For Health Providers
Situation Update - Swine Influenza Health Alert - Sonoma County
Posted: April 29, 2009
To: Health Providers
From: Mark Netherda, Deputy Public Health Officer 565-4400
As of 8PM Tuesday, April 28th, the Centers for Disease Control (CDC) reported 65 confirmed cases of Swine Influenza A/H1N1 in five states with a total of 5 hospitalizations. No deaths have been reported. CDC officials describe the situation as "rapidly evolving" and expect that additional cases will continue to be identified. U.S. cases have been generally mild; affecting individuals aged 7 to 54, with an incubation period of two to seven days.
In California, 12 cases of swine flu have been confirmed. Sonoma County has reported no cases. As of 6 PM on April 28th, the Sonoma County Public Health Lab had tested a total of 17 local samples, all of which were negative for swine flu. Marin County reported 2 cases as "probable" (meaning they were identified as an unsubtypeable Influenza A strain); further confirmation by gene sequencing was pending.
Testing Recommendations:
Sonoma County remains in a state of enhanced surveillance, although this has been revised. At this time, testing of patients should focus on:
- Hospitalized patients with influenza-like illness (ILI) who do not have another diagnosis.
- Outpatients with ILI in one or more of the following categories:
- Patient is a contact of a confirmed swine influenza A (H1N1) case
- Patient is in a high-risk setting for transmission (e.g., school, prison)
- Patient is part of a cluster of people (like a family) with ILI (only one patient needs laboratory confirmation)
- Patient returned from Mexico within 7 days of illness onset or cared for ill household members with this travel history.
Healthcare providers should deliver collected specimens with the proper documentation to the Sonoma County Public Health lab. Please do not send patients to the lab for testing or have them deliver the specimens themselves. See the attached document on proper specimen collection and transport. This attached document should replace all other guidance regarding test submission to the Sonoma County Public Health. If you have questions, please call the lab at 565-4711.
Treatment Recommendations:
There is currently no vaccine for swine flu and no plan for mass vaccination. The anti-viral neuraminidase inhibitors (oseltamivir and zanamivir) are effective against swine flu in laboratory testing. These medications should be reserved for patients whom the provider believes to be at high risk of morbidity or mortality from influenza (i.e elderly patients, patients with serious underlying medical, especially respiratory, conditions). Guidance on the possible use of oseltamivir or zanamivir for prophylaxis (for certain groups - exposed healthcare providers, household contacts, etc.) is forthcoming, but is not currently recommended. California is mobilizing the state stock pile of anti-virals and will be accepting shipment from the Strategic National Stockpile of anti-virals and PPE. The State is working with Sonoma County on plans to distribute these supplies, should the situation warrant it.
Infection Control Precautions:
In addition to the guidance issued in the Health Alert dated 4/24/09, the following recommendations are being made. The general use of masks is not being recommended to the public. Individuals with an ILI should stay home from school or work, but if they must go out in public they should be advised to wear a mask. Surgical face masks are adequate to prevent disease transmission, N95 and higher level respirators are required to prevent disease acquisition. Clinics and physician offices are recommended to establish respiratory hygiene precautions, such as:
- putting up signage asking patients to identify themselves to the office staff if they have an influenza like illness
- asking coughing patients to wear masks in the waiting room and exam rooms or to wait outside until they can be seen
- supplying alcohol hand gel or antiseptic hand wipes and tissues to patients in waiting rooms
Additional information for Physicians and Public Health Professionals is available at http://www.cdc.gov/swineflu/guidance/.
Recorded information for the public regarding Swine Flu is available in English and Spanish at 565-4477.
The Department of Health Services receives regular updates from the Department of Public Health and Centers for Disease Control. The Sonoma County Public Health website www.sonoma-county.org/publichealth is updated continuously to reflect new information. More information about swine flu is available at:
www.cdph.ca.gov
www.cdc.gov/flu/swine
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