Dr.Firman Abdullah,Sp.OG / OBGYN .BLOG: H1N1 Flu (Swine Flu) Information for Health Care Professionals

H1N1 Flu (Swine Flu) Information
for Health Care Professionals

Search:

(Updated on 08/07/09)

For current, frequently updated information, visit the CDC H1N1 flu (swine flu) Web site and the What's New section of this Web page.

Important Message

On June 11, 2009 the World Health Organization raised the world pandemic alert level to Phase 6, indicating that a global pandemic of novel influenza A H1N1 (swine influenza) virus is underway. The decision was based on the continuing rapid spread of novel A H1N1 which is now in more than 70 countries and is causing community level outbreaks in multiple parts of the world, the outbreak in the United States is waning although there are still some communities with significant increasing activity. Most of the influenza like illness being seen now in the US is being caused by novel influenza A H1N1. There is significant novel influenza A H1N1 activity in the Southern Hemisphere which indicates that the virus may become the predominant strain during the US 2009-2010 influenza season. Virus isolates are being evaluated as possible vaccine candidates and the Federal Government is working closely with vaccine manufacturers to attempt to create a vaccine.

New information and analyses will continue to become available which will result in updates and changes in guidance and recommendations by the Centers for Disease Control and Prevention (CDC), other federal agencies, and local and state public health officials.

To keep its members up-to-date, the American Academy of Pediatrics (AAP) will continue to share the latest details about H1N1 influenza (swine influenza) through:

Our Web site, including this page and a separate page with information for parents/caregivers

Regular email blasts to members

Keeping Up-to-Date

This rapidly evolving situation requires health care providers to monitor the updated information and recommendations from theCDC, other federal agencies, and their state and local health departments.

The AAP is closely monitoring communications from the CDC and WHO. As this outbreak progresses we anticipate having additional information available about the scope of illnesses associated with this novel swine influenza strain.

The AAP will continue to assist pediatric healthcare practitioners with operational issues associated with this swine influenza outbreak. AAP will keep members well informed with the latest information and recommendations for the control of this influenza outbreak. The AAP has assembled key resources to help pediatricians in their practice to:

Know case definitions
Assess influenza-like illness
Do select diagnostic testing, when appropriate
Maintain infection control
Manage swine flu cases, including when to use antiviral therapy
Give advice to parents, caregivers, schools, and child care programs
Be aware of travel guidance

Recommendations may continue to change as new information becomes available from the CDC and other federal and international agencies. Providers should frequently visit the CDC novel influenza H1N1 web site to supplement information received from your local and state public health authorities.

Brief Overview

This new virus strain of influenza A (H1N1) not previously found in pigs or humans was first detected in April 2009. It is a hybrid, with genetic elements of swine influenza (both American and Eurasian components), avian influenza, and human influenza.

A Public Health Emergency has been declared in the United States due to the outbreak of H1N1 influenza infections and the US pandemic response plan was activated. In addition, the intensifying multi-country outbreak of the same swine influenza virus, led the World Health Organization (WHO) to raise the worldwide pandemic alert level to Phase 6 on June 11, 2009, indicating that a pandemic is underway. Recent evidence of virus spread in areas of Australia, which is just beginning its influenza season, suggests that the virus may circulate extensively this winter in the Southern Hemisphere. So far, the outbreak in the United States appears to have a severity similar to seasonal flu, but is likely to be more widespread given the fact that there currently is no vaccine against this virus. The attack rate among contacts so far has been high. Most people with infection due to novel influenza A H1N1 have recovered, but as of June 12th, 44 deaths have been reported, including 5 children. The Centers for Disease Control and Prevention (CDC) recognizes the possibility of more cases, hospitalizations and deaths in the coming days and weeks.

Virus activity in the US is now being followed through the CDC’s routine influenza surveillance systems and is reported weekly in FluView http://www.cdc.gov/h1n1flu/update.htm. Since this is a new virus, most people will not have immunity to it. Therefore, illness may be more severe and widespread in:

Children less than 5 years of age
Anyone of any age with an underlying medical condition that places them at high risk for serious complications from seasonal influenza
Pregnant women

Since this is a new influenza virus it is impossible to predict whether the virus will become more severe if it continues to become more widespread.

CDC has deployed 25% of the supplies (antiviral drugs, personal protective equipment and respiratory protection devices) in the Strategic National Stockpile to all states in the continental US and to US territories. Efforts to develop a vaccine are underway.

What’s New?

1. The AAP has developed answers to frequently asked questions for parents and caretakers to provide up-to-date information on key issues and concerns. These can be downloaded and used in the office. (UPDATED May 11th)

ADDITIONAL KEY INFORMATION FOR PEDIATRIC PROVIDERS

Summary information

Testing for novel H1N1 swine origin influenza virus

Summary: CDC continues to recommend testing for novel influenza H1N1 virus to aid in patient recognition and management as well as to develop a more accurate picture of the burden of disease in the US.

Recommendations for whom to test may differ by state or community. However, testing should be prioritized to include infants and children who require hospitalization or who are at risk for severe disease due to age less than 5 years, with emphasis on those under 2 years of age who are normally at risk for more severe influenza, or the presence of a medical condition which increases the risk for severe disease and complications.

Specimens are to be sent to the state public health laboratory. CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has distributed the kits to all states. Each state has a protocol in place identifying patients from whom specimens should be obtained, as well as how to collect, store and ship specimens.

Case definition

Case definitions being used by state and local health departments for investigation of cases: Use of Rapid Influenza Diagnostic Tests for Patients with Influenza-like Illness during the Novel H1N1 Influenza Virus (Swine Flu) Outbreak

Clinicians may consider using rapid diagnostic tests as part of their evaluation of patients with signs and symptoms compatible with influenza, but results should be interpreted with caution.

It is reasonable to assume that rapid diagnostic tests that detect influenza A viral nucleoprotein antigen can detect novel H1N1 flu infection in respiratory specimens as these nucleoprotein antigens are highly conserved across influenza A viruses. However, the sensitivity and specificity of the different rapid tests is not yet known for this novel virus. CDC has received anecdotal reports of false positive and false negative results.

CDC has developed a PCR diagnostic test kit to detect this novel H1N1 virus and has distributed the kits to public health laboratories in all states. State public health authorities will provide information on specimen collection, storage and shipment.

Infection control in healthcare settings

CDC's office-based recommendations
Infection Prevention and Control in Pediatric Ambulatory Settings (AAP Policy). Committee on Infectious Diseases PEDIATRICS 2007; 120: 650-665

Key guidelines for Novel Influenza A (H1N1)

If tolerated and feasible, consider provider a size- appropriate mask for the patient to wear to prevent respiratory droplet dispersal while in common reception and waiting areas.
Consider having masks available for distribution to symptomatic patients by staff.
In waiting rooms of ambulatory facilities, use of some or all components of respiratory hygiene/ cough etiquette should be considered for patients and accompanying persons with suspected respiratory infection (category II). Category II. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.

At present, health care providers should use standard influenza infection control precautions when providing care to symptomatic patients with “influenza-like illness” until further data are available on the virulence of this strain. This includes implementing respiratory hygiene/cough etiquette infection control measures at first point of contact with a potentially infected person. For confirmed cases or highly suspect cases of swine influenza, health care providers should follow the enhanced infection control practices which include the use of fitted N95 masks.

Additional guidance on use of N95 masks can be found at:

http://www.cdc.gov/h1n1flu/masks.htm

http://www.cdc.gov/h1n1flu/eua/pdf/n95factsheet.pdf

Antiviral therapy

Summary: Treatment should be considered for infants and children (down to 1 day of age) with moderate to severe influenza, and those at high risk of complications, including children younger than 5 years of age. While antiviral treatment earlier in the course of infection is likely to have a greater impact on decreasing clinical illness, treatment can be started even if duration of illness is greater than 48 hours. Further details are provided on treatment and prophylaxis for close contacts of cases that are at high-risk for complications of influenza and for health care personnel.

The US FDA has issued Emergency Use Authorization for oseltamivir for treatment and prophylaxis of children less than one year of age and therapy in persons ill for more than 48 hours. Dosing recommendations are included in this guidance. There is also information in the package insert for using capsules to formulate a suspension if the suspension is not available.

Interim guidance on antiviral recommendations for patients with novel influenza A (H1N1) virus infection and their close contacts: (UPDATED May 6th)

Message to Pediatric Clinics

Recorded audio message (3.5min) for phone triage in clinics caring for children, including basic novel H1N1 influenza information, when to seek emergency care, keeping your child healthy, and where to seek additional information.

Mitigation strategies

Initiation of mitigation strategies in areas where H1N1 (swine flu) has occurred

For Parents/Caregivers:

Interim guidance for public gatherings in response to human infections with Novel influenza A (H1N1) from CDC (UPDATED May 10th)

Decisions regarding public gatherings (e.g., commencement exercises, church services, sporting events, social celebrations) are to be made by local and state health authorities based on local influenza activity and evolving information about severity of illness and identification of high-risk groups.
Continuing emphasis is being placed on:

People with influenza-like illness remaining at home until 7 days after the onset of illness (10 days for children) or at least 24 hours after symptoms have resolved, whichever is longer.
Use of appropriate respiratory and hand hygiene precautions.
Persons with known risk factors for complications of influenza should consider their own personal risk of exposure where novel influenza A virus is circulating.

Masks are not recommended for non-healthcare settings.
These recommendations are based on current information and are subject to change based on ongoing surveillance and risk assessment.

Guidance for closures of schools and childcare facilities: from the CDC (UPDATED August 5)

Most U.S. cases have not been severe and are comparable in severity to seasonal influenza.
Current spread within communities makes individual school and child care program closure less effective as a control measure.
At this time, CDC recommends the primary means to reduce spread of influenza in schools and child care programs focus on:
1. early identification of ill students and staff

2. staying home when ill

3. good cough and hand hygiene etiquette
Decisions about school and child care program closure should be at the discretion of local authorities based on local considerations, including public concern and the impact of school or child care program absenteeism and staffing shortages.

For Travelers:

Traveler’s Health Precautions (CDC)

For Child Care Programs and Schools:

Interim guidance for Institutions of Higher Education and Post-Secondary Educational Institutions in Response to Human Infections with Novel Influenza A (H1N1) Virus (UPDATED August 5)

CDC is not currently recommending that institutions cancel or dismiss classes or other large gatherings.
The term “institutions” is used to refer to institutions of higher education, such as universities, colleges, and community colleges and other post-secondary educational institutions.
If confirmed cases of novel influenza A (H1N1) virus infection or a large number of cases of influenza like illness (ILI) (i.e. fever with either cough or sore throat) occur among students, faculty, or staff or in the community, institutions officials should consult with state and local health officials regarding an appropriate response.
Update on School (K-12) and Childcare Facilities: Interim CDC Guidance in Response to Human Infections with the Novel Influenza A (H1N1) Virus (UPDATED May 9th)

Interim CDC Guidance for Colleges, Universities, and Post – secondary Educational Institutions in Response to Human Infections with Novel A H1N1 (H1N1) Virus

Updates for Schools and Childcare Facilities - Interim Guidance from CDC
Excerpts from “Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, Second Edition” (Copyright American Academy of Pediatrics 2009).

As the outbreak has continued to unfold, the U.S. Department of Education, in conjunction with the CDC and the Homeland Security Council, has provided updated guidance to school personnel.
Stopping the Spread of Germs at Home, Work & School (CDC)

For State Information:

The Association of State and Territorial Health Officials (ASTHO) has created a page of resources related to H1N1 flu (swine flu).

Information about H1N1 flu (swine flu) in other Languages:

© COPYRIGHT AMERICAN ACADEMY OF PEDIATRICS, ALL RIGHTS RESERVED.	Site Map \| Contact Us \| Privacy Statement \| About Us \| Home
American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL, 60007, 847-434-4000