8 Additional confirmed cases of swine influenza A (H1N1) continue to be identified in California, Kansas, Ohio, New York City and Texas.  Arizona has yet to identify a case of swine influenza but continues to see seasonal influenza A cases.  The following is an interim update and guidance for clinicians. 
 
Clinical Presentation of Initial 20 U.S. Swine Flu Cases
·        Symptoms alone cannot distinguish swine flu from seasonal flu.  The 20 US patients have all recovered and their illness was not more severe than seasonal influenza.
 
Laboratory Testing for Swine Flu
·        Clinicians should consider swine influenza infection in the differential diagnosis of patients with fever [>100°F (37.8°C)] and cough and/or sore throat in the absence of a known cause. Patients who meet these criteria should be tested for influenza. 
·        At this time, do NOT conduct rapid testing or other diagnostic testing for influenza unless it can be performed under Biosafety level 2 (BSL2) precautions using a BSL 2 cabinet. 
o       If a patient meeting these criteria tests positive for influenza A, contact your local public health department to facilitate submitting specimens to the Arizona State Public Health Laboratory (ASPHL)
·        When BSL 2 measures cannot be met for influenza testing, clinicians should collect a nasopharyngeal swab for influenza (following the infection control guidelines below). Place the swab in a viral transport medium, refrigerate the specimen, and then contact their local health department to facilitate transport and testing at the ASPHL.  Please indicate travel history of the seven days prior to onset.
 
Infection Control for Health Care Workers (HCWs)
·        HCWs should always use droplet and standard precautions (surgical mask and eye protection) for influenza-like illnesses with good hand washing before & after patient contact.
·        HCWs caring for patients with laboratory-confirmed swine influenza or ill contacts of lab-confirmed cases should use N95 masks, eye protection (face shield or goggles), disposable gloves and gown, and place the patient in an airborne infection isolation room (AIIR)
·        Swine flu patients and ill contacts of known swine flu patients should be placed in an AIIR (where possible) or a private room and should wear a surgical mask or
 
Treatment & Prophylaxis
·        The U.S. swine flu isolates are sensitive to oseltamivir and zanamivir and resistant to amantadine and rimantadine, so use current influenza antiviral treatment recommendations for empiric therapy of patients with influenza-like illnesses
o       Use of zanamivir for treatment and chemoprophylaxis, or
o       Use dual therapy with both oseltamivir and rimantadine (or amantadine)
 
Resources - continue to check for updates at...
·        CDC Swine Influenza Site:  http://www.cdc.gov/swineflu
·        ADHS Swine Influenza Site: http://www.azdhs.gov/phs/oids/epi/flu/swine/index.htm
 
  
This is an official CDC Health Advisory Distributed via Health Alert Network 
April 26, 2009,11:00 EST (11:00AM EDT)
CDCHAN-000282-2009-04-26-ALT-N
Risk of Swine Flu Associated with Travel to Affected Areas
Public health officials within the United States and throughout the world are investigating outbreaks of swine influenza (swine flu).  
Swine flu is a respiratory disease of pigs caused by a type A influenza virus that regularly causes outbreaks of influenza among pigs.  Swine flu viruses do not normally infect humans; however, human infections with swine flu do occur.  Public health officials have determined that this strain of swine flu virus spreads from human to human and can cause illness.
The outbreak is ongoing and additional cases are expected.  For more information concerning swine flu infection, please see the Centers for Disease Control and Prevention (CDC) website: http://www.cdc.gov/swineflu/. For specific information on travel precautions and an update on the affected areas, please visit: www.cdc.gov/travel.

The symptoms of swine flu in people are similar to the symptoms of seasonal flu in humans and may include:

Fever (greater than 100°F or 37.8°C)

Sore throat

Cough

Stuffy nose

Chills

Headache and body aches

Fatigue

 

Avoid contact with ill persons.

When you cough or sneeze,cover your nose and mouth with a tissue or your sleeve (if you do not have a tissue).  Throw used tissues in a trash can.

After you cough or sneeze, wash your handswith soap and water,or use analcohol-basedhand gel.

If you think you are ill with flu, avoid close contact with others as much as possible.Stay at home or in your hotel room.  Seek medical care if you are severely ill (such as having trouble breathing).  There are antiviral medications for prevention and treatment of swine flu that a doctor can prescribe.  Do not go to work, school, or travel while ill.

*First and most importantly, remind parents and enforce policies for having ill children stay at home during their illness.
*In addition, remind and inform workers not to come to work while ill.
*A child may be infectious for up to 10 days after illness onset with influenza while adults are generally infectious for 5-7 days.
*Review their plans for responding to a pandemic and make sure they are up to date.
*Know local/state plans for child care in the event of a mild or severe pandemic.This information may be available from state or local health authorities, child care licensing agencies or resource and referral agencies.
*Develop and implement a system to track illness and absence due to illness among children and staff if one is not already in place. The system should be simple and easy to maintain but should record the number of persons with various illnesses (e.g. respiratory, diarrhea, rash) by day or at least by week. (see Caring for Our Children Standards 3.001 and 3.002 for information on how to do this http://nrckids.org/CFOC/PDFVersion/Chapter%203.pdf )
*Review and implement CDC Guidelines and Recommendations for Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff,
(http://www.cdc.gov/flu/professionals/infectioncontrol/childcaresettings.htm)
*Make sure staff are familiar with the above guidelines and that they are being followed in your program. Remind child care staff to clean/disinfect frequently touched surfaces within the facility.
*Provide information to parents on steps that they could take to prevent flu. (See attached fact sheet that could be distributed to each parent or posted on a door to the facilities with providers calling attention to the posted fact sheet).
*Monitor the postings on the CDC web site about this virus to see if child care facilities should begin preparing for possible closure or changes in operation (www.cdc.gov/swineflu).

*Contact your local public health department if you have questions or suspected cases.
Review your facilities emergency preparedness plans and consult with state and/or local health department's pandemic plans, particularly if the number of cases escalate dramatically.
Child care and preschool programs can help protect the health of their staff and the children and families they serve by calling attention to the every day preventive actions that parents can initiate to protect their children. (Please consider posting or distributing the attached message in your child care facility).
 
More information on preventing the spread of influenza can be found at:
http://www.pandemicflu.gov/plan/school/preschool.html. For generic information on disaster preparedness, see NACCRRA's web site
http://www.naccrra.org/for_parents/coping/disaster.php
 
Additional generic planning information for schools, including examples of state and local plans, can be found on the Department of Education's website at: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/index.html.
 
  
Preventing the Flu: Good Health Habits Can Help Stop
Germs
Fact Sheet
Avoid close contact.
Avoid close contact with people who are sick. When you are
sick, keep your distance from others to protect them from
getting sick too.
Stay home when you are sick.
Stay home from work, school, and errands when you are sick.
Keep sick children at home. You will help prevent others
from catching the illness.
Cover your mouth and nose.
Cover your mouth and nose with a tissue when coughing or
sneezing. Cover your nose and mouth with a tissue when you cough or
sneeze. Throw the tissue in the trash after you use it.
Wash your hands often.
Washing your hands and the hands of your children often will
help protect you from germs.
Avoid touching your eyes, nose or mouth.
Germs are often spread when a person touches something
that is contaminated with germs and then touches his or her
eyes, nose, or mouth.
Practice other good health habits.
Get plenty of sleep, be physically active, manage your stress,
drink plenty of fluids, and eat nutritious food.
There is no vaccine available at this time for the current outbreak of the Swine Flu virus, so it is important for people living in the affected areas to take steps to prevent spreading the virus to others. If people are ill, they should stay at home and limit contact with others, except to seek medical care. Healthy residents living in these areas should take the everyday preventive actions listed above.
People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed.
 
STAT is published on an as needed basis in between editions of ArMA's "Medicine This Week." It includes news we feel can't wait. The newsletter is produced at the association's headquarters in Phoenix. Chic Older, executive vice president; Sharla Dudley, Director of Communications. Copyright © 1999-2008 ArMA. All Rights Reserved.