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Instructions to submit a Public Records Request
Health advisory: Swine Flu Update
April 26, 2009

ACTION REQUESTED:

  • Consider the possibility of swine influenza A (H1N1) [SIV] virus infections in patients presenting with febrile respiratory illness who:
    • Live in an area where human cases of SIV has been identified
    • Have traveled to an area where human cases of SIV has been identified within 7 days of symptom onset
    • Have been in contact with ill persons from these areas in the 7 days prior to their illness onset.
  • A current list of areas where human SIV has been confirmed by CDC is available at www.cdc.gov/swineflu/investigation.htm
  • If swine flu is suspected, obtain a respiratory (nasopharyngeal) swab for swine influenza testing and place it in a refrigerator (not a freezer) and contact Public Health immediately at 206-296-4774 to facilitate testing and case investigation.
  • Suspect cases should be informed to remain at home and minimize contact with others until 7 days after symptom onset or resolution of symptoms, whichever is longer.
  • Use phone and clinic-based triage procedures to identify persons that may be suspect cases in order to implement infection control measures promptly upon patient presentation.
  • Report cases of unexplained severe respiratory illness in healthcare workers immediately to Public Health.
  • Clinical laboratories should also submit all specimens testing positive for influenza A from patients not suspected to have SIV to the WA State Public Health Laboratory using usual specimen transport methods.

Background:

As of April 26, CDC reports a total of 20 confirmed cases of swine influenza virus (SIV) infection from California, Texas, New York City, Ohio and Kansas. To-date, most cases have been mild and there have been no deaths. Cases are under investigation in a number of states and other countries. There have been no cases confirmed in Washington State. At this time no travel restrictions are advised but this may change in the coming days.

Public Health DOES NOT recommend persons with mild or no illness who have been to areas with SIV activity or who have been in contact with ill persons from these areas seek medical evaluation or testing. Persons should seek medical evaluation and testing for more severe illness based on usual criteria for seeking medical care.

Empiric antiviral treatment is recommended for any ill person suspected to have SIV infection. Antiviral treatment with either zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine should be initiated as soon as possible after the onset of symptoms.

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals

  1. Household close contacts who are at high-risk for complications of influenza (persons chronic medical conditions, elderly) of a confirmed or suspected case.
  2. School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
  3. Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
  4. Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
  5. Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case’s infectious period.

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir can be considered for the following:

  1. Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
  2. Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

Resources:

  • Guidance and recommendations are evolving. Please check the CDC swine flu web site frequently for current recommendations on antiviral drug use, infection control and PE, areas reporting SIV cases and travel advisories: www.cdc.gov/swineflu (Follow link for "Human swine flu investigation".)
  • Antiviral treatment recommendations

To subscribe to receive e-mail and/or fax health alerts from Public Health, contact Maybelle Tamura at 206-296-4774 or Maybelle.Tamura@kingcounty.gov