2009 swine flu pandemic in the United States

Main article: 2009 swine flu outbreak

Further information: 2009 swine flu outbreak by country

Reported cases by state/territory

State or territory	State-reported confirmed cases	State-reported hospital- izations	Confirmed deaths
Total	115,318	27,632	3,433
Alabama	2,453/NLU	NR	19
Alaska	1,563	18wave 1	13 (11)
Arizona	8,726	1,897	152
Arkansas	154/NLU	NR	53
California	10,545	8,589	657
Colorado	1,321	578	70
Connecticut	5,491	766	35
Delaware	381	NR	7
District of Columbia	54	NR	1
Florida	3,676	1,227	230
Georgia	1,012	860	81
Hawaii	2,221	NR	13
Idaho	1,171	389wave 2	23wave 2
Illinois	3,387	3,042	111
Indiana	782	NR	39
Iowa	929	700	41
Kansas	1,201	NR	29
Kentucky	2,092	NR	39
Louisiana	1,876	NR	52
Maine	2,232	230	21
Maryland	1,772	996	45
Massachusetts	1,979	397	33
Michigan	655/NLU	NR	88
Minnesota	2,220	1,813	61
Mississippi	1,292	NR	26
Missouri	1,523	NR	17
Montana	961	9	19
Nebraska	430	40	15
Nevada	5,516	NR	44
New Hampshire	722	NR	10
New Jersey	1,006/NLU	512	42
New Mexico	1,007	1,007	58
New York	2,738	909	206
North Carolina	638	267	107
North Dakota	650	60	2
Ohio	227/NLU	NR	52
Oklahoma	237/NLU	7	44
Oregon	1,833	1,419	79
Pennsylvania	10,940	NR	78
Rhode Island	203	76	13
South Carolina	1,634	NR	49
South Dakota	2,081	422	23
Tennessee	1,163	NR	57
Texas	6,128	1,994	231
Utah	988	302	48
Vermont	404	149	3
Virginia	327	NR	37
Washington	1,882	1,561	99
West Virginia	1,214	853	22
Wisconsin	9,579	1,317	55
Wyoming	725	NR	10
American Samoa	90	NR	1
Guam	338	NR	2
Northern Mariana Islands	71	NR	0
Puerto Rico	908	NR	60
U.S. Virgin Islands	80	NR	1
NR: Not Reported - NLU: No Longer Updated

In March, April, and May 2009, an outbreak of a new strain of influenza commonly known as swine flu infected many people in Mexico and parts of the United States, causing severe illness in the former. The new strain was identified as a combination of several different strains of Influenzavirus A, subtype H1N1, including separate strains of this subtype circulating in humans (see human influenza) and in pigs (see swine influenza). The strain transmits between humans and has been reported to have a relatively high mortality rate in Mexico. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have expressed serious concerns that the new strain has the potential to become an influenza pandemic. It is reported that, because the virus is already widespread, containment will be impossible.

On April 28, 2009, the director of the Centers for Disease Control and Prevention confirmed the first official US death of swine flu. Tests confirmed that a 23-month old toddler from Mexico, who was probably infected there, died from the flu while visiting Texas. The following day, President Obama suggested U.S. schools should consider shutting down as a future possibility if students are infected. By April 30, 2009, 300 U.S. schools and school districts had announced closures in response to the outbreak, giving 169,000 students time off.

Response

Congruent U.S. Government and WHO Pandemic Response Charts.

Health and Human Services Secretary Kathleen Sebelius in a meeting in the Situation Room of the White House regarding the H1N1 virus.

An official for the White House said on April 24 that "the White House is taking the situation seriously and monitoring for any new developments. The president has been fully briefed." President Barack Obama stated that "We are closely monitoring the emerging cases of swine flu". He also noted, "This is obviously a cause for concern ... but it is not a cause for alarm".

White House Press Secretary, Robert Gibbs said the effort to get a team in place to respond to the health scare has not been hindered by the lack of a secretary of Health and Human Services or appointees in any of the department’s 19 key posts. The president's nominee, Kansas Gov. Kathleen Sebelius, was still awaiting confirmation from the U.S. Senate until passing on April 28. The President has not yet made appointments to either the Commissioner of the Food and Drug Administration, the Surgeon General, or the Director of the Centers for Disease Control and Prevention. The current acting Surgeon General, Steven K. Galson, is also currently serving as the Acting Assistant Secretary for Health.

The United States federal government has declared a public health emergency, and several U.S. states have indicated they may follow suit. Secretary of Homeland Security Janet Napolitano noted that this declaration was standard operating procedure, which was also done for the 2009 presidential inauguration and for flooding.

The Federal response remains at US Pandemic Stage 0, congruent with the World Health Organization (WHO) Pandemic Phases 1, 2 and 3; however, the WHO's Pandemic Phase was raised to 4 on April 27, which is congruent with US Pandemic Stage 2. On April 29, the WHO raised the pandemic alert level to phase 5.

Meanwhile, an April 28, 2009 CNN article stated, "There had been no confirmed deaths in the United States related to swine flu as of Tuesday afternoon. But another virus had killed thousands of people since January and is expected to keep killing hundreds of people every week for the rest of the year. That one? The regular flu... No fewer than 800 flu-related deaths were reported in any week between January 1 and April 18, the most recent week for which figures were available."

In addition, the flu death toll in Mexico could be lower than first thought, Dr. Gregory Evans, head of the Association of Medical Microbiology and Infectious Disease Canada and a member of a federal pandemic-planning committee, said on April 29:

There was a lot of speculation and what seemed to be evidence there were dozens and dozens of deaths. Careful analysis showed these people likely died of something else, and not flu. That's really good news, and that would fit with what we've seen outside of Mexico.

Moreover, another Canadian expert, Dr. Neil Rau, criticized the WHO's decision to raise its Pandemic alert to level 5, saying:

I don't agree with (the WHO) because I think it's a panic metre, not a pandemic metre. [...] If that flu-like illness is not deadly, I don't know what the cause for alarm is for people who are not really sickened by this virus. [...] I'm really eager to know how much worse this is than seasonal flu. So far it's looking like it's not that serious.

Centers for Disease Control and Prevention (CDC)

Confirmed human cases with known dates of illness onset (USA, April 27, 2009).

In the United States, the majority of the 70 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories do not report the influenza A subtype. However, in 2007 human infection with a novel influenzavirus A became a nationally notifiable condition. Novel influenza A virus infections include all human infections with influenza A viruses that are different from currently circulating human influenza H1 and H3 viruses. These viruses include those that are subtyped as nonhuman in origin and those that are unsubtypable with standard methods and reagents. The new strain responsible for this outbreak was one such virus.

In this video, Dr. Joe Bresee, with CDC's Influenza Division, describes the symptoms of swine flu and warning signs to look for that indicate the need for urgent medical attention.
See also: See this video with subtitles in YouTube

The Centers for Disease Control and Prevention (CDC) identified the first two A/09(H1N1) swine flu cases in California on April 17, 2009 via the Border Infectious Disease Program, for the San Diego County child, and a naval research facility studying a special diagnostic test, where influenza sample from the child from Imperial County was tested. By April 21, enhanced surveillance was established to search for additional cases in both California and Texas and the CDC determined that the virus strain was genetically similar to the previously known A(H1N1) swine flu circulating among pigs in the United States since about 1999.

It was established that the virus was a combination of human, North American swine, and Eurasian swine influenza viruses; the viruses from the initial two Californian cases were also noted to be resistant to amantadine and rimantadine, two common influenza antiviral drugs. No contact with pigs was found for any of the seven Californian nor either of the two Texas cases, suggesting human-to-human transmission of the virus.

During the week of April 19th, the CDC activated its Emergency Operations Center (EOC) to augment the ongoing investigation of human cases of swine influenza A (H1N1). More than 250 CDC professionals are working from the CDC EOC as part of the agency's response.

At a press briefing on April 27, acting CDC director Dr. Richard Besser stated that out of 40 confirmed cases at that point, only one individual was hospitalized. He also revealed that the median age was 16 years "with a range in age of 7 to 54 years."

As of April 29, only the CDC could confirm U.S. swine flu cases. Dr. Besser stated during an April 30 press briefing that California and New York had diagnostic test kits, and that the kits would be sent to all states the starting the following day.

Affected states

As of UTC 05:00, 3 May 2009:

  Death(s) confirmed

  Case(s) confirmed

  Case(s) unconfirmed (both suspected and probable cases)

Alabama

On May 2, 2009, the Alabama Department of Public Health confirmed the first case of H1N1 (swine flu) in Madison, Alabama, with an additional 8 probable cases statewide. [2] Seven of the probable cases are in Madison County, Alabama, and the eighth probable case is in Montgomery, Alabama. Previously, two children at an elementary school in Madison were declared by the State Health Officer Don Williamson as having a non-seasonal strain of flu, which has a 95 percent correlation with swine influenza. As a result, all public schools and most private schools and daycare centers in Madison County, Alabama, including the cities of Huntsville and Madison, closed for two days. Subsequently, one of two Madison school children became the first confirmed case in Alabama.

Arizona

On April 28, Arizona's Department of Health submitted samples from four patients to the CDC for testing. Those four samples were confirmed to be H1N1 swine flu virus, and were all from elementary-school students in the Phoenix metropolitan area. Three schools in the area were closed for seven days as a precautionary measure.

State health officials informed that they had 58,000 anti-viral treatment courses on hand, and that they had received over 200,000 doses from the Strategic National Stockpile.

California

CDC conference with the media on the swine flu outbreak on April 25, 2009

The first two cases detected in the US were two children living in San Diego County and Imperial County (a county in which 18% of their residents are not U.S. citizens), who became ill on March 28 and 30 respectively. A CDC alert concerning these two isolated cases was reported in the media on April 21. As of April 24 eight human cases were known in the US, including six in Southern California. The patients have recovered. The acting director of the US Centers for Disease Control (CDC) said that preliminary tests on seven out of fourteen samples from patients in Mexico had matched the virus found in the US, which experts say is a new strain of swine flu. None of the US patients had any contact with pigs, leading CDC officials to believe that human-to-human transmission has been occurring.

Gov. Arnold Schwarzenegger and the state of California activated the Joint Emergency Operations Center of the Department of Public Health, and are coordinating with the California Emergency Management Agency, the CDC, and the Mexican government. They have additionally stepped up other preparations to lessen the flu's threat. On April 28, Gov. Schwarzenegger declared a state of emergency which allows the state to deploy additional resources to the Department of Public Health and more quickly and easily purchase equipment and materials.

St. Mels Catholic School in Fair Oaks was closed after Sacramento County Health Department notified the school that a 7th grade student who reportedly recently returned from a family vacation in Mexico tested positive for an unidentified strain of Influenzavirus A. On April 27, CDC officials confirmed that the student tested positive for swine flu. In Marin County, a grandmother and her 20-month-old granddaughter have been confirmed to have the flu. By April 28, the CDC had confirmed 10 cases of swine flu in California.

California State University, Long Beach reported on April 29 that a student had returned a "probable positive" test result for swine influenza. The student showed symptoms on Sunday April 26 and went to the campus health services office the following day. The test results were received by the school on April 28 and distributed to all students and faculty. The affected student had not attended any classes since falling ill and has an apparently mild case of the disease that does not appear life threatening. Three high schools in Riverside County were closed April 29 after two teenage girls, from Corona and Indio respectively, were confirmed to have contracted the virus. Branham High School in Santa Clara County was closed that day for a week after one teenage girl was confirmed to be a probable case. Rucker Elementary School in Gilroy, California is set to be closed on Friday, May 1 after at least one student was being tested after exhibiting flu-like symptoms. At least three students at the Grizzly Youth Academy in San Luis Obispo are considered to have probable cases of swine influenza (awaiting test results) as of May 1. As many as 73 students are exhibiting flu-like symptoms. The Academy is set to stay open.

Colorado

On April 30 two cases of the flu virus were confirmed in the state of Colorado. The confirmed cases were a woman from Arapahoe County who recently returned from a cruise to Mexico and a Denver International Airport baggage handler.

Connecticut

On April 28, it was announced that there were suspected cases of swine flu in three Connecticut towns. Schools were closed due to suspected cases in East Haddam and Wethersfield, though tests on these patients later came back negative. On April 30, two students at Fairfield University were announced as having "probable" swine flu, in addition to another person in Glastonbury, bringing the total number of likely cases to 6. On May 1, the first confirmed case of swine flu was reported in Connecticut in Stratford. On May 2, the second confirmed case was reported in a child from Middlefield that had recently returned from a family trip to Mexico.

Delaware

The first probable cases of swine flu in Delaware were reported on Monday, April 27. Four probable cases of swine flu were reported on the University of Delaware campus after the students were experiencing flu like symptoms. Tests were sent to the CDC to see if the students had the swine flu. All four cases were confirmed by the CDC on April 28. The students were reported to be recovering, and the campus set up a temporary Public Health clinic. The Delaware Division of Public Health reported on May 1 a further 17 probable cases, all from the University.

Florida

On April 28, it was reported that an individual in Florida had tested positive for influenza type A, of which swine flu is a subtype. A culture from that person has been sent to Jacksonville to be tested for swine flu, with results expected within 48 hours. Gov. Crist announced the first two confirmed cases in Florida on May 1. The cases are both children and in Lee and Broward counties.

Georgia

The first case of laboratory confirmed swine flu was reported on April 30. A Kentucky woman was hospitalized in LaGrange while visiting family in Georgia; she had recently returned from a trip to Mexico. While Georgia health officials reported this as a confirmed case for the state, the CDC and the Kentucky health department reported it as a case in Kentucky. State officials say they have no plans to close schools or other public institutions.

Illinois

The state's first probable case of swine flu was reported on Wednesday, April 29. An elementary school in Chicago's Rogers Park neighborhood, on the city's Far North Side, was closed because a 12-year-old student was presumed to have the disease. The CDC is conducting laboratory tests to confirm, but the student reportedly was recovering at home. By April 30, over 40 probable cases had been identified by state and local health officials. In addition to 16 cases in the city of Chicago, and 11 in surrounding Cook County, cases were reported in Kane, Lake, DuPage, McHenry, and Will counties. Several schools in the affected areas were temporarily closed.

Indiana

On April 28, an unidentified Notre Dame student was confirmed as the first case of swine flu in this state. The patient had not recently traveled to Mexico or been in contact with anyone who has traveled to Mexico. The student was in voluntarily quarantine, and was "doing well" according to Judy Monroe, Indiana's state health commissioner. Two other cases in the state have been confirmed by the CDC, which occurred in two Indianapolis elementary schools.

Kansas

Health officials in Kansas announced April 25 that two new cases of swine flu had been confirmed in Dickinson County, after both were isolated. The week prior, one patient had traveled to Mexico by plane to attend a professional conference; both he and his wife experienced minor influenza symptoms.

Kentucky

A Warren County woman who had recently visited Mexico tested positive for the virus April 30. After returning to Kentucky from Mexico, she traveled to Georgia where she was hospitalized. Health officials from both states announced this as the first confirmed case in their states, however the CDC listed the case in Kentucky.

Louisiana

State officials in Lousiana reported six probable cases of swine influenza on April 29. Five cases are in Lafayette, Louisiana, where the private Cathedral Carmel School has been closed indefinitely. In New Orleans an 8 year old boy tested positive for Influenza A after reportedly having traveled to Mexico within a week prior to the news articles. All cases are awaiting further results.

As of April 30 at least two more probable cases have been reported in Louisiana, bringing the total to 8. These probably cases have been reported in the following parishes : Lafayette Parish (5 suspected), Orleans Parish (1 suspected), St. Martin Parish (1 suspected), St. Tammany Parish (1 suspected).

As of May 3 there have been 23 probable swine flu cases in Louisiana.

Maine

On April 29 three cases of H1N1 (swine flu) were confirmed in Maine, according to the Maine Center for Disease Control. The three adults, two from Kennebec County and one from York County, were reported to be recovering at home. Dr. Dora Anne Mills, director of Maine's CDC, said on April 28 that at least 12 suspected cases were being tested.

Late on April 29, Maine Governor John Baldacci declared a "civil emergency" and ordered a school and daycare facility in York County to close for 7 days.

Maryland

By May 1, 2009, eleven probable cases had been identified in Maryland, in Anne Arundel, Baltimore, Charles, Prince Georges, and Montgomery Counties. One of these cases, that of a high school student in Rockville, resulted in the closing of Rockville High School, the first Maryland school closing due to the outbreak. On May 1, three other schools in the state were closed.

Massachusetts

Two middle school students in Lowell, Massachusetts have tested positive for swine flu as of April 29, 2009. The two had gone on a family trip to Mexico, and became mildly sick on returning home. The local health department said that the boys had not returned to school since coming back from Mexico, and there were no concerns that the illness had been spread.

In Spencer, Massachusetts, two students who also had recently returned from Mexico were tested for possible swine flu infection. The results of those tests were both negative.

The Harvard School of Dental Medicine in Boston announced that it would close on Friday, May 1 along with the dental clinic there after 2 'probable' cases and 7 other suspected cases of swine flu was detected there. The schools will remain closed until the full extent of the virus can be determined, and faculty, staff, and students were encouraged to remain at home. Harvard School of Public Health and Harvard Medical School which share the same campus as Harvard School of Dental Medicine will remain open, but classes have been canceled.

CBS News reported reported that 2 students had probable cases and 8 students do have the virus, at Amherst College in Amherst, MA. All 10 students are being isolated on campus.

The CDC had announced 4 additional confirmed cases, from 2 adults and 2 school-age residents (of the state), from the following counties: (3) Middlesex County and (1) Plymouth County.

A member of the U.S. Coast Guard stationed on Cape Cod, acquired the virus while training in California, but reportedly recovered.

On May 1, 2009, a United Airlines Flight 903 from Munich to Washington D.C., was diverted to Logan International Airport in Boston. A 53-year old passenger complained of flu-like symptoms, that led him to be admitted to Massachusetts General Hospital.

A male passenger in his 40's complained of flu-like symptoms upon landing at Logan International Airport in Boston May 2, 2009. He was flying aboard American Airlines Flight 155, from London to Boston, that had originated from Malaysia. He, too, was admitted to Massachusetts General Hospital in Boston.

The Massachusetts Department of Public Health informed the Ashland school superintendent that two Ashland High School students have "probable" cases of H1N1 flu.

The Lincoln Public Schools Superintendent had confirmed a Lincoln middle school student been diagnosed with the H1N1 virus.

The health inspector of Quincy confirmed that a New York resident who checked into Quincy Medical Center on May 1st, 2009, and tested positive for the H1N1 flu.

Michigan

On April 29, a 34-year-old woman from Livingston County, Michigan was Michigan's first reported case of swine flu. On April 30, another 34-year-old woman from Ottawa County was confirmed as Michigan's second case.

Several schools and school districts across the state shut down due to suspected cases. Woodhaven schools were closed April 30 and May 1 due to a suspected case of the swine flu. Test results came back saying that the student did not have the virus.

Minnesota

On April 30, 2009, the Minnesota Department of Health announced that the first case of "H1N1 novel influenza virus" in the state was confirmed by the CDC. The infected individual is an unidentified resident of Cold Spring, Minnesota. Two schools in the affected city will remain closed until May 6, 2009.

Nebraska

There is one confirmed case of swine flu in Nebraska. One person from Chadron is now isolated.

Nevada

The first confirmed case of the virus was reported in Nevada on April 29. A two year-old girl from Reno contracted the virus, but it is unclear how as the case did not appear to be linked to any previously affected areas. It is to be predicted that a California man visited Reno, had the swine flu, and passed it on to her.

New Hampshire

The New Hampshire Department of Health and Human Services announced the state's first confirmed case of the H1N1 flu May 2, 2009. The confirmed case involves a employee of Concord Hospital in Concord, New Hampshire.

New Mexico

On April 29, 2009 gov. Bill Richardson announced that there are two very probable cases in New Mexico. The suspected cases were a 1 year old boy from Santa Fe County and an 18 year old man from Valencia County. The 1 year old tested negative for H1N1, but the 18 year old man tested positive. More cases were raised in the interveneing days, and by May 1 the probable case number was raised up to Nine. In addition to the cases above, a 17 year old Girl from Eddy County, a 22 year old woman also from Eddy County, a 15 year old girl from Valencia County, a 17 Year old boy from Hidalgo County, and a 27 year old man from Bernalillo County are also likely to be infected.

New York

On April 24, New York City Department of Health and Mental Hygiene dispatched a team of investigators to the private St. Francis Preparatory School in Queens after 150 students complained of symptoms consistent with the disease. Several of the students had recently traveled to Mexico City. New York City Health Commissioner Dr. Thomas Frieden reported on April 25 that eight of the New York school cases were "probable" swine flu. On April 26 the Centers for Disease Control and Prevention (CDC) confirmed that the Queens cases are indeed associated with the H1N1 virus. The students suffered only mild symptoms, and some have since recovered. On April 27 federal officials confirmed 20 new U.S. cases at the same school in New York in which eight cases were confirmed earlier. As of April 29, one undergraduate commuter student on the Queens Campus of St. John's University had contracted the Swine Flu (A/H1N1) virus. The student was treated and recovered. Representative Eric Massa (D-New York), a member of the House Homeland Security Committee, said "we need to close our borders to Mexico immediately and completely."

Two suspected cases in were reported in Rockland County, as well as seven suspected cases in Monroe County. Ontario, Wyoming and Genesee counties also reported suspected cases.

North Carolina

The state health director, Dr. Jeffrey Engel, announced that there had been two probable cases of swine flu in the state. The first case was a man traveling through Wake County, where the capital is located, on business. The other case was an Onslow County resident who had recently traveled to Texas. On a related note, North Carolina is one of 29 states that have deemed to have not stockpiled enough flu medicines by federal guidelines. However, Dr. Engel dismissed these concerns, saying, "I think the commercial supply will keep up at the present time."

Ohio

On April 26, the Ohio Department of Health reported that a nine-year-old boy attending Elyria City Schools in Elyria, Lorain County, had been diagnosed with a mild case of the new strain of swine influenza and that his immediate family was undergoing testing. After the confirmed case in Ohio and eight in New York occurred Federal officials declared a public health emergency. On April 29, a probable case was reported in Columbus. Two new cases were confirmed in Columbus on May 2, one of them being an OSU medical center employee.

The Cleveland health department has received numerous calls from concerned residents, although it has been difficult to tell whether or not the cases are swine flu, since it is regular flu season.

Oklahoma

In Muskogee, Oklahoma a man who recently visited Mexico has been admitted into a hospital after having swine flu symptoms, test results will determine if he has the flu or not. May1: Test for the man came back negative, and there are still no confirmed cases in Oklahoma.

Oregon

On Apr 29, 2009 at 9:50 PM at 4:30 PM PDT, there were 14 flu samples awaiting testing in Oregon. This was confirmed during a press conference held by state health officials. “I do expect that at some point, perhaps this week, perhaps next week, we are going to have a case, and probably more, here in Oregon," Dr. Mel Kohn, the state’s director of public health.

As of April 30, 12:30 PM, Oregon's first probable case of H1N1 flu was identified late Wednesday, April 29 following testing by the Oregon State Public Health Laboratory. As of May 2, 2009 at 4:00 PM PDT Oregon identified 11 possible cases of swine flu. Counties in Oregon with possible cases are: Lane (2), Marion (1), Multnomah (2), Polk (2), Umatilla (1), Wallowa (1), and Washington (2).

“None of these 11 individuals has been hospitalized,” Mel Kohn

South Carolina

13 cases of the flu virus were confirmed in South Carolina on April 30. All 13 were students or parents from the private Newberry Academy in Newberry, South Carolina; many had traveled to Mexico earlier in the month. All nearby public schools were closed for May 1. The S.C. Department of Health said there were nine more probable cases, and a further 22 cases still under investigation throughout the state.

South Dakota

Test results for two suspected cases of swine flu in South Dakota came back negative. The University of Nebraska Medical Center looked into suspicious specimens to determine if a Nebraska resident had the flu. However the test turned up negative, but the Medical center is currently testing more than a dozen other specimens for the strain.

Tennessee

Officials announced Wednesday in Williamson County that a child in Middle Tennessee is believed to have swine flu. The child's school, Harding Academy in Davidson County, has been closed. A second possible case of swine flu in Collierville has been reported in Tennessee. Medical tests at St. Jude Children's Research Hospital indicate the child has swine flu. Incarnation Catholic School the second child's school, has also been closed for the next week, per CDC guidelines.

Texas

Two students attending Byron P. Steele II High School in Cibolo were confirmed to have the A/H1N1 swine flu; the patients recovered. A third possible case in a student who attends the same high school as the two other cases in Texas has been identified and the school is closed temporarily. On April 25, the Texas Department of State Health Services (DSHS) decided to close Byron P. Steele II High School for the following week. Following the discovery of more possible swine flu illnesses, the DSHS ordered that all schools and district facilities in the Schertz-Cibolo-Universal City Independent School District be closed for the week.

On April 27, a 7-year-old, a 24-year-old, and a 3-month-old in Dallas County were confirmed to have swine flu. All recovering and were not hospitalized. That same day, the Richardson Independent School District in the northern Dallas suburb of Richardson shut down Canyon Creek Elementary School due to a confirmed and two suspected cases of swine flu. All schools in New Braunfels—private schools and all campuses of the Comal and New Braunfels Independent School Districts—have closed through May 10 on the recommendation of the Medical Authority of Comal County. Due to the swine flu, the University Interscholastic League (UIL) has suspended all events in the state of Texas until May 11.

On April 28, the City of Houston Health Department and Texas Children's Hospital sent samples in to the CDC. There are also possible cases at the Baylor College of Medicine outpatient clinic, Memorial Hermann Hospital, and St. Luke's Hospital.

A 23-month-old Mexican toddler who had been brought to Houston from Brownsville died on April 28, making the child the first US death due to the outbreak. The child had come to Brownsville April 4 to visit relatives and was admitted to a Brownsville hospital a few days later, then transferred to Texas Children's Hospital the next day.

Texas Governor Rick Perry issued a disaster declaration and the UIL suspended all high school meets until May 11.

On April 29, it was confirmed by Harris County that a 17-year-old girl from Fort Bend County attending Episcopal High School in Bellaire had contracted and recovered from the A/H1N1 swine flu. In compliance with the directives of the Harris County Public Health and Environmental Services Department, the school has been closed until further notice. Also that day, a probable case caused the closure of Lucy Read Pre-Kindergarten Demonstration School in north Austin.

Denton County reported its first confirmed swine flu case April 30, in a child in Plano; the student attended Wilson Middle School in the Plano Independent School District, and the district decided to close the Collin County school until 11 May. Navo Middle School and Lee Elementary were also closed after three students at both schools respectively were diagnosed with type A influenza. Also on April 30, 8 Suspected cases have been recognized in El Paso County. Lab samples have been sent to CDC. No further information has been provided at this time until cases are confirmed. At this time, international borders will remain open.

As of May 2, the rest of the Denton Independent School District has officially closed for the next week. []

The Superintendent of Keller Independent School District in Keller reported 3 possible cases, one in each of three schools; .

The El Paso Dept. of Public Health identified 11 more suspect cases of H1N1 flu in El Paso County on Friday, May 1, to bring the total number of suspect cases to 19. Lamar Consolidated ISD closed Lamar Junior High School due to a suspected (probable) case. Weslaco ISD closed all campuses for 7 days after a student was confirmed to have contracted type A influenza.

Utah

On April 28, 2009, one student in Park City, Utah was suspected to have Swine Flu. Two more students in the school district began showing similar symptoms making three probable cases. All 8 schools in the Park City School District closed the following day. On May 1st the number of probable cases was increased to 9; 6 in summit county (Park City), 2 in Salt Lake County and 1 in the Morgan-Weber Health District and about 80 suspected cases. May 2 at around 11 o'clock the first confirmation came back for the original case, the remaining 8 are pending.

Virginia

The Virginia Department of Health has confirmed two cases in the state. One in the "eastern" part of the state, and one in "Central" Virginia. Two other probable cases have been reported in Lexington, Virginia on the campus of Washington and Lee University.

Washington

As of the evening of Saturday, May 2, 2009, Washington state has reported 25 probable Swine Flu. An additional two are considered highly suspicious. So far, probable cases have been identified in five Washington state counties, with public facilities closed as a precaution in those counties and several others.

A majority of probable cases so far (15) have occurred in King County. The probable cases include eight in Seattle, and one each in Auburn, Des Moines, Kent and Lake Forest Park. Some sources have indicated a probable case in Des Moines. This case may be redundant to the Federal Way case, as the two cities share a school district boundary. Precautionary school closures have been undertaken in Des Moines and Seattle. A closed school in Redmond re-opened after officials determined the absence of any probable cases. An additional six probable cases, of unknown origin, were announced the evening of May 2nd.

Six probable cases have been reported in Snohomish County. Media reports have variously indicated cases in Edmonds, Everett, Lynnwood, Mountlake Terrace, Mukilteo and Snohomish. In addition, a Seattle case is in a 33 or 37-year-old (sources vary) pediatrician who worked out of The Everett Clinic in Mill Creek. The doctor's patients have thus far all tested negative for influenza. One school in Everett is closed, and another in Mukilteo was but has been re-opened. An additional probable case was identified May 2nd.

A middle-aged man from Spokane (in Spokane County) is considered a probable case, as is his son. One probable case each has also been identified in Puyallup in Pierce County, and in Skagit County. Although no other Washington counties have reported probable cases, two youth camps -- one in San Juan County and one in Thurston County -- have closed due to influenza-like symptoms. A high school in Lakewood, in Pierce County, was briefly closed after three students were hospitalized for severe influenza symptoms, but all three students have tested negative for Swine Flu.

Other states

There have been several reports of possible cases in New England. In New Hampshire, 2 people, both employees at Concord Hospital in Concord, are listed as probable for swine flu and were voluntarily quarantined. The third probable case is a person from Sullivan County. In Rhode Island, a North Kingstown student who recently returned from Mexico on vacation may have H1N1 flu. North Kingstown High School, so as not to risk possible transmission, will not have classes until results return from the CDC. As of April 30, there are two more suspected cases in Smithfield and Westerly. As of May 2, 2009, Rhode Island confirmed its first case of H1N1 Flu in a Westerly woman.

In Oregon, several samples collected by doctors around the state were being tested for swine flu as part of an active surveillance system. A probable case was found and has been forwarded to the CDC for confirmation. In Missouri, Gov. Jay Nixon announced in a written statement that a probable case had been discovered in a Platte County man, and that a sample had been sent to the CDC for confirmation.

Suspected cases are also under investigation in several other locations, including (but not limited to) Idaho, Wisconsin,, Mississippi, and New Jersey.

On April 30, it was reported that an aide to Steven Chu, the US Energy Secretary, had fallen ill from the virus after helping arrange President Barack Obama's trip to Mexico. However, the White House stated that the President is not at risk of obtaining the flu.

See also

• 1918 flu pandemic
• 2009 swine flu outbreak
• 2009 swine flu outbreak in Canada
• 2009 swine flu outbreak in Mexico
• Avian influenza
• Pandemic Preparedness and Response Act
• Severe acute respiratory syndrome (SARS)
• Swine influenza 1976 U.S. outbreak

External links

U.S. federal government

• PandemicFlu.gov - Access to U.S. Government swine, avian and pandemic flu information.
• U.S. Centers For Disease Control (CDC) H1N1 Flu – Updates periodically as the CDC releases new information
• Medical Encyclopedia Medline Plus: Swine Flu Encyclopic Information from the National Institutes of Health

State governments

• California Department of Public Health provides updates on Swine Flu
• Nebraska Department of Health and Human Services
• North Carolina Department of Health and Human Services
• New York State Department of Public Health provides updates on Swine Flu
• Ohio Department of Health
• South Carolina Department of Health and Environmental Control
• South Dakota Department of Health
• Tennessee Department of Health
• Texas Department of State Health Services provides updates on Swine Flu and a county breakdown of confirmed cases
• Utah Beauru of EpidemologySwine Flu
• Vermont Department of Health Swine Flu Outbreak
• Washington State Department of Health Swine Flu Information
• West Virginia Beauru for Public Health Swine Influenza
• pandemic.wisconsin.gov Wisconsin's Pandemic Flu Resource
• DC Department of Health

International organizations

• World Health Organization (WHO) Influenza A(H1N1) page – Updates periodically and links to archived WHO releases

Other websites

• Global map of reported H1N1 outbreaks in 2009
• H1N1 swine flu outbreak timeline
• BioHealthBase Bioinformatics Resource Center – Database of influenza genomic sequences and related information.
• USA Today – State-by-state preparations
• Confirmed and suspected cases from FluCount.org
• Medical Encyclopedia WebMD: Swine Flu Center