agents on September 30, 2005. Following this recommendation, CDC amended its
you are sick helps
everyone you care regulations and designated all reconstructed replication competent forms of the 1918 pandemic
about influenza virus containing any portion of the coding regions of all eight gene segments
(reconstructed 1918 Influenza virus) as a select agent.

Questions
Flu Vaccine:
& Answers
Q&A What are the appropriate biosafety practices and containment conditions for work with the
1918 strain of influenza?
Vaccine Dosage & Biosafety Level 3 or Animal Biosafety Level 3 practices, procedures and facilities, plus
Administration enhancements that include special procedures (discussed in the next question below), are
Vaccine Supply for recommended for work with the 1918 strain. There are four biosafety levels that correspond to
2010-11 Season the degree of risk posed by the research and involve graded levels of protection for personnel,
the environment, and the community. Biosafety Level 4 provides the most stringent containment
Vaccine Supply and conditions, Biosafety Level 1 the least stringent. These biosafety levels consist of a combination of
Distribution in the
United States laboratory practices and techniques, safety equipment, and laboratory facilities that are
appropriate for the operations being performed. The specific criteria for each biosafety level are
 Vaccine Effectiveness detailed in the CDC/NIH publication Biosafety in Microbiological and Biomedical Laboratories.
Flu Shot What is Biosafety Level 3 "enhanced"? What are the specific enhancements used for work
Nasal Spray Vaccine with the 1918 strain of influenza?
(LAIV) A Biosafety Level 3 facility with specific enhancements includes primary (safety cabinets, isolation
chambers, gloves and gowns) and secondary (facility construction, HEPA filtration treatment of
Thimerosal
exhaust air) barriers to protect laboratory workers and the public from accidental exposure. The
Guillain-Barré specific additional ("enhanced") procedures used for work with the 1918 strain include:
Syndrome (GBS)
l Rigorous adherence to additional respiratory protection and clothing change protocols;
Antiviral Drugs: Key
Facts l Use of negative pressure, HEPA-filtered respirators or positive air-purifying respirators
(PAPRs);
Antiviral Drugs: Q&A
l Use of HEPA filtration for treatment of exhaust air; and
Antiviral Drug
Resistance l Amendment of personnel practices to include personal showers prior to exiting the
laboratory.
Links, Information, &
Resources Further details of the biosafety recommendations for work with various human and animal
influenza viruses, including 1918 virus, can be found in the interim CDC/NIH guidance for such
Good Health Habits work at Interim CDC-NIH Recommendation for Raising the Biosafety Level Laboratory Work
Preventing the Flu: Involving Noncontemporary Human Influenza Viruses.
Q&A
Can these experiments be done safely using containment provided by BSL-3 with
enhancements?
Highly trained laboratorians can work with the 1918 influenza virus strain safely using BSL-3-
enhanced containment. Researchers at CDC have specialized training and go through a rigorous
Info for Businesses & biosafety (and security) clearance process. For the work reported in the Science article, the lead
Employees CDC researcher provided routine weekly written reports to CDC management officials, including
What
Diagnosis
To Do If You Get the agency's Chief Science Officer, and was instructed to notify agency officials immediately of any
Sick concerns related to biosafety or biosecurity.
Symptoms
Antiviral Drugs A BSL-3 facility with specific enhancements includes primary (safety cabinets, isolation cabinets,
gloves, gowns) and secondary (facility construction) barriers to protect laboratory workers and the
Taking Care of Yourself public from accidental exposure. Specific enhancements include change-of-clothing and shower-out
Taking
Make Care
a SickofRoom requirements, and the use of a powered air purifying respirator (PAPR; half body suits). The
Someone Who is Sick primary and secondary barriers plus additional personal safety practices provide appropriate
Follow Sick Room Rules
containment for conducting such influenza research. CDC evaluated the specific studies to be
Clean the Sick Room conducted as well as the highly experienced scientific team conducting the research and concluded
Tips for Caregivers that this work could proceed under BSL-3 containment with enhancements.
Prevent Fluid Loss Why was BSL-3-enhanced containment used for work on the 1918 H1N1 virus when most
human influenza viruses of the H1N1 subtype are handled under much less stringent
Check for Fluid Loss containment?
When to Get Medical The appropriate biosafety measures for working a given pathogen depend upon a number of
Help for Fluid Loss factors, including previous experience with the pathogen or similar pathogens, the virulence and
transmissibility of the pathogen, the type of experiment, and the availability of vaccines and/or
Medicine Safety antimicrobial drugs effective against the pathogen. Prior to reconstruction of the 1918 virus, CDC
Medicine Safety & carefully evaluated the specific studies to be conducted and concluded that this research could
Children safely and securely be done under BSL-3-enhanced containment. All viruses containing one or
Treat Fever more gene segments from the 1918 influenza virus were generated and handled under high-
containment (BSL 3-enhanced) laboratory conditions in accordance with guidelines of NIH and
Treat Dry Cough CDC. The recommendations for biosafety levels are made by a panel of experts and are followed
Treat Other Symptoms in a stringent manner.
A higher level of containment (biosafety level 4) is utilized for work on novel or exotic pathogens
for which there is no treatment or vaccine. This is not the case for the 1918 virus. Decedents of
Questions & Answers the 1918 influenza virus still circulate today, and the current influenza vaccine provides some
protection against the 1918 virus. In addition, two types of antiviral drugs, rimantadine
(Flumadine) and oseltamivir (Tamiflu), are effective against viruses bearing 1918 virus gene
products targeted by the antiviral drugs.
Info
2010-11
Primary
for Health
ACIP
Changes and
Professionals
Recommendations
Updates in the ACIP The physical and engineering design of BSL-3-enhanced containment is very similar to that used in
Recommendations BSL-4 laboratories. The BSL-3 laboratory also has state-of-the-art directional airflow control which
ACIP filters outgoing air, and all waste is autoclaved or decontaminated before it leaves the work area,
Recommendations: preventing escape of infectious agents.
Introduction and
Biology of Influenza Recent media reports have described the disappearance of plague-infected mice from a U.S.
laboratory. Could mice infected with the 1918 influenza virus escape or be removed from CDC
Options for laboratories?
Controlling Influenza The rigorous biosafety and biosecurity precautions used at CDC for experiments done with the
 Summary of influenza 1918 virus make it extremely unlikely that an animal infected with the 1918 virus could escape or
vaccination be removed from CDC laboratories. For the experiments described in this report, all animals used
recommendations, were properly contained and accounted for.
2010
Earlier this year, samples of a "non-contemporary" influenza virus strain (H2N2) were
Recommendations for shipped to laboratories worldwide as part of proficiency testing panels. Could the 1918
Using TIV and LAIV pandemic influenza virus be inadvertently distributed in a similar manner?
During the Influenza No. The "non-contemporary" H2N2 virus was available from many sources and inadvertently
Season shipped by private suppliers as part of the proficiency panel. CDC currently has no plans to
Comparisons of LAIV distribute this virus.
and TIV Efficacy
Influenza Vaccine
Biosecurity Issues
Composition & Major Does the generation of the 1918 Spanish influenza pandemic virus containing the complete
Differences coding sequence of the eight viral gene segments violate the Biological Weapons Convention?
No. Article I of the Biological Weapons Convention (BWC) specifically allows for microbiological
Vaccine Supply research for "prophylactic, protective, or other peaceful purposes. Article X of the BWC encourages
Considerations the "fullest possible exchange of… scientific and technological information" for the use of biological
Dosage, agents for the prevention of disease and other peaceful purposes. Further, Article X of the BWC
Administration, and provides that the BWC should not hamper technological development in the field of peaceful
Storage bacteriological activities. Because the emergence of another pandemic virus is considered likely, if
Influenza Vaccination not inevitable, characterization of the 1918 virus may enable us to recognize the potential threat
Coverage Levels posed by new influenza virus strains, and it will shed light on the prophylactic and therapeutic
countermeasures that will be needed to control pandemic viruses.
Additional Information
about Vaccination of Does the report provide a "blueprint" for bioterrorists to develop and unleash a devastating
Specific Populations pandemic on the world?
Persons for Whom No. This report does not provide the blueprint for bioterrorist to develop a pandemic influenza
Annual Vaccination is strain. The reverse genetics system that was used to generate the 1918 virus is a widely used
Recommended laboratory technique. While there are concerns that this approach could potentially be misused for
Persons Who Should purposes of bioterrorism, there are also clear and significant potential benefits of sharing this
Not Be Vaccinated information with the scientific community: namely, facilitating the development of effective
interventions, thereby strengthening public health and national security.
Timing of Vaccination
Is the 1918 influenza virus a select agent?
Adverse Events After The Intra-governmental Select Agents and Toxins Technical Advisory Committee convened on
Receipt of TIV
September 30, 2005, and recommended that the reconstructed 1918 influenza virus be added to
Adverse Events After the list of HHS select agents. Following this recommendation, CDC amended its regulations and
Receipt of Live, designated all reconstructed replication competent forms of the 1918 pandemic influenza virus
Attenuated Influenza containing any portion of the coding regions of all eight gene segments (reconstructed 1918
Vaccine (LAIV)
Influenza virus) as a select agent.
What is the Select Agent Program?
The Centers for Disease Control and Prevention (CDC) regulates the possession, use and transfer
Vaccination
Influenza Vaccination of select agents and toxins that have the potential to pose a severe threat to public health and
Coverage
safety. The CDC Select Agent Program oversees these activities and registers all laboratories and
Vaccine Supply Update other entities in the United States of America that possess, use or transfer a select agent or toxin.
Influenza Vaccination: The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) published final
A Summary for
Clinicians rules for the possession, use, and transfer of select agents and toxins (42 C.F.R. Part 73, 7 C.F.R.
Part 331, and 9 C.F.R. Part 121) in the Federal Register on March 18, 2005. All provisions of these
Seasonal Influenza final rules supersede those contained in the interim final rules and became effective on April 18,
Vaccine Safety: A 2005.
Summary for Clinicians
Selecting the Viruses
in the Influenza (Flu)
Vaccine
Large-Scale Influenza
Vaccination Clinic
Planning
Flu Vaccine
Effectiveness
Reallocating Influenza
Vaccine
Vaccination
Information for Health
Care Workers
Schools
Information
& Childcare
for
Providers
Schools
School-Located
Vaccination Materials
Influenza School-
Located Vaccination
(SLV): Information for
Planners
Information for
Parents

Antiviral
Summary Drugs
Influenza
2010-11
Antiviral Treatment
Recommendations for
2010-2011
2010-2011 Influenza
Antiviral Medications:
Summary for Clinicians

Infection
InfectionControl
Control
Guidance for the
Prevention & Control
of Influenza in Acute-
Care Facilities
Preventing the
Spread of Influenza
(the Flu) in Child Care
Settings: Guidance for
Administrators, Care
Providers, & Other
Staff
Control of Influenza
Outbreaks in
Institutions
Infection Control
Measures for
Preventing &
Controlling Influenza
Transmission in Long-
Term Care Facilities
Settings Where High-
Risk Persons & Their
Contacts May Be
Targeted For
Vaccination
Prevention & Control
of Influenza in the
Peri- and Postpartum
Settings
Interim Guidance for
the Use of Masks to
Control Influenza
Transmission
Respiratory
Hygiene/Cough
Etiquette

Clinical
Role ofDescription
Laboratory&
Lab
Diagnosis
Diagnosis
Influenza Symptoms
and Laboratory
Diagnostic Procedures
Rapid Diagnostic
 Testing: Information
for Health Care
Professionals
Rapid Diagnostic
Testing: Information
for Clinical Laboratory
Directors
Guidance for Clinicians
on the Use of Rapid
Influenza Diagnostic
Tests for the 2010-
2011 Influenza
Season
Influenza Diagnostic
Testing Algorithm

International
InternationalInfluenza
Situation Update
Influenza Division
International Program
International Flu
Related Links and
Resources
International Past
Situation Updates

Flu
Situation
Activity &
Update:
Surveillance
Summary of Weekly
FluView
Overview of Influenza
Surveillance in the
United States
Current United States
Flu Activity Map
Weekly U.S. Influenza
Surveillance Report
International
Influenza Surveillance
Past Weekly
Surveillance Reports
United States
Surveillance Data:
1997-1998 through
2005-2006 Seasons

Training
References & Resources
Communications to
Healthcare Providers

National
2010–11 Influenza
NIVW Activities
Vaccination Week (NIVW)
Submit Your Own Event
for NIVW!
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Page last updated: February 8, 2011

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