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Re: Lets talk about the Swine flu...
Here's the email from my work yesterday. I sure hope I don' have to wear a surgical mask on the train this week, it's too hot out for that...
Quote:
Dear Colleagues,
On April 23, a high school in Queens was noted to have an outbreak of mild febrile respiratory illness that was confirmed last night to be caused by influenza A. Specimens were sent to the NYC Public Health Laboratory and were untypeable for human H1 or H3 strains, meeting the CDC case definition for probable swine influenza. These specimens are being forwarded to CDC today for further testing to determine if these infections are due to swine influenza. Results should be available tomorrow. The high school has approximately 2,700 students, and as of yesterday, 200 children were reported to be ill, mostly with mild influenza-like symptoms (fever, cough, and/or sore throat). None of the cases were severe or required hospitalization.
In the United States, there are currently 6 California residents and 2 Texas residents who have been diagnosed with swine influenza A (H1N1) virus infection; all of these patients had mild illness (only one hospitalization) and all have recovered. Isolates from California and Texas have been found to be susceptible to the neuraminidase inhibitors (oseltamivir and zanamavir) but resistant to the adamantanes (amantadine and rimantadine). In addition, there has been an outbreak of respiratory illness in Mexico, which has been confirmed as at least partly due to swine influenza; clinical and epidemiologic details of this outbreak are still pending, but preliminary reports are of thousands of cases and approximately 70 deaths.
Surveillance for Swine Influenza in Hospitalized Cases Citywide:
The NYC Health Department is now prioritizing its surveillance efforts for swine influenza on identifying potential cases of febrile, respiratory illness in hospitalized patients, in order to rapidly identify and confirm potential cases with more severe illness. Therefore, DOHMH requests that providers seeing patients with acute febrile respiratory illness only test those patients who are either currently hospi talized or are being admitted to the hospital with unexplained febrile respiratory illness. These patients should be tested for influenza using either a commercial rapid test, or direct or indirect immunofluorescence. Patients who test positive for influenza A should be reported to DOHMH and have specimens referred to DOHMH for further testing to determine whether the influenza A can be subtyped. See contact information below. DOHMH will arrange for transportation of clinical specimens to the Public Health Laboratory. See attached instructions for collecting and submitting laboratory diagnostic specimens for swine influenza testing. Nasopharyngeal swabs are the preferred specimens for influenza testing in the current swine influenza context.
Management of Persons with Milder Influenza-like Illness
At this time, providers assessing patients with mild febrile respiratory illness in clinical settings, including emergency departments, should not test for influenza and should not administer antiviral medications for presumptive therapy, unless patients meet the usual criteria for empiric influenza treatment based on underlying illnesses (listed below) that put them at higher risk for complications of any type of influenza. These patients may be sent home with instructions to stay at home until 24-48 hours after their symptoms resolve and instructed on the importance of hand and respiratory hygiene. Instructions should be given to seek medical care with worsening of symptoms.
Infection Control
For current recommendations on infection control in medical care facilities, see http://www.cdc.gov/swineflu/guidelin...on_control.htm.
Antiviral Treatment and Prophylaxis Guidelines
Swine influenza viruses identified in this outbreak to date have been susceptible to both oseltamivir and zanamivir. Antiviral therapy with one of these agents should be initiated empirically for patients currently hospitalized with sever e unexplained febrile respiratory illness, pending testing for swine influenza. See http://www.cdc.gov/swineflu/recommendations.htm for specific guidelines. This document also includes detailed guidance on antiviral prophylaxis.
The Health Department requests that providers also immediately report any clusters of influenza-like illness in medical facilities, congregate settings such as long-term care facilities, or schools.
To contact the Health Department, including to report suspected cases of swine influenza in hospitalized patients and arrange for specimen testing, please call the Provider Access Line at 1- 917-438-9766. This number is also available for questions or consultations by providers.
As always, we appreciate the cooperation of the medical community in New York City and will update you with further information when it becomes available.
Sincerely,
Scott A. Harper, MD, MPH, MSc
Medical Epidemiologist
Zoonotic, I nfluenza, & Vectorborne Diseases Unit
Bureau of Communicable Disease
Annie Fine, MD
Medical Director
Zoonotic, Influenza, & Vectorborne Diseases Unit
Bureau of Communicable Disease
Definitions of Respiratory Illness
1. Acute respiratory illness
Recent onset of at least two of the following:
1. rhinorrhea or nasal congestion
2. sore throat
3. cough
4. fever or feverishness
2. Influenza-like illness: fever >37.8°C (100°F) plus cough or sore throat
Case Definitions for Infection with Swine Influenza A (H1N1) Virus
1. A Confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:
1. real-time RT-PCR
2. viral culture
3. four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies
2. A Pr obable case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with an influenza test that is positive for influenza A, but H1 and H3 negative.
3. A Suspected case of swine influenza A (H1N1) virus infection is defined as:
1. A person with an acute respiratory illness who was a close contact to a confirmed case of swine influenza A (H1N1) virus infection while the case was ill OR
2. A person with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swine influenza A (H1N1) virus infection OR
3. A person with an acute respiratory illness who has traveled to an area where there are confirmed cases of swine influenza A (H1N1)
Conditions which increase the risk of severe influenza infection
• chronic pulmonary, cardiovascular, renal, hepatic, hematological, or metabolic disorders,
• immunosuppression,
• compromised respiratory function , including conditions which increase the risk for aspiration,
• long-term aspirin therapy
• pregnancy
• age > 65 years
• age < 2 years
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