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Swine Influenza Health Alert - Sonoma County
Posted: April 24, 2009
To: Health Providers
From: Mark Netherda, Deputy Public Health Officer 565-4400
The Centers for Disease Control (CDC) has reported eight confirmed human cases of Swine Influenza A/H1N1 in the USA (six in California and two in Texas) and nine suspect cases. Seven of the confirmed cases had mild Influenza-Like Illness (ILI), with only one requiring brief hospitalization. No deaths have been reported. All six cases in California were detected through routine surveillance for seasonal influenza.
Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others.
Today, the CDC reported over 800 similar cases in Mexico with 59 related deaths, which appear to be related to the cases in the United States. As result, CDC increased their surveillance efforts and asked all California counties to test hospitalized individuals with flu-like symptoms to for possible Swine flu virus.
Enhanced Surveillance for Possible Swine Influenza
At this time, there is no indication of an increase in influenza-like illness in Sonoma County. Also, as influenza is not a reportable disease, suspect cases need not be reported to Public Health at this time. Confirmed influenza A specimens and suspect influenza specimens, however, should be collected and sent for typing per the guidelines given below. The Sonoma County Public Health lab will be performing PCR screening for A/H1N1 influenza, but confirmation of the swine flu variant will need to be performed by the CDC. For information regarding how to utilize the Public Health lab service, please call 565-4711, Monday thru Friday.
Surveillance specimen collection:
We ask that nasopharyngeal specimens be collected and sent for influenza screening from patients hospitalized for undiagnosed acute respiratory illness, or suspect or confirmed influenza.
As resources permit, we also ask that influenza sentinel surveillance providers and emergency room clinicians in Sonoma County collect specimens from outpatients who meet the definition for influenza-like illness:
- Fever >37.8ºC (100ordm;F) and cough and/or sore throat
Please see infection control precautions below.
Specimen collection: Please collect up to 2 nasopharyngeal or throat swabs from each patient with ILI, placing the swabs in a standard container with 2-3 ml of viral transport media. If the patient is hospitalized with pneumonia, specimens from the lower respiratory tract (e.g., tracheal aspirate, bronchoalveolar lavage) should also be obtained. Specimens should be collected within the first 24-72 hours of onset of symptoms and no later than 5 days after onset of symptoms.
Specimen storage: The specimens should be kept refrigerated at 4ºC and sent on cold packs if they can be received by the hospital or Sonoma County Public Health laboratory within five days of the date collected. If samples will be received by the laboratory in five or more days, they should be frozen at -70 ºC or below and transported on dry ice.
Infection control precautions:
Health-care workers providing care for patients with ILI who are not known contacts of a laboratory-confirmed swine flu case should use droplet precautions (i.e., wear a surgical or procedure mask for close contact), in addition to standard precautions including hand hygiene with soap and water or an alcohol-based hand rub.
Health-care workers providing care for an ill close contact of a laboratory-confirmed swine flu case should:
- Wear a fit-tested N95 respirator (if unavailable, wear a tightly fitting surgical mask), disposable gloves, gown, and eye protection (face shield or goggles).*
- When care is completed, place all personal protective equipment (PPE) in a biohazard bag for appropriate disinfection and disposal.
- Clean hands thoroughly with soap and water or an alcohol-based hand gel.
*If all elements of PPE are not available, respiratory protection (N95 respirator or surgical mask) is most important. Suspect swine flu patients (ill close contact of a laboratory-confirmed swine flu case) should be asked to don a surgical mask and should be placed promptly in an airborne infection isolation room, if available, or in a single room with a door that closes.
For additional information about swine flu or this surveillance please visit:
CDPH Swine Flu page http://www.cdph.ca.gov/HealthInfo/discond/Pages/SwineInfluenza.aspx