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The AAP 2009 H1N1 Influenza (Swine Flu) Information for Health Care Professionals. This is a comprehensive web page containing practice and community guidance regarding H1N1, links to the CDC, state resources, and school and day care guidelines.
http://www.aap.org/new/swineflu.htm
Your latest info on H1N1 from the CDC and MN Dept of Health
H1N1 Home Page:
http://www.health.state.mn.us/divs/idepc/diseases/flu/h1n1/index.html
H1N1 Situation update:
http://www.cdc.gov/h1n1flu/update.htm
- At this time, the signs & symptoms of seasonal flu are indistinguishable from H1N1. The mode of transmission is also the same.
- All patients with ILI symptoms should be assumed to have H1N1 influenza.
INFLUENZA –LIKE ILLNESS (ILI) - SIGNS AND SYMPTOMS
Q: How is influenza- like illness (ILI) defined?
Temp 100 or greater PLUS cough / sore throat In absence of another diagnosis
PHONE TRIAGE OF PATIENTS
In children, emergency warning signs that need urgent medical attention include:
- Fast breathing or trouble breathing
- Bluish or gray skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting
- Being so irritable that the child does not want to be held
- Flu-like symptoms improve but then return with fever and worse cough
LAB TESTING / HEALTH DEPARTMENT REPORTING
Q; Should all patients with ILI be tested for H1N1?
- NO - H1N1 testing is available only at state health department and specialty labs.
- Since H1N1 has become “Pandemic" the focus has shifted from detection to surveillance.
- Because the signs & symptoms of seasonal flu are indistinguishable from H1N1, patients with ILI symptoms should be assumed to have H1N1 influenza.
Minnesota Department of Health (MDH) has limited testing to patients with Influenza-like illness (ILI) AND
- hospitalized (or deceased following ILI illness) OR
- have had contact with pigs in the 7 days prior to the onset of symptoms or during their illness (e.g. swine worker)
Atypical situations, such as a cluster investigation, will be considered for testing after consultation with MDH epidemiology at 651-201-5414 or 1-877-676-5414.
Reference: http://www.health.state.mn.us/divs/idepc/diseases/flu/h1n1/hcp/testing.html
Q: If I order Flu antigen testing and the rapid test is negative, can I assume my patient doesn’t have
influenza? Please refer to http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm
- NO
- A RIDT positive for Influenza Type A can not distinguish influenza A virus subtypes. That is, this test cannot distinguish influenza infections caused by novel influenza A viruses versus seasonal influenza A viruses.
1 A RIDT negative for Influenza A and B does not rule out either novel influenza A viruses or seasonal influenza viruses. The sensitivity of this assay has been shown to range between [10-70%*] for the detection of novel influenza A (H1N1) virus and between [20-100%*] for seasonal influenza viruses. If influenza is circulating in the community, a diagnosis of influenza should be considered based on a patient’s clinical presentation and empiric antiviral treatment should be considered, if indicated.
- In settings where policies indicate exclusion of patients who may have influenza (e.g., schools, camps, day care centers), a negative RIDT, performed on a patient with clinically compatible illness, should not be used as justification for early return to that setting.
- A negative RIDT result can not exclude influenza as a cause of an outbreak in a facility with ill residents or patients with clinically compatible illness."
ANTIVIRALS
Q: What are current recommendations for the use of antiviral medications for treatment of influenza?
- CDC recommendations as of September 6, 2009: http://www.cdc.gov/H1N1flu/recommendations.htm
"The priority use for antiviral medications during the upcoming influenza season remains the same as outlined in the antiviral recommendations posted on May 6, 2009; that is to prioritize use of these drugs for those patients who are severely ill (hospitalized) and those patients who are ill with influenza-like illness and who are at high risk for influenza related complications:
- People hospitalized with suspected or confirmed influenza
- People with suspected or confirmed influenza who are at higher risk for complications
- Children younger than 5 years old (children under 2 years old are at higher risk for complications than older children)
- Adults 65 years and older
- Pregnant women
- People with certain chronic medical or immunosuppressive conditions
- People younger than 19 years of age who are receiving long-term aspirin therapy
Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.
1 Children aged 2 years to 4 years without high risk conditions and with mild illness do not necessarily require antiviral treatment.
Q: What about family members of above groups? They are often ask for antivirals?
Prophylactic use of antivirals is not recommended. Antivirals should be reserved for the persons outlined above to reduce the risk of resistant flu strains.
QUARANTINE / WORK & SCHOOL RESTRICTION
Q: What are recommendations for work/school restriction of individuals with ILI?
- http://www.cdc.gov/h1n1flu/guidance/exclusion.htm:
- CDC recommends that persons with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications, even if they are using antiviral drugs.
- EXCEPTION: Healthcare personnel who develop a febrile respiratory illness should be excluded from work for 7 days or 24 hours after symptoms have resolved, whichever is longer.
Q; My child/household member was diagnosed with the flu. Is it okay for me to come to work?
- YES – however if you develop a fever (100° F [37.8°C]), along with a cough or sore throat, you should not report to work for a minimum of 24 hours after you no longer have a fever. See above question.
PATIENT EDUCATION MATERIALS
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