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Dramatic Increase in H1N1 in Sonoma County

Posted: June 26, 2009
To: Healthcare Providers
From: Mark Netherda, Deputy Health Officer, 565-4567

In a press release on June 25th, Dr. Mark Horton, California State Health Officer, urged all Californians to "remain vigilant about preventing spread" of H1N1 virus. Although the regular flu season is over, cases of influenza-like illness (ILI) are being reported at levels higher than normal for this time of year and even higher than what is typically seen at the height of the regular flu season.

Novel H1N1 influenza virus is now widely circulating in California and has become the dominant influenza virus in the community. The last seasonal type A influenza (non-H1N1) was reported by the Public Health Lab on May 19th. The Department of Health Services continues to monitor the situation, including outbreaks at one overnight camp for youth, the Sonoma Developmental Center, and a local skilled nursing facility.

Current Situation as of 12 noon, June 26, 2009

H1N1 Cases in Sonoma County:
Confirmed - 10
Probable - 28

Of the 38 confirmed and probable cases, 32 were reported since June 10, demonstrating that H1N1 activity has increased markedly in Sonoma County in the past three weeks. The CDPH is reporting at least 17 deaths in California from H1N1, including one confirmed death in an elderly Sonoma County resident which was reported in a press release on June 19th (http://www.sonoma-county.org/health/ph/news/20090619h1n1.htm). Of these 17 California deaths, 10 were noted to have complicating underlying medical conditions. Many of the cases also had associated obesity or morbid obesity - which has not typically been considered a potential complicating factor in influenza.

Because of this increase in influenza activity, Sonoma County Public Health is reminding local healthcare providers of several important issues:

• Influenza like illness is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than influenza.
• H1N1 Influenza virus is circulating widely and ILI is being reported at higher than usual numbers.
• Patients who report mild illness AND who have no underlying medical conditions that place them at higher risk of complications from influenza need not be seen in the office. These patients can be screened by phone, given symptomatic treatment recommendations, and instructed to contact their physician for any signs of worsening severity of illness.
• Rapid tests for influenza are not reliable for detecting or ruling out H1N1 virus and are not recommended ( http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm )
• Current recommendations from the California Department of Public Health limit testing to persons with influenza-like illness who:
1. require hospitalization or
2. are pregnant or
3. are direct care health care providers or
4. have died from influenza-like illness
• Testing result availability should not delay treatment. Report of an unsubtypable Type A influenza (a probable case) from the Public Health Lab or a commercial lab is enough to verify H1N1 infection at this time; confirmatory testing by the State lab may only be done on ICU admissions, fatal cases and cases which local labs are unable to process.
• Treatment guidelines can be found at: http://www.cdph.ca.gov/HealthInfo/discond/Documents/CDPH-Updated-Interim-Guidance-on-Antivirals-for-H1N1-050809.pdf

Simple prevention measures:

1. Remind patients and staff to cover coughs and wash hands frequently.
2. Provide hand gel and surgical masks in waiting rooms, reception areas and patient exam rooms.
3. Post signs on exterior and interior doors reminding patients to wash hands frequently and to cover their faces when they cough and sneeze. A link to examples which can be downloaded and printed are available on the right side of the Public Health H1N1 web page at: www.sonoma-county.org/h1n1
4. Reminder healthcare staff to use all appropriate personal protective equipment when working with known and suspected cases of ILI and to stay at home when they are ill with any infection until 24 hours after their symptoms subsides.
5. Advise all individuals with ILI, to stay home or be isolated from other patients for 7 days, or until 24 hours after their symptoms subside, WHICHEVER IS LONGER.

For further information please refer to:

Sonoma County Public Health: H1N1 (Swine) Flu website

California Department of Public Health: Novel Influenza A (H1N1) Virus website

The Centers for Disease Control and Prevention: H1N1 Flu (Swine Flu) website

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