Health Alerts > 5/4/09 - Flu Update
Date: May 4, 2009
Global Updates: World Health Organization phase:
Worldwide, laboratories now have confirmed 898 human cases of the new swine flu in 18 countries.
No change in WHO pandemic phases of 5
National Updates:
National data (to date) includes:
o United States has 298 cases in 37 states
o Hospitalization rate of about 4% (compared to seasonal flu of 1%)
o One death thus far
o Median age is 17 years old, but seeing it now in all generations
o Incubation period is thought to be 2 – 5 days.
o The secondary attack rate is 22.5%, and is defined as the probability that infection occurs among susceptible persons within a reasonable incubation period following known contact with an infectious person or an infectious source.
o A group is being convened by the CDC to see determine if N95 masks can be reused.
o CDC is check supply of N95 masks at manufacturer level
CDC has issued new guidance for patients with chronic cardiovascular disease, heart disease or stroke (http://www.cdc.gov/h1n1flu/guidance/cardiovascular.htm);
o Patients with chronic cardiovascular disease and cerebrovascular disease (CVD) are at increased risk of experiencing an acute exacerbation of disease during influenza epidemics.
o Patients with CVD risk factors such as hypertension, smoking, obesity, and family history of premature heart disease might be considered for priority care over healthy individuals but not before health care providers, the very young, elderly people, and the ill.
o Health care providers should be aware that influenza might produce increased numbers of cardiovascular events, leading to increased hospitalizations and use of resources to treat acute coronary events, heart failure, and stroke.
o Consideration should be given for having adequate supplies of commonly used cardiovascular medications for prevention and treatment of cardiovascular events.
o Patients are being encouraged to keep a 2 week supply of medicine on hand. I personally would make the same recommendation for diabetics.
New guidance for pregnant healthcare workers (http://www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm):
All health care workers in direct patient care, including pregnant women, should follow standard precautions with all patients, regardless of infection status
Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated.
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
· Endotracheal intubation
· Aerosolized or nebulized medication administration
· Diagnostic sputum induction
· Bronchoscopy
· Airway suctioning
· Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
· High-frequency oscillatory ventilation
State/Local
No new cases as of now in Allen County, Indiana has 3 confirmed cases.
Health care providers who have questions about what should be released to the media can call the toll-free number for providers at: 1-866-233-1237, from 8:00 a.m. - 4:45 p.m. daily.
Although the CDC guidance for testing has recently changed, in Indiana we will continue to test those persons who present with Fever > 100o F and either a sore throat or cough who:
o Are hospitalized
o Or who have traveled within 7 days to a community either within the United States or internationally where there are one or more confirmed swine influenza A (H1N1) cases.
o Or present to our sentinel sites for assessment.
Please feel free to call with any questions.
Deb McMahan, MD
