Health Alerts > 9/28/09 H1N1 Update
GLOBAL UPDATES:
- The 2009 H1N1 influenza virus remains the predominant influenza virus in circulation worldwide and has not demonstrated significant mutation.
NATIONAL UPDATES:
Current Flu Epidemiology
As of September 19, 2009):
Influenza activity increased in the U.S. Indiana increased from sporadic activity to regional activity.
99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1)
Less than 1% of 2009 Influenza A H1N1 virus are resistant to Tamiflu but 100% are resistant to the Amantadines.
Three influenza-associated pediatric deaths were reported last week and all three were associated with 2009 influenza A (H1N1) virus infection.
o Since September 28, 2008, CDC has received 117 reports of influenza-associated pediatric deaths that occurred during the current influenza season (25 deaths in children less than 2 years, 12 deaths in children 2-4 years, 35 deaths in children 5-11 years, and 45 deaths in individuals 12-17 years). Forty-nine of the 117 deaths were due to 2009 influenza A (H1N1) virus infections, and four of these have occurred since August 30, 2009.
o Nineteen (38.8%) of the 49 children with confirmed 2009 influenza A (H1N1) infection had a specimen collected from a normally sterile site; five (26.3%) of the 19 children had a positive bacterial culture (MSSA, MRSA, and Streptococcus constellatus).
New Recommendations:
What to do if you get sick (http://www.cdc.gov/flu/freeresources/2009-10/pdf/what_to_do_if_you_get_sick.pdf)
Great informational flyer you may want to download and provide to your at risk population!.
Questions and Answers Use of Antiviral Medicines for the Treatment and Prevention of Flu among Pregnant Women for the 2009–2010 Season (Update – Sept 25th) (http://www.cdc.gov/H1N1flu/pregnancy/antiviral_pregnant_qa.htm)
Great Q and A for pregnant patients. May want to download for your office. No new recommendations for physicians.
Emergency Authorization Use for Tamiflu for non-standard populations (http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf)
Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season - September 22, 2009 (http://www.cdc.gov/h1n1flu/recommendations.htm)
Most healthy persons who develop an illness consistent with influenza, or persons who appear to be recovering from influenza, do not need antiviral medications for treatment or prophylaxis. However, persons presenting with suspected influenza and more severe symptoms such as evidence of lower respiratory tract infection or clinical deterioration should receive prompt empiric antiviral therapy, regardless of previous health or age.
Treatment with Oseltamivir or Zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization.
Early empiric treatment with Oseltamivir or Zanamivir should be considered for persons with suspected or confirmed influenza who are at higher risk for complications including:
o Children younger than 2 years old and Persons aged 65 years or older
o Pregnant women
o Persons of any age with certain chronic medical or immunosuppressive conditions and persons younger than 19 years of age who are receiving long-term aspirin therapy.
Actions that should be taken to reduce delays in treatment initiation include:
o Informing persons at higher risk for complications of signs and symptoms of influenza and need for early treatment
o Ensuring rapid access to telephone consultation and clinical evaluation for these patients and those who report severe illness;
o Considering empiric treatment of patients at higher risk for influenza complications based on telephone contact.
Treatment should not wait for laboratory confirmation of influenza.
Consideration for antiviral chemoprophylaxis should generally be reserved for persons at higher risk for influenza-related complications who have had contact with someone likely to have been infected with influenza. However, early treatment is an emphasized alternative to chemoprophylaxis after a suspected exposure. Household or close contacts (with risk factors for influenza complications) of confirmed or suspected cases can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their health care provider for evaluation and possible early treatment if clinical signs or symptoms develop.
LOCAL EFFORTS:
We have not received H1N1 vaccine as of yet. No official rec on doses for children yet, prelim data from NIH indicates that one dose for children over 10 years of age will likely be sufficient – but based on one manufacturer only.
I am hearing that we are seeing more admissions for pneumonia and asthma exacerbations. Remember could be secondary to H1N1.
We will be participating in a local live TV special on October 5th 7 PM to 8 PM regarding H1N1. More info to follow
As of now, the CDC is still recommending the use of N95 masks for healthcare providers providing care to patients with potential H1N1. We would be happy to assist you in fit testing the appropriate personnel -- contact the Fit Testing Coordinator via phone at (260) 449-7105.
Offices will need to provide information on the following:
• Number of employees to be fitted • Dates and times they would prefer • Location
• A contact person, including phone and email contact info
The offices will be responsible for the following:
• Completing all necessary paperwork, including the physician review of forms and recommendations prior to fit testing
• Ordering and supplying adequate masks (one of each employee, additional sizes)
• Providing space for the fit testing
Deb McMahan, MD
