Update for clinicians 5-8-09 final

Department of Human Services
Interim Guidance for Laboratory Testing, Infection Control,
and Use of Antiviral Medication for Treating H1N1 Swine
Influenza
Laboratory Testing: Given that Oregon has now confirmed numerous cases of H1N1 Swine Influenza from across the state, intensive case finding is no longer warranted, and our recommendations for testing have been modified accordingly. Please visit CDC’s swine flu website for the most recent information: http://www.cdc.gov/h1n1flu/guidance/. Testing for novel influenza A H1N1 infection should be considered for patients who: a. Fever >37.8°C (100°F) and b. Respiratory symptoms (may include cough, sore throat, etc.) a. A clinical need for hospitalization; or b. Risk factors for severe complications of influenza (see algorithm). Infection Control: Gloves, a gown, and a surgical mask should be worn when attending suspected H1N1 Swine Influenza cases. An N-95 respirator should be worn instead of a surgical mask while performing aerosol generating procedures (e.g. bronchoscopy, intubation, open suctioning, or administering nebulized medications). If exposure of the eyes to droplets is anticipated, then eye protection should be considered. Patients who do not require hospitalization should be advised to stay home until symptoms resolve; to use hand, respiratory and cough hygiene; and to call if symptoms worsen. To test for H1N1 Swine Influenza, obtain 2 swabs and refrigerate them until testing. Preferred swabs are made of inorganic material to avoid the possibility that foreign DNA will cause false-positive PCR tests. Use a flocked or Dacron-tipped nasopharyngeal swab on a non-wooden shaft. Initial testing on one of the swabs in your regular lab to determine if the patient has influenza A is recommended. If the patient tests positive for influenza A and meets the above testing criteria, notify your local health department that your patient requires testing for H1N1 Swine Influenza. Send the second “Assisting People to Become Independent, Healthy and Safe” swab in viral transport medium, refrigerated or on cold packs, to the Oregon State Public Health Lab (OSPHL). Label these “RULE OUT SWINE FLU,” and send with them a completed Virology/Immunology Request Form with “rule out swine flu” indicated under “other” in the “virus isolation” section. These samples will be processed at NO COST. Information on specimen collection procedures, ordering test kits, and test request forms can be found at: http://www.oregon.gov/DHS/ph/phl/. Preliminary test results will be available within 48 hours after receipt at OSPHL. For additional information on specimen collection, shipment, and test kits, call 503.693.4100. Positive lab results will be reported to your office by Public Health Epidemiology, or you may call Public Health Epidemiology at 971.673.1111. While guidelines may be subject to change, antiviral treatment is currently recommended for suspected cases of influenza at high risk for complications, who have symptoms severe enough to require hospitalization, or as clinically warranted in the clinician’s judgment. Chemoprophylaxis with antivirals is recommended for close contacts of an H1N1 Swine Influenza case who are at high risk of complications (see list on following page). Chemoprophylaxis is also recommended for health care or public health workers who were not using appropriate personal protective equipment during close contact with an H1N1 Swine Influenza case during the case’s infectious period. State stockpile medication can be used for chemoprophylaxis in accordance with the above guidelines. Interim Guidelines for Influenza Testing and Treatment † Amantadine or Rimantidine will cover seasonal (non-swine) influenza A * ”Clinically Warranted” refers to whether, in the H1N1; Oseltamivir will cover all other strains. (All influenza strains clinician’s judgment, the patient ought to be treated: “High Risk”: Persons at risk for severe complications from influenza ‡ Oregon State Public Health Laboratory all children aged 6 months--4 years (59 months); § Swine influenza A H1N1: Oseltamivir or Zanamivir Seasonal (non-swine) influenza A H1N1: Amantadine or Rimantadine children and adolescents (aged 6 months--18 years) who Influenza A H3N2: Oseltamivir or Zanamivir are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;women who will be pregnant during the influenza season;adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus);adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration; andresidents of nursing homes and other chronic-care facilities.

Source: http://www.oswapic.org/Update%20for%20Clinicians%205-8-09%20final.pdf