2009 swine flu pandemic in the Philippines by region
The 2009 flu pandemic in the Philippines began on May 21, 2009 when a young Filipina girl first contracted the A(H1N1) virus while in the United States. In the following days, several local cases were reported to be caused by contact with two infected Taiwanese women who attended a wedding ceremony in Zambales.


2009 swine flu pandemic in the Philippines by region
The 10-year-old Filipina girl arrived the country on May 18 and was hospitalized the day after at the Research Institute for Tropical Medicine in Muntinlupa. On May 21, Department of Health (DOH) secretary Francisco Duque confirmed the case being the first Philippine swine flu case.


2009 swine flu pandemic in the Philippines by region
On June 22, 2009, first fatality was reported, a 49-year-old female from Metro Manila, being also the first death in Asia associated with the disease. At the same time, the Department of Health assured that the patient did not die because of the novel virus, instead, due to heart attack. Later on, Philippine Congress learned that the woman was a regular employee of the House, and prompted the government to shut down the legislature for five days.


2009 swine flu pandemic in the Philippines by region, Luzon
Almost half of the western side of mainland Luzon was so far not infected by the influenza virus. The northern regions, Bicol Region and southern island of Luzon has no reported infections so far.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
Being the location of DOH authorized H1N1 hospital, Metro Manila reported its first influenza A(H1N1) case on May 22, 2009, in aligned with the first confirmed case in the Philippines.> As the time progresses, Metro Manila has the highest number of influenza A(H1N1) cases compared to other locations on the country due to the vicinity of available hospitals to conduct respiratory swab tests. On May 18, 2009, a Filipina girl who arrived from the US was the first confirmed case of H1N1 virus in the Philippines. Health Secretary Duque said that the girl is in stable condition and is in quarantine.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
Metro Manila had its second confirmed case of Influenza A(H1N1) virus infection (as well as in the country) being a 50-year-old patient who arrived in the country from the United States on May 20, 2009 showed symptoms of the dreaded flu, including coughs and fever. The patient is currently under observation at the Research Institute of Tropical Medicine (RITM) in Manila.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 3, 2009, a foreign exchange student in De La Salle University-Manila was confirmed with H1N1 virus and the school was closed for ten days starting June 4. The university then became the first school in the Philippines to shut down classes due to H1N1 infection. De La Salle then recorded the highest number of flu cases in Metro Manila schools.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 4, 2009, the confirmed cases of A(H1N1) virus rose to 29, after another De La Salle-Manila student and a staff of the Asian Development Bank (ADB) were confirmed that they were infected with the virus. ADB office in Makati was then subjected for closure and quarantine was made to infected or possible contacted people.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 8, 2009, East Asia College of the Far Eastern University in Manila confirmed its first case which rose to three.<


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 9, 2009, Ateneo de Manila High School department reported that three of its students were tested positive of the flu. Classes were suspended immediately after. Six days after, on its sister Loyola school Ateneo de Manila University in Quezon City reported four flu infections. The same day, La Salle's sister college St. Benilde had its first flu case which eventually rose to two.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 10, 2009, St. Andrew's School in Parañaque suspended classes after a student was infected by flu.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 15, 2009, Quezon City had its first public school flu cases that started on a school: two of them are elementary school pupils of Lagro Elementary School in Lagro, Quezon City and the remaining three are high school students of Miriam College in Katipunan Avenue, Loyola Heights. The same day, city government of Makati announced that three students of Mapúa Institute of Technology Makati Campus was tested positive for H1N1 together with two residents in San Miguel Village and one in Cembo.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 17, 2009, San Juan City had its first flu case, a student in Dominican College. Senate President pro Tempore Senator Jinggoy Estrada announced June 24 that two of his children contracted flu virus, one in De La Salle and the other one in Xavier School (Greenhills), even though the latter school did not announce infection so far.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
The same day, June 17, Don Alejandro Roces, Sr. Science and Technology High School, also in Quezon City confirmed first flu case after swab samples turned positive. Our Lady of Perpetual Succor College in Marikina also confirmed first influenza case. On June 18, 2009, first case in Mandaluyong school was reported in Lourdes School with two positive for flu.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 19, 2009, Adamson University in Manila suspended its classes due to confirmation of infection on one of its students.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 20, 2009, several schools announced flu infection: PAREF Southridge School in Muntinlupa, Reedley International School in Quezon City and San Beda College in Manila.


2009 swine flu pandemic in the Philippines by region, Luzon, Metro Manila
On June 21, 2009, virus reached Don Bosco Technical College in Mandaluyong. The same day, nearby school La Salle Green Hills announced flu infection. St. Scholastica's College in Manila also reported infection.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
The DOH-Cordillera confirmed on May 29 its first swine flu case. Similar to other flu patients, the identity and disclosure of the sick person was not publicized to promote confidentiality. A day after, on May 30, second flu patient was confirmed by the DOH Cordillera director Myrna Cabotaje, a man around his twenties.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
On the other hand, Baguio City Health Officer Florence Reyes said that the referral centers in the region include the Baguio General Hospital and Medical Center, Benguet General Hospital, Abra Provincial Hospital, Far North Luzon General Hospital and Medical Center in Apayao, Ifugao Provincial Hospital, Kalinga Provincial Hospital, Bontoc General Hospital, and Luis Hora Memorial and Regional Hospital also in Bontoc.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
On June 18, Cordillera cases rose to six, all of whom have history of travels to the United States and other flu-infected countries. Dr. Nick Gordo assured that there is no community level outbreak so far in the region.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
Meanwhile, on June 26, 2009, Dr. Anthony Bantog, head of the livestock division of the Department of Agriculture said that there is no swine flu or hog cholera outbreak among Cordillera pigs, despite the rising number of cases in the region. He added, instead, that porcine reproductive and respiratory syndrome affects pigs.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
On July 12, DOH Cordillera declared a low-level community outbreak of transmission all over Cordillera when its July 6 count of 14 rose to 47. Most of the cases came from Baguio. On the same hand, five of Baguio's universities temporarily closed their schools when students showed influenza-like illness and symptoms: St. Louis University, University of Baguio, Pines City Educational College, Baguio City National High School, and St. Louis Center.


2009 swine flu pandemic in the Philippines by region, Luzon, Cordillera Administrative Region
On July 27, 2009 afternoon, DOH Cordillera Region announced four more A(H1N1)-related deaths: an infant, a child, a woman who had just given birth and a teenager died within the past week.


2009 swine flu pandemic in the Philippines by region, Luzon, Ilocos Region
As of June 26, 2009, the only province in the region to report influenza cases is Pangasinan, with two confirmed infections last June 18.


2009 swine flu pandemic in the Philippines by region, Luzon, Cagayan Valley
Cagayan Valley has recorded five positive A(H1N1) cases, regional health authorities based in this city said last July 8. Most of these cases, three from Cagayan and two from Isabela.


2009 swine flu pandemic in the Philippines by region, Luzon, Cagayan Valley
In Cagayan, a seven-year-old boy in Solana town was found positive of H1N1, bringing to nine the confirmed cases in Cagayan Valley.


2009 swine flu pandemic in the Philippines by region, Luzon, Cagayan Valley
Floro Orata, Department of Health-Cagayan Valley information officer, said the boy underwent swab test last week and the sample was sent to the Research Institute for Tropical Medicine in Manila. He later tested positive for the virus. The boy, who was on 10-day quarantine, reportedly contracted the virus from a relative who arrived from the United States.


2009 swine flu pandemic in the Philippines by region, Luzon, Cagayan Valley
Contact tracing operations to his relatives showed that there are no indications that other relatives also contracted the virus. Eight of the confirmed H1N1 cases in the region were in good health now.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon
To date, all provinces in Central Luzon except Aurora have confirmed influenza A(H1N1) cases.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Nueva Ecija
Around May 28–29, 2009, around 29 students felt influenza-like illnesses at the same grade level in Hilera Elementary School, barangay Hilera (Jaen, Nueva Ecija). Six days later, on June 5, the students under observation rose to forty, so much that Jaen mayor Santiago Austria ordered suspension of classes. He also announced that the students are all in grade six level. National Epidemiology Center director Eric Tayag, on the other hand, increased the number of cases under observation in Hilera to 57, all of which are grade six pupils and the school principal of Hilera Elementary. On June 11, 2009, Department of Health confirmed first case of influenza in Nueva Ecija, an 11-year-old student from the same school.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Nueva Ecija
A day after, 10 more children tested positive for the flu, nine of which are from the same school and another four-year-old toddler.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Nueva Ecija
Due to the fact that the first local influenza case in Central Luzon has no history of travel abroad nor close contact with the earlier cases, the DOH then speculated possible reasons how the student contracted the disease, One theory by local government of Nueva Ecija is that flu virus was transmitted by a member of a foreign medical mission, only known as Palanghay which conducted services on the school on May 31, and incubated into some students of the school.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Nueva Ecija
Philippine Daily Inquirer, on the other hand, reported that there are around 36 people quarantined (in Nueva Ecija) after they mingled and had closed contact in a wake with the 19-year-old girl tested positive for the disease; though the DOH never mentioned this possibility. Third possible theory was based on DOH Central Luzon director Rio Magpantay statement that the eleven-year-old boy possibly had flu infection during his summer vacation on the province of Bulacan.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Nueva Ecija
After suspecting 92 influenza cases, the Department of Health on June 14 declared community outbreak in barangay Hilera, Jaen, Nueva Ecija. The community outbreak includes the Hilera-nearby barangays of Kalabasa, Pitak, Pakul and Lambakin. The outbreak declaration created generalized stigma to Hilera residents:


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Zambales
On May 17, 2009, a wedding feast was conducted on the Central Luzon province of Zambales, with the DOH-estimated number of attendees around fifty. The occasion was said to be in a beach resort in the province. Two of the wedding attendees were Taiwanese nationals, a mother and her daughter, were found positive of the influenza virus when upon arrival in Taipei. In the successive, DOH tracked the location of the remaining guests through contact tracing, where they found around ten more positive for the flu.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Zambales
Later, DOH Central Luzon Director Dr. Rio Magpantay said that the total attendees were around eighty, contrary to the previously reported around 50. Other news sources claimed that it was not a wedding occasion, but a yoga seminar instead, where around a hundred foreign nationals attended.


2009 swine flu pandemic in the Philippines by region, Luzon, Central Luzon, Zambales
On June 28, 2009, seven Philippine Navy soldiers were tested positive for the influenza. According to Lieutenant Colonel Edgard Arevalo upon press conference in Camp Aguinaldo in Quezon City, these soldiers may contracted the novel disease when spending their vacation. Defense secretary Gilbert Teodoro, Jr., on the other hand, believes that one of the infected soldiers might have caught the virus when he attended a wedding in Zambales province, where two Taiwanese had also contracted the disease in May.


2009 swine flu pandemic in the Philippines by region, Luzon, Calabarzon, Rizal
On June 19, 2009, classes at the Karangalan Elementary School in Cainta, Rizal province were canceled when 43 of its students and three faculty members exhibited flu-like symptoms. Due to this, the town government was urged to order the release of P5 million in calamity funds to be used for the purchase of anti-flu vaccines, face masks, alcohol, and other equipment. On June 21, swab tests of the suspected patients arrived from Research Institute for Tropical Medicine, which confirmed that two of the students have influenza, thus making Cainta be the first municipality in Rizal province to report influenza case. On the same hand, Cainta mayor Ramon Ilagan cited that there were earlier cases of A(H1N1) on the town, one being a high school student from Greenland Executive Village in San Juan, and his mother who apparently caught the disease from him.


2009 swine flu pandemic in the Philippines by region, Luzon, Calabarzon, Quezon
On July 7, 2009. The Maryhill College confirmed its first A(H1N1) virus case in Lucena City.


2009 swine flu pandemic in the Philippines by region, Luzon, Calabarzon, Quezon
On July 14, 2009. 6 of 72 students that shows the symptoms of the Influenza A(H1N1) underwent the swab test and the result came out as positive.


2009 swine flu pandemic in the Philippines by region, Luzon, Mimaropa
To date, majority of Mimaropa provinces has no confirmed infections yet.


2009 swine flu pandemic in the Philippines by region, Luzon, Mimaropa
On July 18, 2009, around 132 students of Managpi Elementary School in Managpi, Calapan City, Oriental Mindoro mysteriously felt ill. The next day, in a radio interview with Calapan City mayor Paulino Salvador Leachon ordered schools officials of Managpu ES to temporarily close classes until July 26, where at the same day, 5 of its students were confirmed to have A(H1N1).


2009 swine flu pandemic in the Philippines by region, Luzon, Mimaropa
Four days later, additional five cases were confirmed by the DOH Mimaropa Regional Director Dr. Gloria Balboa and city health officer Dr. Basilisa Llanto, two of them came from J.J. Leido National High School and three from Adriatico Elementary School. This prompted the city mayor and the council to declare suspension of classes among levels in Calapan City and to resume August 1, as more and more children acquire the disease (though no other figures provided). At the same day, all of Calapan City under state of calamity as a mysterious fever downed around 400 students there.


2009 swine flu pandemic in the Philippines by region, Luzon, Bicol Region
On July 13, 2009, classes were suspended in Philippine Science High School in Goa, Camarines Sur when 70 of its 300 dormers exhibited some influenza-like illnessess. Three days later, local government officials from Goa denied that an influenza A(H1N1) infected the school, but was a seasonal flu instead. Furthermore, the toll of students infected with the seasonal flu rose to 96.


2009 swine flu pandemic in the Philippines by region, Visayas
Visayas group islands has the most number of provinces infected in terms of geographical extent. Provinces that do not have flu cases so far include Aklan, Antique, Biliran, Guimaras, Eastern Samar, Negros Oriental, Northern Samar, Siquijor and Southern Leyte.


2009 swine flu pandemic in the Philippines by region, Mindanao
There are some parts of Mindanao which are affected from the virus.


2009 swine flu pandemic in the Philippines by region, Mindanao, Zamboanga Peninsula
On July 2, 2009. The Ateneo de Zamboanga University confirmed its first A(H1N1) virus case in Zamboanga City. University President Fr. Antonio Moreno said that the grade 4 student had contacted with a relative who was found positive of the illness in Manila. Due to this incident, Fr. Moreno announced its suspending the classes at the elementary level of the university starting this Friday, July 3, until July 13.


2009 swine flu pandemic in the Philippines by region, Mindanao, Northern Mindanao
There are at least 10 confirmed cases in Northern Mindanao. Two are from Cagayan de Oro City, and six are soldiers training in a local military camp from Malaybalay City, Bukidnon. The other two are confirmed in Cotabato City and Ozamis City. On June 28, 2009, DOH confirmed that all these 10 patients had fully recovered.


2009 swine flu pandemic in the Philippines by region, Mindanao, Northern Mindanao
On July 15, 2009, there are 9 confirmed cases of A(H1N1) virus from Xavier University - Ateneo de Cagayan. 8 are High School students from Xavier University - Ateneo de Cagayan High School in Pueblo de Oro and 1 is a faculty of Xavier University-Ateneo de Cagayan Main Campus. All are now undergoing confined treatment and are now recovering. All classes of all levels in all four campuses of the university are suspended for 10 days starting from July 16, 2008 (July 15, 2009 for XUHS) and will resume on July 27, 2009.


2009 swine flu pandemic in the Philippines by region, Mindanao, Northern Mindanao
On the same date, there are also suspected cases from Pilgrim Christian College to have the virus and are now undergoing the swab test according to Cagayan de Oro's Committee on Health and Social Services Chairman Dr. Dante Pajo.


2009 swine flu pandemic in the Philippines by region, Mindanao, Northern Mindanao
On July 17, 2009, Lourdes College and Corpus Christi School of Cagayan de Oro City suspended classes, fearing that their personnel would be exposed to infected students. Furthermore, some of the students are experiencing with the symptoms of the virus and currently waiting for the results of the swab tests conducted.


2009 swine flu pandemic in the Philippines by region, Mindanao, Davao Region
During the course of the pandemic, no cases has benn confirmed in the Davao Region.


2009 swine flu pandemic in the Philippines by region, Mindanao, Soccsksargen
The first case in the region was a woman in Kidapawan City who visited her OFW husband in Manila. The husband, however is negative of the virus.


2009 swine flu pandemic in the Philippines by region, Mindanao, Caraga
On June 22, 2009, Mindanao has its first confirmed flu infection when a four-year-old boy who visited his working mother in Hong Kong tested positive for the disease. The child developed a fever and cough after arriving with his parents from a vacation in Hong Kong on June 13. The boy's location was revealed to be in the independent city of Butuan inside the province of Agusan del Norte.


2009 swine flu pandemic in the Philippines by region, Mindanao, Caraga
Three days later, on June 25, the same city, Butuan, confirmed another case, a nine-year-old girl who had close contact with the first case in Butuan. The patient was then rushed into the Davao Medical Center.


2009 swine flu pandemic in the Philippines by region, Mindanao, Autonomous Region in Muslim Mindanao
During the course of the pandemic, no cases has benn confirmed in the Autonomous Region in Muslim Mindanao.


2009 swine flu pandemic in the United Kingdom
The 2009 flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On 11 June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experienced mild symptoms, but some persons were in higher risk groups, such as those with asthma, diabetes, obesity, heart disease, who were pregnant or had a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point of respiratory failure.


2009 swine flu pandemic in the United Kingdom
The virus reached the United Kingdom in April 2009. The first cases were confirmed on 27 April 2009 in passengers returning from Mexico. The first case of person to person transmission within the UK was announced on 1 May 2009. In the UK, 5- to 14-year-olds were the age group predominantly affected. Laboratory tests demonstrated that older people had some immunity.


2009 swine flu pandemic in the United Kingdom
After a slow start, the virus spread rapidly in the UK in July 2009, with new cases peaking at 110,000 in the last week of that month, according to The Health Protection Agency's modelling estimate, but declining sharply in the first week of August 2009. Cases fell progressively down to 3,000 in the first week of September 2009, then began to rise again. The decline in cases during the summer had been predicted, but a large surge was expected in the autumn to coincide with the normal flu season. Cases rose to 84,000 by the end of October, well below the summer's peak, and then declined during November.


2009 swine flu pandemic in the United Kingdom, Reported cases
Until 2 July 2009 the HPA published daily reports of laboratory-confirmed cases with breakdown by region, by age, and by source of infection (travel, community, etc.). From that date routine laboratory testing of all suspected cases and reporting of figures was discontinued. As of 8 July 2009 figures shown in this article are laboratory confirmed cases reported on 2 July.


2009 swine flu pandemic in the United Kingdom, Reported cases
Deaths are often reported as occurring "after contracting the swine flu virus" without flu being necessarily the cause of death of people with underlying health problems.


2009 swine flu pandemic in the United Kingdom, Reported cases
Researchers at Imperial College London said in July 2009 that the best estimate was that about 0.5% of those who get swine flu bad enough to seek medical help die from it, a figure very similar to the estimate for seasonal influenza.


2009 swine flu pandemic in the United Kingdom, Reported cases, Cases by region
Laboratory-confirmed  cases of AH1N1 Influenza in the United Kingdom  up to 2 July 2009


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
On 25 April 2009, a member of British Airways cabin crew was taken to Northwick Park Hospital in Harrow and quarantined after falling ill with flu-like symptoms on a flight from Mexico City though he was later found not to have swine flu.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
On 26 April, two people were admitted to Monklands Hospital in Airdrie, North Lanarkshire, with mild flu-like symptoms after returning from Mexico. The next day, the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, confirmed that these were cases of the swine influenza A (H1N1) virus. Authorities in both Scotland and England stated that there were no plans to trace the fellow airline passengers who may have travelled alongside the couple, since the authorities do not classify them as "close contacts". These cases along with one in Spain are the first confirmed cases in Europe.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
At noon on 29 April the government reported three more confirmed cases in the UK, including the first cases in England. All three had recently returned from Mexico. The secondary school, Paignton Community and Sports College, closed for seven days.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
By 26 May the number of people who had contracted the disease in-country increased to 125, the highest in Europe and triple the second highest, Spain.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
On 28 May, sixty four people connected with a primary school in Birmingham were diagnosed with swine flu .


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
On 8 June the HPA issued a report stating that the majority of cases are in school age children and young adults, which has not been the case in most pandemics with the notable exception of 1918.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
On 25 June the chief medical officer Sir Liam Donaldson said certain areas were seeing rapid community spread which meant that it was no longer practical to attempt in those areas (initially parts of London, the west Midlands and east Berkshire) to put a ring around the outbreaks by tracing the people with whom confirmed cases have come into contact and giving them drugs to try to prevent flu developing. In these areas, anti-viral drugs may in the future only be given to people showing symptoms, and tracing of contacts will stop. The contingency plans always envisaged the containment phase would not last indefinitely. The start of the treatment (as against containment) approach was announced on 2 July 2009.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
Every year in late June and early July the Wimbledon tennis championships are held in London, attracting worldwide interest and with many hours of UK television coverage every day. On 1 July 2009 it was reported that 28 Wimbledon staff had been asked to stay at home with flu-like symptoms. Two named players are reported to have caught the virus.


2009 swine flu pandemic in the United Kingdom, Reported cases, Detailed reports
A study published in the August 2009 issue of The Lancet (available on 20 July) suggests that prolonging the school holidays could reduce the spread of the virus by up to 17%. This would be disruptive, and would not reduce the overall number of infections, but could delay the spread and buy time for preparation of a vaccine. The government's advice is that schools should not be closed, but that the evidence will be reviewed in August as school summer holidays end.


2009 swine flu pandemic in the United Kingdom, Public information
The Department of Health announced on 29 April 2009 that they intended to send an information leaflet on swine flu to every household in the UK. The information leaflets were distributed at the beginning of May. On 29 April, Alan Johnson announced that television and radio advice would also be broadcast starting on 30 April. The slogan "Catch it, Bin it, Kill it" was used to encourage good hand and respiratory hygiene. On 30 April 2009, a swine flu information line was launched with advice on setting up "flu friends" (this is not the National Flu Line service mentioned below).


2009 swine flu pandemic in the United Kingdom, Public information
The Department of Health Pandemic Plan (revised November 2007) states "UK health departments (directorate in Scotland) will run a national door drop and advertising campaign in Phase 5, alerting the public to the heightened risk, emphasising the need for personal preparation and socially responsible behaviour. A public information film will demonstrate how to slow the spread of the virus, and the National Flu Line service will be available. Information materials will also be available through primary care, pharmacies and on the Department of Health website." After criticism of the lateness of its launch, it was announced in late July that the National Flu Line service was to be launched on 24 July 2009.


2009 swine flu pandemic in the United Kingdom, Public information
There are government websites with general information and the latest updates on human swine flu in England, Northern Ireland, Scotland, and Wales.


2009 swine flu pandemic in the United Kingdom, Public information
The HPA website includes frequently updated advice for the public, advice on exclusion from schools and workplaces (and a document specifically for schools), and information for health professionals.


2009 swine flu pandemic in the United Kingdom, Public information
During the initial containment phase of the swine flue outbreak the HPA published detailed information in daily and weekly reports linked from its Epidemiological data page on its website. On 2 July, when the policy of containment was dropped in favour of treatment of presumed cases, the daily updates of laboratory confirmed cases were stopped. A weekly epidemiological update and pandemic flu update are published each Tuesday, with much detailed information including regional information and breakdown by age.


2009 swine flu pandemic in the United Kingdom, Control measures
On 11 May 2009 UK epidemiologists at Imperial College London considered that H1N1 swine flu was spreading fast enough to justify the preparations for a pandemic. It was showing "sustained human-to-human transmission", thereby justifying the WHO's pandemic phase 5 rating. It is estimated that on average each person who contracts flu passes it on to between 1.4 and 1.6 other people, no worse than the three influenza pandemics of the twentieth century. Early analysis suggested that the spread was likely to be similar to the earlier pandemics. Up to the date of the study, clinical severity was similar to 1957 and less than 1918 flu pandemic. However, the clinical severity of the outbreak and how the virus will evolve cannot yet be predicted.


2009 swine flu pandemic in the United Kingdom, Control measures, Travel to and from affected areas
On 27 April, the Foreign & Commonwealth Office advised against all but essential travel to Mexico and stated that British citizens in Mexico... "may wish to consider whether they should remain in Mexico at this time". On 28 April the Mexican Tourist Board estimated that there were "a few thousand" British tourists in Mexico.


2009 swine flu pandemic in the United Kingdom, Control measures, Travel to and from affected areas
Holiday companies Thomas Cook and Airtours said that between them they had about "3,000 holidaymakers in Mexico" as of 28 April 2009. The first British tourists being brought back early from Mexico on 28 April 2009 told reporters that they had received little or no information about health precautions, either from the Mexican authorities, hotels, or from local tour guides.


2009 swine flu pandemic in the United Kingdom, Control measures, Travel to and from affected areas
A leaflet was being distributed at all ports of entry into the UK providing passengers arriving in the UK with information on swine flu.


2009 swine flu pandemic in the United Kingdom, Control measures, Travel to and from affected areas
Until 21 May HPA staff met travellers arriving from Mexico. This was discontinued on 22 May, but advice remained that travellers from affected areas who become unwell within seven days of arrival, and contacts with symptoms of a confirmed or probable case, should stay at home and contact their GP or NHS Direct. Contact tracing of passengers deemed to be at risk of swine flu will be carried out on the basis of risk, as for other communicable diseases.


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
Information, advice, and guidance both general and for specific cases (schools, workplaces) is being made available and updated by the HPA (see Public information campaign section above).


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
As of 13 June 2009 the government estimated that the UK has enough anti-viral drugs for 50% of the population but has plans to raise that figure to 80%.


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
There is a pandemic plan covering topics from distributing the drugs and setting up helplines to closing schools and banning public events which was tested in a large exercise in 2007. There is also a specific response plan for London. Oseltamivir (Tamiflu) and zanamivir (Relenza), the two anti-virals known to be effective, must be taken within 48 hours of onset of symptoms or earlier to be effective; the positive effects are greatest if treatment is started within six hours.


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
The HPA reported in its 24 June 2009 weekly epidemiological report that all 17 samples of the virus laboratory tested for resistance that week were found to be sensitive to oseltamivir and zanamivir, but resistant to amantadine. The first case of resistance of the virus to oseltamivir, in Denmark, was reported on 29 June 2009.


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
On 5 May 2009 plans were announced for pupils unable to sit examinations at schools affected by flu to be assessed in other ways to ensure that children are not disadvantaged.


2009 swine flu pandemic in the United Kingdom, Control measures, Preparations
The Department of Health has listed all the pandemic flu guidance that it had published as of 8 June 2008.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Genetic analysis
Samples from suspected cases have been analysed by the National Institute for Medical Research in London, which is also examining samples of the U.S. strain of the disease.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Genetic analysis
By 8 May 2009 the US Centers for Disease Control and Prevention had made genetic information on the swine flu virus available, and the virus from European samples had been isolated and its full genetic fingerprint determined by UK researchers. The genetics and effects of the virus in general are discussed in the article on the 2009 swine flu pandemic.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
The fastest way for laboratory confirmation of swine flu is by the PCR method, described as a real-time method. According to the World Health Organization there are four laboratories in the UK able to perform PCR to diagnose influenza A (H1N1) virus infection in humans: Regional Virus Laboratory, Royal Victoria Hospital, Belfast, NI; Regional Virus Laboratory, Gartnavel General Hospital, Glasgow, Scotland; Health Protection Agency, Centre for Infections, Enteric, Respiratory, & Neurological Virus Laboratory, London; WHO Collaborating Centre for Reference and Research on Influenza, National Institute for Medical Research, London.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
Another laboratory confirmation is a fourfold increase in virus-specific antibodies 10 to 14 days later.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
From 2 July 2009 when a treatment, rather than containment, approach was adopted, the official clinical diagnostic criteria became: "fever (pyrexia ≥38 °C) or a history of fever, and also influenza-like illness (two or more of the following symptoms: cough; sore throat; rhinorrhoea; limb or joint pain; headache; vomiting or diarrhoea) or severe and/or life-threatening illness suggestive of an infectious process".


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
Professor Neil Ferguson, an epidemiologist at Imperial College London, who advises the Government and the World Health Organization, said on 8 June 2009 that HPA statistics were at best accounting for half of cases.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
In the USA mathematical modelling based on surveys estimated that there were about 1 million cases of H1N1 flu on 25 June 2009, compared to 28,000 reported officially. Such a study has not been carried out in the UK.


2009 swine flu pandemic in the United Kingdom, Control measures, Testing suspected cases, Diagnosis
As of 2 July 2009 GPs will diagnose based on clinical observation and routine swabbing will stop, and the HPA will "no longer be providing a daily update of the numbers of cases confirmed through laboratory tests"


2009 swine flu pandemic in the United Kingdom, Control measures, Hygiene recommendations
According to the Health Protection Agency's "Swine flu: frequently asked questions" web page, transmission of this new virus is thought to occur in the same way as seasonal flu:


2009 swine flu pandemic in the United Kingdom, Control measures, Hygiene recommendations
When the issue of touching your eyes, nose or mouth is combined with other infection control practices and good hygiene measures as recommended by the Health Protection Agency's website, the following recommendations emerge as important ways to help reduce the spread of swine flu and other viruses:


2009 swine flu pandemic in the United Kingdom, Control measures, Hygiene recommendations
For people belonging to a high-risk group it is particularly important that they start taking anti-virals as soon as possible after infection. High-risk groups include people with long-term conditions, those over 65, children under five and pregnant women.


2009 swine flu pandemic in the United Kingdom, Control measures, Immunity
A study at the U.S. Centers for Disease Control and Prevention published in May 2009 found that children had no pre-existing immunity to the new strain but that adults, particularly those over 60, had some degree of immunity. Children showed no cross-reactive antibody reaction to the new strain, adults aged 18 to 64 had 6–9%, and older adults 33%. The large proportion of cases in the UK affecting children and young adults is consistent with this pattern of resistance.


2009 swine flu pandemic in the United Kingdom, Control measures, Vaccine
The usual seasonal flu vaccines give little or no immunity against the new strain of flu. There is an international program to produce a vaccine which will be effective against the new H1N1 strain. The chief medical officer Sir Liam Donaldson said on 25 June that it seemed likely that the UK would receive the first batches of vaccines slightly earlier than expected, possibly from August rather than the autumn as first expected, although some industry sources do not expect supplies to be available so soon. The government has contracts for 132 million doses. There are risks involved in shifting resources to the new vaccine: it will not be possible to produce the seasonal flu vaccine, and it is possible that the virus will mutate to make a vaccine developed before the mutation ineffective.


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
The then Health Secretary Alan Johnson told MPs on 27 April that "Although we are aware that face-masks are being given out to the public in Mexico, the available scientific evidence does not support the general wearing of face-masks by those who are not ill, whilst going about their normal activities."


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
Professor Steve Field, chairman of the Royal College of General Practitioners, said people in the UK were "perfectly safe at the moment", and did not need to start wearing face-masks or stop eating pork.


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
The Head of Pandemic Planning at the Royal College of General Practitioners, Dr Maureen Baker, stated on 27 April that "Masks become ineffective when they become damp or after a few hours. There has been a lot of debate on the use of face-masks and some authorities say that, in the community, the most effective use is to give to patients who may have symptoms when they present in the surgery – that should help reduce the infectivity of that patient to surgery staff and other patients. I expect the Department of Health will issue guidance on use of face-masks if we move into a pandemic phase." Masks may not protect the wearer from inhalation of the virus, but might protect other people from picking up the virus from the wearer.


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
Professor John Oxford, a virologist at leading London hospital, The Barts and the London, said: "Really, there is very little evidence that masks actually offer much protection against flu."


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
It was reported that the UK government was urgently seeking to acquire more face-masks.


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
The advice given by authorities in several countries on the use of face masks has been summarised in an article, with many references, published on 4 June 2009.


2009 swine flu pandemic in the United Kingdom, Control measures, Possible use of face-masks
Aside from their obligations under health and safety legislation, employers can help to minimise the spread of the virus and support good infection control practice by positively encouraging any employee who reports feeling unwell with influenza-like symptoms to stay at home until their symptoms resolve, by sending people home who develop influenza-like illness at work (avoiding public transport and wearing a face mask if possible) and by ensuring that stocks of surgical face-masks are available in the workplace for symptomatic staff to wear until they get home.


2009 swine flu pandemic in the United States
The 2009 flu pandemic in the United States was caused by a novel strain of the Influenza A/H1N1 virus, commonly referred to as "swine flu", that was first detected on 15 April 2009. While the 2009 H1N1 virus strain was commonly referred to as "swine flu",  there is no evidence that it is endemic to pigs (i.e. actually a swine flu) or of transmission from pigs to people; instead, the virus spreads from person to person. On April 25, the World Health Organization declared a public health emergency, followed concurringly by the Obama administration on April 26.


2009 swine flu pandemic in the United States
The U.S. Centers for Disease Control and Prevention (CDC) reported that during the outbreak about half of all influenza viruses being reported were 2009 H1N1 viruses, with the other half being those of the regular seasonal influenza. Unique to this particular strain, about 60% of the 2009 H1N1 influenza cases were occurring among people between 5 years and 24 years of age, and 40% of the hospitalizations were occurring among children and young adults. About 80% of the deaths were in people younger than 65 years of age.


2009 swine flu pandemic in the United States
The CDC noted that this differed greatly from typical seasonal influenza epidemics, during which about 70% to 90% of deaths are estimated to occur in people 65 years and older. Antibody studies showed that children had no existing cross-reactive antibody to the 2009 H1N1 influenza virus, while about one-third of adults older than 60 years of age had cross-reactive antibody.


2009 swine flu pandemic in the United States
By April 21, 2009, CDC had begun working to develop a virus that could be used to make a vaccine to protect against the new virus. Following  preparation for distribution beginning in June, the first doses were administered in October 2009.


2009 swine flu pandemic in the United States
On August 10, 2010, WHO declared an end to the global 2009 H1N1 influenza pandemic. However, the virus continues to circulate as a seasonal flu virus, and cause illness, hospitalization, and deaths worldwide every year.


2009 swine flu pandemic in the United States
From April 12, 2009 to April 10, 2010, the CDC estimates there were 60.8 million cases (range: 43.3 - 89.3 million), 274,304 hospitalizations (range: 195,086 - 402,719), and 12,469 deaths (range: 8868 - 18,306) in the United States due to the virus.


2009 swine flu pandemic in the United States
A follow-up study done in September 2010 showed that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu. For comparison, the CDC estimates the global H1N1 death toll at 284,000 and the WHO estimates that 250,000 to 500,000 people die of seasonal flu annually.


2009 swine flu pandemic in the United States, History
The earliest reported cases in the US began appearing in early April 2009, in California. In late April, the Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center and declared a public health emergency. On April 25, the World Health Organization (WHO) declared a public health emergency of international concern. WHO declared H1N1 a pandemic on June 11.


2009 swine flu pandemic in the United States, History
By the end of May, the flu had infected people in all 50 states. As of June 16, the total number of confirmed cases was 27,717 and on June 25, the CDC said there were over one million (1,000,000) cases,  most of which had not been reported or diagnosed. Deaths relating to influenza began appearing in the US in late April, and by early June, 15 states had reported fatalities related to or directly occurring from the virus.


2009 swine flu pandemic in the United States, History
By October 5, the first doses of an H1N1 vaccine were given in the U.S. The CDC distributed vaccines for the flu using mechanisms already in place for its Vaccines for Children (VFC) program.


2009 swine flu pandemic in the United States, History
On October 24, and the CDC  said  more than 1,000 had died from the flu. President  Obama declared a national emergency. On December 10, 2009, the CDC reported an estimated 50 million Americans or 1 in 6 had been infected and 10,000  had died. On December 23, 2009 the CDC reported a reduction of the disease by 59% percent. On February 12, the CDC reported 57 million Americans had been sickened, 257,000 had been hospitalized and 11,690 people had died (including 1,180 children) due to flu from April through to mid-January.


2009 swine flu pandemic in the United States, Initial cases
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 a 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.


2009 swine flu pandemic in the United States, Initial cases
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.


2009 swine flu pandemic in the United States, Initial cases
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 on April 27 from the flu while visiting Texas.


2009 swine flu pandemic in the United States, Outbreak across the US
Cases of H1N1 spread rapidly across the United States, with particularly severe outbreaks in Texas, New York, Utah, and California. Early cases were associated with recent travel to Mexico; many were students who had traveled to Mexico for spring break. On May 4, 2009, the CDC reported one death, 286 confirmed cases of H1N1 flu across 36 states, 35 hospitalizations, and expected H1N1 to eventually spread to all states.


2009 swine flu pandemic in the United States, Outbreak across the US
A large number of cases, according to medics, have happened in the days that preceded the launch of the alert and came out only in these days due to a massive backlog. By May 5, 2009, the number had risen to 403 and a second death was reported in Texas. The CDC and government officials had expressed cautious optimism about the severity and spread of H1N1.


2009 swine flu pandemic in the United States, Outbreak across the US
Changes in surveillance of cases of influenza-like illness, including new guidelines for identifying cases to test, increased laboratory testing, and new test kits able to distinguish this novel strain, resulted in a spike in the percent of cases tested positive for influenza. Of the positive cases, about a third were due to the novel strain. Also found were a substantial number of cases where the strain could not be subtyped.


2009 swine flu pandemic in the United States, Outbreak across the US
The proportion of US deaths due to pneumonia and influenza climbed above the epidemic threshold in the 2007–2008 winter flu season but not in the 2008–2009 season. Although the 2009 H1N1 outbreak reached epidemic levels of infection early in 2009, it did not contribute to epidemic levels of pneumonia and influenza related deaths until October 2009.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
In early October 2009, the Centers for Disease Control and Prevention announced that swine flu was widespread across the country. It also said there was significant flu activity in virtually all states, which was considered to be quite unusual for this time of year. There was particular worry about pregnant women. As of late August, 100 had been hospitalized in intensive care units and 28 had died since the beginning of the outbreak in April. On October 1, it was acknowledged that a recruit in basic training in Fort Jackson, South Carolina, was the Army's first swine flu death. The recruit fell ill on September 1 and died of pneumonia on September 10.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
Dell Children's Medical Center in Austin, Texas, erected two tents in its parking lot to handle emergency room visits, and hospitals around Colorado Springs recorded a 30 percent spike in flu visits. As pediatric cases were increasing, the Dept. of Health and Human Services released 300,000 courses of children's liquid Tamiflu from the national pandemic stockpile in late September, with the first batches sent to Texas and Colorado.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
In late September, the disease centers reported that 936 had died of flu symptoms or of flu-associated pneumonia since August 30, when it began a new count of deaths, including some without laboratory-confirmed swine flu.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
The Agriculture Department reported on October 16 that three pigs at the Minnesota State Fair, in St. Paul, were tested positive in late August for H1N1 virus, which were the first cases in the country, although infected pigs had been found in eight other countries. There were 103 pigs tested at the Fair, including the three infected, though all appeared healthy. Scientists said the virus was already spreading widely among people, and, in fact, was more common in humans than in pigs, so humans were more likely to catch it from others than from pigs.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
In mid-October, it was reported that flu caused by the H1N1 virus was widespread in 41 states, and flu-like illnesses accounted for 6.1 percent of all doctor visits, which was considered high, particularly for October. Forty-three children had died from H1N1 since August 30, which is approximately the number that usually dies in an entire flu season. Nineteen of the forty-three were teenagers while sixteen were between ages five to eleven. The rest were under five. It is reported that the severity of the disease was not increasing. About fifteen to twenty percent of the patients hospitalized for the flu were placed in the intensive care unit, a level similar to that for seasonal flu.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
Projections of the supply of H1N1 vaccine had decreased significantly from a level of 120 million doses ready in October, estimated during the summer, to an estimate of 28 to 30 million doses by the end of the month. On October 14, 11.4 million doses of the H1N1 vaccine were said to be available.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
As of November 20, 2009, the CDC reported sharp declines in H1N1 activity throughout the United States, with influenza-like illness (which may also include meningitis, pneumonia, strep pharyngitis, gastroenteritis, and the common cold) accounting for 5.5% of doctors visits, down sharply from 8% in late October, the peak of the second wave. However, taking the vaccine is still urged by the CDC, as a third wave of the disease may sweep across the US, possibly in January/February 2010.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
As of December 24, the second wave of H1N1 has clearly peaked, with pneumonia and influenza deaths falling below the epidemic threshold for the first time in 11 weeks, and the proportion of doctors visits due to influenza-like illness falling to baseline (2.3%), down from 5.5% 1 month before, on November 20. However, it was reported that influenza activity was beginning to increase in West Virginia, with 5.2% of patients treated by West Virginia health care providers having influenza-like illness, a major increase from 2% of patients treated by West Virginia health care providers having influenza-like illness in November.


2009 swine flu pandemic in the United States, Outbreak across the US, The second wave
On August 10, 2010, WHO declared an end to the global 2009 H1N1 influenza pandemic. However, the virus continues to circulate as a seasonal flu virus, and cause illness, hospitalization, and deaths worldwide every year.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
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 was initially reported to have a relatively high mortality rate in Mexico. In April 2009 the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) expressed serious concerns that the new strain had the potential to become an influenza pandemic. On April 25 it was reported that, because the virus was already widespread, containment would be "nearly impossible."


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
By this time, there had also been speculation that the flu death toll in Mexico could be lower than first thought. Gerald 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:


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
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 influenza. That's really good news, and that would fit with what we've seen outside of Mexico.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
Another Canadian expert, Neil Rau, criticized the WHO's decision to raise its pandemic alert to level 5, saying:


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
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.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
CNN noted on April 28, 2009, that in any individual week between January 1 and April 18, there had been at least 800 deaths in the U.S. due to normal influenza, which is higher than the 150 total deaths worldwide from the swine flu up to that time.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity
As of May 28, 2010, the official U.S. death toll attributed directly to the novel H1N1 and seasonal influenza was 2,117. This total exceeds the 849 U.S. deaths directly attributed to seasonal influenza in 2006. Many of the other deaths commonly attributed to influenza are caused by complicated influenza, where a second infection causes death, usually pneumonia (of which 48,657 of 55,477 official deaths in 2006 occurred in people aged 65 years and older). The final estimate was of over 12,000 deaths over the course of the pandemic (April 2009 – April 2010).


2009 swine flu pandemic in the United States, H1N1 characteristics and severity, H1N1 unique characteristics
The CDC reported that during the outbreak about half of all influenza viruses being detected through laboratory reports were 2009 H1N1 viruses, with the other half being those of the regular seasonal influenza viruses. Surveillance reports indicated that about 57%  of the 2009 H1N1 influenza confirmed and probable cases were occurring among people between 5 years and 24 years of age, and 41% of the hospitalizations were occurring among older children and young adults.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity, H1N1 unique characteristics
The highest rates of hospitalization were among children younger than 5 years of age; the next highest hospitalization rate was in people 5 years to 24 years of age. Antibody studies showed that children had no existing cross-reactive antibody to the 2009 H1N1 influenza virus, while about one-third of adults older than 60 years of age had cross-reactive antibody. One possible explanation for this pre-existing antibody in older adults was that they may have had previous exposure, either through infection or vaccination, to an influenza A H1N1 virus that was more closely related to the 2009 H1N1 flu virus.


2009 swine flu pandemic in the United States, H1N1 characteristics and severity, H1N1 unique characteristics
Based on data from previous influenza pandemics and seasonal influenza, pregnant women had been recognized as a high-risk group early in the outbreak. People with other previously recognized medical conditions that placed them at high risk of complications from seasonal influenza also appeared to be at increased risk of complications from 2009 H1N1 influenza. One report found that  seventy-one percent of hospitalized patients had one or more underlying chronic medical conditions and reported deaths had occurred in people ranging in age from 22 months old to 57 years old. Also, only 13% of hospitalizations had occurred in people 50 years and older, and there were few cases and no deaths in people older than 65 years, which was unusual when compared with seasonal flu.


2009 swine flu pandemic in the United States, Response
The Federal response remained 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.


2009 swine flu pandemic in the United States, Response
The United States federal government declared a public health emergency, and several U.S. states then indicated that 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.


2009 swine flu pandemic in the United States, Response
After many days of deliberation the WHO declared that the current influenza had become a true pandemic, raising the Pandemic Alert level to Phase 6, the highest on the WHO scale and congruent with U.S. Federal Government Response Stages 3–6.


2009 swine flu pandemic in the United States, Response, Obama Administration reactions
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". Obama suggested that U.S. schools should consider shutting down, as a future possibility, if their students were to become infected.


2009 swine flu pandemic in the United States, Response, Obama Administration reactions
White House Press Secretary Robert Gibbs said the effort to get a team in place to respond to the health scare had 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 had 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, was also currently serving as the Acting Assistant Secretary for Health.


2009 swine flu pandemic in the United States, Response, Obama Administration reactions
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 Obama's trip to Mexico. However, the White House stated that the President was not at risk of contracting the flu. Kathleen Sebelius was confirmed as the Secretary of Health and Human Services by the Senate on April 28, 2009 with a vote of 65–31.


2009 swine flu pandemic in the United States, Response, Obama Administration reactions
On October 24, President Obama declared the 2009 H1N1 swine flu a national emergency. The declaration made it easier for U.S. medical facilities to handle a surge in flu patients by allowing the waiver of some requirements of Medicare, Medicaid and other federal health insurance programs as needed.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Activation of Emergency Operations Center
During the week of April 19, 2009, the CDC activated its Emergency Operations Center (EOC), with RADM Stephen Redd as the Incident Commander, to augment the ongoing investigation of human cases of swine influenza A (H1N1). More than 250 CDC professionals worked from the CDC EOC as part of the agency's response. As of May 4, 2009, the CDC reported that it had deployed 25% of the supplies and medicines in the Strategic National Stockpile to the various states.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Swine flu test kits
As of April 29, only the CDC could confirm U.S. swine flu cases. 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 starting the following day. On May 6, the CDC announced that testing kits were now available for all states. It was expected this would generate an increase in the number of confirmed cases as more states began doing their own tests.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Influenza reporting requirements
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.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Influenza reporting requirements
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.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Recommendations for schools
Initially the CDC had issued a recommendation that schools close for as long as two weeks if a student catches swine flu. Some school districts closed all schools if a single child was classified as probable. On May 5 the CDC retracted its advice stating that schools that were closed based on previous CDC guidance related to this outbreak may reopen. By that time at least 726 schools nationwide serving more than 480,000 students had closed for at least some period of time.


2009 swine flu pandemic in the United States, Response, Centers for Disease Control and Prevention (CDC), Recommendations for schools
The CDC amended its advice, citing new information on disease severity and the limiting effectiveness of school closure as a control measure. The new advice given stated, "Decisions about school closure should be at the discretion of local authorities based on local considerations, including public concern and the impact of school absenteeism and staffing shortages."


2009 swine flu pandemic in the United States, Response, Food and Drug Administration
The Food and Drug Administration (FDA) authorized emergency use of medicines and diagnostic tests for flu. (FDA is part of Department of Health and Human Services.) The FDA stated it was also responding to this threat by:


2009 swine flu pandemic in the United States, Response, Food and Drug Administration
On May 6, 2009, the FDA announced that it had approved a new manufacturing facility for seasonal flu vaccine, owned by Sanofi Pasteur, which could also be used for manufacturing a vaccine for the new H1N1 flu strain. The FDA also issued a warning for consumers to be wary of products claiming to cure or prevent swine flu.


2009 swine flu pandemic in the United States, Response, Other federal agencies, Department of Homeland Security
Secretary Napolitano stated that DHS was the principal federal office for incidents such as the H1N1 flu outbreak, and "Under that role, we have been leading a true collaborative effort." The Department of Homeland Security issued a document, dated November 1, 2005, entitled "National Strategy for Pandemic Influenza", detailing planning for potential pandemics.


2009 swine flu pandemic in the United States, Response, Other federal agencies, State Department
The State Department suggested travelers to Mexico stay alert and comply with guidance from Mexican public health officials, but did not impose any travel restrictions on US citizens to Mexico. However, the State Department did recommend US citizens avoid non-essential travel to Mexico.


2009 swine flu pandemic in the United States, Response, Other federal agencies, Department of Agriculture
The Department of Agriculture (USDA) reported no swine in the US have been infected so far, but the USDA is monitoring swine across the US for signs of infection.


2009 swine flu pandemic in the United States, Response, Other federal agencies, Department of Commerce
The Department of Commerce sent a letter to Russia and China requesting that those countries lift their ban on American pork products.


2009 swine flu pandemic in the United States, Response, Other federal agencies, Department of Defense
The Department of Defense (DOD) monitored the swine flu situation and had contingency plans to deal with such outbreaks. As of May 7, 2009, the DOD reported 104 confirmed cases among Armed Forces personnel and their families. DOD maintained a daily summary and map.


2009 swine flu pandemic in the United States, Response, Other federal agencies, Department of Education
The Department of Education provided guidance to schools in the US affected by swine flu, as well as precautions to take.


2009 swine flu pandemic in the United States, Response, State and local
Schools closed in many states in response to local flu outbreaks. 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. On May 4, 2009, about 533 schools in 24 states in the U.S. were closed, affecting about 330,000 students. On September 25, 2009, 42 schools were closed in eight states as the second wave of the pandemic began.


2009 swine flu pandemic in the United States, Response, State and local
On May 5, Kathleen Sebelius stated in a CDC news conference that school closures for single confirmed cases of H1N1 influenza were unnecessary, but that parents keep their child home if he or she displayed an influenza-like illness.


2009 swine flu pandemic in the United States, Response, Travel industry
Several US airlines waived fees for cancellations and flight changes. At least one cruise line changed itinerary to avoid Mexican ports of call.


2009 swine flu pandemic in the United States by state
The United States experienced the beginnings of a pandemic of a novel strain of the influenza A/H1N1 virus, commonly referred to as "swine flu", in the spring of 2009. The earliest reported cases in the US began appearing in late March 2009 in California, then spreading to infect people in Texas, New York, and other states by mid-April. Early cases were associated with recent travel to Mexico; many were students who had traveled to Mexico for Spring Break. This spread continued across the country's population and by the end of May there were approximately 0 confirmed cases throughout all 50 states.


2009 swine flu pandemic in the United States by state
On April 28, 2009, the director of the Centers for Disease Control and Prevention (CDC) confirmed the first official US death of swine flu, a 23-month-old toddler from Mexico who died on April 27 while visiting Texas. By June 24, 132 deaths had been attributed to the virus. As of January 11, 2010, at least 554,000 deaths were attributed to the virus worldwide, and at least 12,469 deaths in the US were confirmed to be due to the virus. The CDC suspects, however, that the total number of deaths in the US is much higher than the official total, as some deaths probably went unconfirmed.


2009 swine flu pandemic in the United States by state, Alabama
On May 2, 2009, the Alabama Department of Public Health confirmed the first case of H1N1 (swine flu) in Madison, Alabama, one of two probable cases previously identified at an elementary school in Madison. 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. After meeting with the state public health officer on May 3, 2009, all Madison city elementary schools were to be closed through May 13, 2009, but were reopened after the CDC updated its guidance to schools.


2009 swine flu pandemic in the United States by state, Alabama
As of December 5, 2009, the Alabama Department of Public Health reports 2453 confirmed and 36 deaths from swine flu. As of January 9, 2010, Alabama was the only US state reporting widespread A/H1N1 flu activity.


2009 swine flu pandemic in the United States by state, Alaska
On May 10, 2009, the Alaska state Division of Public Health reported the state's first probable case of swine flu in a crew member of a Royal Caribbean cruise ship traveling in Alaska waters. On May 12, they confirmed that the woman had been infected with swine flu but they do not consider it to be Alaska's first case because she became ill before entering state waters.


2009 swine flu pandemic in the United States by state, Alaska
As of December 5, 460 cases of swine flu and 11 deaths were confirmed in Alaska. On July 27, Alaska health officials confirmed the first H1N1-related death.


2009 swine flu pandemic in the United States by state, Arizona
As of October 31, the Arizona Department of Health Services had reported a total of 6,302 confirmed cases of H1N1 infection since April 2009, with at least one case reported in each of the state's 15 counties. 786 of the cases had resulted in hospitalization of the patient, and 81 deaths were associated with H1N1 infection in that period of time. Of the H1N1 associated deaths reported in the state, 72% suffered an underlying medical condition (asthma, lung or heart conditions, cancer, metabolic disorders, pregnancy, immunosuppressive disorders, neurologic diseases or other chronic diseases) at the time of death.


2009 swine flu pandemic in the United States by state, Arizona
On April 28, the first cases of H1N1 influenza infection in Arizona were confirmed in four school-aged patients in the Phoenix metropolitan area. The schools attended by the patients were immediately closed following recommendations from the CDC; after only 3 days, however, local authorities reopened the schools, stating that the H1N1 flu appeared to be no more deadly than the seasonal flu. School closures in the area have since been eliminated in favor of simply sending the infected children home, resulting in slightly elevated absence rates statewide. The first death in the state due to H1N1 swine flu complications was reported by the Maricopa County Department of Public Health on May 14. As of January 15, Arizona has reported 142 deaths due to confirmed A/H1N1 influenza, including at least 2 in 2010 alone.


2009 swine flu pandemic in the United States by state, Arkansas
As of July 16, 2009, the Arkansas Department of Health has reported 51 confirmed cases of swine flu. Four of the cases were from Camp Robinson, a US Army National Guard base located in North Little Rock in Pulaski County.


2009 swine flu pandemic in the United States by state, California
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 the residents are not US 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.


2009 swine flu pandemic in the United States by state, California
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.


2009 swine flu pandemic in the United States by state, California
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.


2009 swine flu pandemic in the United States by state, California
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 influenza virus 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.


2009 swine flu pandemic in the United States by state, 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.


2009 swine flu pandemic in the United States by state, California
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 San Jose was closed that day for a week after one teenage girl was confirmed to be a probable case. Rucker Elementary School in Gilroy is set to be closed on Friday, May 1 after at least one student was being tested after exhibiting flu-like symptoms. Three students at the Grizzly Youth Academy in San Luis Obispo are confirmed cases of swine influenza.


2009 swine flu pandemic in the United States by state, California
As many as 73 students are exhibiting flu-like symptoms at The Academy and are assumed to have the virus. All are being isolated. The Academy is set to stay open. On May 3, 2009, parent of students attending King Middle School in Berkeley were notified that their school would be closed down due to a swine flu outbreak involving students at the school. Days later, other schools were closed down because of students or staff exhibiting flu-like symptoms; for example, Sunnyside Elementary School and Woodville Elementary School, both in Tulare County.


2009 swine flu pandemic in the United States by state, California
On June 1, 2009, the first two deaths were confirmed, one by a middle-aged man in San Bernardino County, and another one by a middle-aged woman in Los Angeles County. A third death was confirmed on June 4, when a nine-year-old girl from Contra Costa County died. They were followed by an Orange County man's death on June 8 and a middle-aged man's death in Alameda County on June 9. As of June 9, there were 973 confirmed cases, 266 probable cases, and five deaths caused by the H1N1 flu. On June 10, another middle-aged man died in Alameda County, thus making it the third death in the San Francisco Bay Area.


2009 swine flu pandemic in the United States by state, California
On July 1, a woman who had been hospitalized in Marin County died of swine flu.


2009 swine flu pandemic in the United States by state, California
As of July 23, 2009, 2,655 cases and 61 deaths in California had been confirmed.


2009 swine flu pandemic in the United States by state, California
A list of hospitalizations and deaths can be viewed at the California Department of Health Website.


2009 swine flu pandemic in the United States by state, California
As of mid-September 2009, California had 2,655 cases and 152 deaths. As of January 15, at least 479 California residents had died from confirmed H1N1 infection.


2009 swine flu pandemic in the United States by state, 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. Two more H1N1 influenza cases were confirmed on May 2, both in Jefferson County, Colorado. One case is a middle school student, which has caused the school he attends to close for a week. The tally increased to seven on May 4 when The University of Colorado at Boulder (CU) confirmed three of its students contracted the virus.


2009 swine flu pandemic in the United States by state, Colorado
There were 171 cases reported in Colorado as of July 18. On July 29, 2009 Colorado reported its first A(H1N1) swine flu death in El Paso County of a woman in her forties.


2009 swine flu pandemic in the United States by state, 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.


2009 swine flu pandemic in the United States by state, Connecticut
On May 2, the second confirmed case was reported in a child from Middlefield that had recently returned from a family trip to Mexico. On May 5, Fairfield University announced that two "probable" cases had tested positive for the H1N1 flu, with five other "probable" cases awaiting test results. One May 8, Fairfield announced that those five students had also tested positive, although the students by that time were nearly recovered, and there remained one "probable" case remained to be confirmed.


2009 swine flu pandemic in the United States by state, Connecticut
On Wednesday, June 3, The first death confirmed to be linked to the H1N1 virus happened in New Haven County. As of Wednesday, June 17 there are 7 confirmed cases of the H1N1 virus at Joseph A. Foran High School of Milford. The school is following a half day schedule until the end of the year, which was reported as being successful for preventing the virus.


2009 swine flu pandemic in the United States by state, Connecticut
By July 22, 2009, there were 1,713 confirmed cases of swine flu in Connecticut. New Haven has the most of any town with 175 cases. In January 2010, the Connecticut CDC stated that there were 1,996 confirmed cases of A/H1N1 influenza in the first wave of the A/H1N1 influenza pandemic, and 3,386 confirmed cases of A/H1N1 influenza in the second wave of the A/H1N1 pandemic. 31 deaths from A/H1N1 were confirmed over the course of the pandemic.


2009 swine flu pandemic in the United States by state, 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.


2009 swine flu pandemic in the United States by state, Delaware
As of July 24, the CDC had reported 381 cases for Delaware.


2009 swine flu pandemic in the United States by state, Delaware
October 22, a Kent County woman was Delaware's first H1N1-related death. As of January 2010, six deaths in Delaware had been confirmed to be due to H1N1 influenza.


2009 swine flu pandemic in the United States by state, District of Columbia
As of June 19, 2009, the DC Department of Health reported 43 confirmed and 2 probable cases of swine flu. The department website has since not updated its case counts.


2009 swine flu pandemic in the United States by state, 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. Governor Crist announced the first two confirmed cases in Florida on May 1. The cases are both children and in Lee and Broward counties.


2009 swine flu pandemic in the United States by state, Florida
On May 3, the Hillsborough County Health Department announced 5 possible cases of H1N1, 4 of the persons are students, and the other is a relative who has recently traveled to Mexico. Three public schools (Wilson Middle School, Freedom High School, and Liberty Middle School) where the students attended have been closed till May 11.


2009 swine flu pandemic in the United States by state, Florida
On May 7, Alachua County announced its first case of H1N1 (Swine Flu). The person is a University of Florida student and has since recovered. On May 8, a 7-year-old boy tested positive of swine influenza in Rockledge, Brevard County, Florida . Two other children tested positive for influenza. It caused Golfview Elementary School in Rockledge to close on May 11.


2009 swine flu pandemic in the United States by state, Florida
On June 9, a 9-year-old boy died of Swine Flu in Miami Dade On July 10, a woman died of H1n1 in Palm Beach County.


2009 swine flu pandemic in the United States by state, Florida
As of July 30, Florida has reported 3,221 cases of swine flu and there is at least one in each of Florida's 67 counties.


2009 swine flu pandemic in the United States by state, 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. In relation to this case, state officials said they had no plans to close schools or other public institutions.


2009 swine flu pandemic in the United States by state, Georgia
On May 4, the Georgia Department of Human Resources announced that all classes have been temporarily suspended at Eagle's Landing Christian Academy in Henry County until the CDC confirms the status of a student who became ill. The Georgia Public Health Laboratory sent three probable cases to the CDC over the weekend for confirmation. On May 5, the Georgia Division of Public Health confirmed three cases of H1N1 located in Cobb, DeKalb and Henry Counties. Swine flu has been confirmed on the Georgia Tech and Agnes Scott College campuses.


2009 swine flu pandemic in the United States by state, Georgia
The CDC has reported 222 cases of swine flu for Georgia as of July 24.


2009 swine flu pandemic in the United States by state, Hawaii
On May 4, 2009, the Hawaii Department of Health announced that there were three suspected cases of swine flu in the state. Governor Linda Lingle announced that the cases were mild and that the patients were recovering at home. On May 5, 2009, all three cases were confirmed on the island of Oahu by the CDC. All three cases involve recent travel to the mainland United States. One case is a school-age child, who recently traveled to California. The two other cases are a military member, and his or her spouse. The military member traveled to Texas, and has exposed their spouse.


2009 swine flu pandemic in the United States by state, Hawaii
Two more cases were confirmed on May 6. Another four were confirmed on May 13, with two identified at Anuenue School, a Hawaiian language immersion school. In response to the outbreak, the University of Hawaii at Manoa announced that it will not be shaking graduates' hands at its commencement.


2009 swine flu pandemic in the United States by state, Hawaii
On June 19, 2009, Hawaii confirmed its first swine flu-related death, a 60-year-old woman who had complications from the swine flu who later died at Tripler Army Medical Center.


2009 swine flu pandemic in the United States by state, Hawaii
As of July 24, the CDC has reported 1,424 cases for Hawaii. As of January 20, 2010, Hawaii has reported 13 confirmed deaths due to A/H1N1 influenza.


2009 swine flu pandemic in the United States by state, Idaho
On May 3, 2009, the CDC confirmed the state's first H1N1 infection, that of a Kootenai County woman in her 60s.


2009 swine flu pandemic in the United States by state, Idaho
On September 29, 2009, The Idaho Department of Health and Welfare confirmed that a Canyon County man in his 50s, with an already existing medical condition, died from the H1N1 virus, by which time 488 cases had been confirmed.


2009 swine flu pandemic in the United States by state, Idaho
By late October the H1N1 vaccine was available for high-risk groups for whom H&W set up clinics and distribution centers in, among other places, defunct big box stores.


2009 swine flu pandemic in the United States by state, Idaho
By December 10, 2009, there had been 812 laboratory-confirmed cases, 381 influenza-related hospitalizations  (most of them of children under ten), and 18 deaths. Furthermore, the vaccine became readily available to the general public under 65.


2009 swine flu pandemic in the United States by state, Idaho
By December 30, 2009 the state had 824 laboratory-confirmed cases since September 1, and the virus had contributed to the deaths of 20 people.


2009 swine flu pandemic in the United States by state, Idaho
By January 23, 2010 despite at least 23 Idaho deaths and 385 hospitalizations and the widespread availabilityof the H1N1 vaccine, only 10% to 15% of the populace of Ada County had been inoculated, prompting concern amongst public health officials.


2009 swine flu pandemic in the United States by state, 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 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.


2009 swine flu pandemic in the United States by state, Illinois
Many other flu cases happened during or even before the launch of the alert were then confirmed, principally in the urban area of Chicago. By May 20, the following 17 counties had confirmed cases: Boone, Cook, DeKalb, DuPage, Franklin, Kane, Kankakee, Kendall, Knox, Lake, McDonough, McHenry, Ogle, Sangamon, Will, Williamson, and Winnebago. Total confirmed cases in Illinois were 794, up from 707 the previous day.


2009 swine flu pandemic in the United States by state, Illinois
Cases in Illinois throughout May 2009 continued to climb and by May 31, 2009 the published CDC numbers had reached 1002 confirmed cases with 2 deaths. A third confirmed death – the first outside of the Chicago metropolitan area – was reported by state health authorities on May 28, 2009 but this was not reflected in the CDC official numbers by the end of the month.


2009 swine flu pandemic in the United States by state, Illinois
A total of 3,366 cases and 17 deaths have been confirmed in Illinois as of July 24. As of January 2010, a total of 2931 hospitalizations due to confirmed A/H1N1 infection and a total of 97 confirmed deaths due to H1N1 have been reported in Illinois.


2009 swine flu pandemic in the United States by state, 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 which occurred in two Indianapolis elementary schools were confirmed by the CDC shortly thereafter. Additional cases later surfaced in the counties of Hendricks, Lake, Marion, Putnam, St. Joseph, and Tippecanoe. On July 10, 2009, a young teenager died of Swine Flu, this was the first death in Indiana because of this disease.


2009 swine flu pandemic in the United States by state, Indiana
As of July 24, the CDC has reported 291 cases of swine flu. As of February 2010, there have been at least 38 confirmed deaths due to A/H1N1 infection. Also, since September 1, there have been at least 468 confirmed cases of H1N1 in Indiana.


2009 swine flu pandemic in the United States by state, Iowa
On April 29, two probable case of swine flu were reported in Des Moines County and Clinton County. One was a woman from California, the other one was a man from Mexico. On May 3, another case was found in Marshall County causing schools to close. On the week of February 28, 2009, a three-year-old caught the swine flu due to close contact with ill pigs, but not the same dangerous strain that came from Mexico. In early May, cases climbed up to 43. A few were in Polk County, where Des Moines is.


2009 swine flu pandemic in the United States by state, Iowa
As of July 24, 165 cases have been reported by the CDC.


2009 swine flu pandemic in the United States by state, Iowa
In Iowa City's Iowa City High School, there were over 400 students absent on Oct. 7 with suspected H1N1. The recent homecoming dance is credited with causing this. The school's 9-day absence limit is also believed to have influenced this, restricting sick students from going home if they have already been absent 9 days. The school has refused to close despite protests from parents, teachers and students alike. On October 9, 32% of all students were absent out of over 1,600.


2009 swine flu pandemic in the United States by state, Iowa
The school has continued to stay open despite advisement by the Johnson County Health Department even as more and more of the student population falls ill. There are serious concerns of students passing along the virus to the community, creating a large local outbreak. As of October 15 the school is still open.


2009 swine flu pandemic in the United States by state, 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.


2009 swine flu pandemic in the United States by state, Kansas
As of July 24, 2009 there were 213 confirmed cases of swine flu in Kansas, 101 in adults and 112 in children. However, in Wyandotte and Johnson counties the state had instructed that only hospitalized patients needed to be tested so the numbers were quite possibly higher. By June 30, 2009 there were 129 confirmed swine flu cases in Kansas.


2009 swine flu pandemic in the United States by state, Kansas
As of January 9,26 people have died of infection with H1N1, including a healthy 52-year-old man with no underlying health problems that would place him at higher risk for A/H1N1 infection.also, a 6-year-old Kansas boy and 27-year-old Kansas woman, have also died from infection with H1N1, reinforcing the fact that young, healthy people can die from infection with A/H1N1, and that vaccination is recommended even for those without preexisting medical problems.


2009 swine flu pandemic in the United States by state, 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.


2009 swine flu pandemic in the United States by state, Kentucky
In Jefferson County, Meyzeek Middle school has three cases of H1N1 influenza. This initially started from a staff member, but spread to students.


2009 swine flu pandemic in the United States by state, Louisiana
As of July 21, there are a total of 232 swine flu cases confirmed by The Louisiana Department of Health and Hospitals. Up from 114 reported on May 28. As of January 2010, 1,973 confirmed cases of H1N1 have been reported, and 43 H1N1 deaths have been confirmed, in Louisiana.


2009 swine flu pandemic in the United States by state, 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, former director of Maine CDC, said on April 28 that at least 12 suspected cases were being tested.