Talking Points for Providers Treating Patients Concerned about Swine Flu
Concerned patients will soon be calling and visiting Navy clinics throughout the country and asking many questions about the swine flu. This information is meant to be a resource for information in discussing this new influenza with your patients.
A novel Human H1N1 influenza, dubbed the “swine flu” because it has swine H1N1 genetic components, was recently isolated by the CDC and has since been discovered in several states around the country. The origin of this new human influenza appears to come from Mexico as all US cases thus far have either returned Mexico recently or live on a border State. All US cases thus far have been mild in nature. The only US fatality was a young child from Mexico who had been transferred to a US hospital for intensive care. This virus has been shown to have human-to-human transmission though ease of transmissibility has yet to be determined. It is not related to eating pork products or handling sick swine.
It is important to keep in perspective that seasonal influenza affects several hundred thousand Americans a year and is associated with over 30 thousand deaths annually. The current swine flu is a concern as a novel virus, which may have the potential for affecting more people; however, we do not have enough information at this time to know how severe or how extensive it may become.
Current Case Definitions for Infection with Swine Influenza A (H1N1) Virus: A confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:
1. real-time RT-PCR
2. viral culture
A probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute febrile respiratory illness who is:
• positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, or
• positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case
A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onset:
• within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or
• within 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, or
• resides in a community where there are one or more confirmed swine influenza cases.
Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset.
Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A (H1N1) virus infection during the case’s infectious period.
Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness)
High-risk groups: A person who is at high-risk for complications of swine influenza A (H1N1) virus infection is defined as the same for seasonal influenza (see MMWR: Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008).
Special Considerations for Children
Aspirin or aspirin-containing products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered to any confirmed or suspected ill case of swine influenza A (H1N1) virus infection aged 18 years old and younger due to the risk of Reye syndrome. For relief of fever, other anti-pyretic medications are recommended such as acetaminophen or non steroidal anti-inflammatory drugs.
Please periodically review these definitions on the CDC website for any changes.
General Guidance for Patients:
The most important thing to stress to worried well and inquisitive patients is to push good personal hygiene and other protective measures that they should be doing during a typical flu season, such as:
– Avoid close contact with sick individuals
– Stay home when you are sick
– Cover your nose and mouth when coughing or sneezing (preferably in sleeve rather than hand to avoid spreading germs by contact)
– Routinely wash hands or use hand sanitizers (at least 60% alcohol)
– Avoid touching eyes nose and mouth
– See CDC - Influenza (Flu) | Fact Sheet: Good Health Habits for Preventing Seasonal Flu
for more information
Further public health guidance from the CDC is as follows:
– Strongly Recommend Home Isolation of Cases
Voluntary isolation of cases (till 7 days after onset or at least 24 hours after symptoms resolve)
If sick and must go into community should try and wear mask or tissue to decrease risk of transmission when cough, sneeze, talk, or breathe.
Home isolation of household contacts IS NOT required at this time, however voluntary isolation of household contacts SHOULD remain home at earliest signs of illness
– If ill, avoid traveling
– Screening at the land borders is NOT necessary at this time due to the low number of cases and very mild illness
– Exit screening is NOT recommended at this time for the same reasons
– Broad-based school closures involving cases is NOT recommended at this time
– See This Page Has Moved
for more information
Questions and Answers:
Some questions that may be pertinent to patients and providers working at your clinic:
Should I be wearing a mask?
It is more important to stress decreasing exposure to sick individuals, staying home when sick, and limiting exposure to crowded areas when swine flu has been diagnosed in your area. However, per the CDC pending clarification of transmission patterns for this virus, healthcare personnel providing direct patient care for suspected or confirmed swine influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator when entering the patient room. If you have not been fit tested and work in a health care setting, work through your chain of command to ensure you are fitted appropriately before cases arrive in your area.
For general population in communities with known swine flu the follow site provides recommendations for use of mask and respirators: This Page Has Moved
Details on use of masks for your patients as well as other infection control guidelines: This Page Has Moved
Should I be vaccinated or re-vaccinated for seasonal influenza?
Currently there is insufficient evidence to show if this year’s flu vaccine will be partially protective against the swine flu. One should not expect that it will be as this is a novel virus. However, the virus does contain a small part of genetic coding that is seen in seasonal H1N1, thus the seasonal flu vaccine may prove to have some benefit and is still reasonable to be given in patients that do not have a contraindication. Giving a second dose (re-vaccinating) to patients who have already had this year’s seasonal vaccine is not recommended. The CDC reports they may begin work on a vaccination specific for swine flu or including part of the swine flu in next years vaccine, however this vaccine is not currently available
Who should get Tamiflu?
Guidance on use of antivirals is continually being updated by the CDC and can be found at - This Page Has Moved
. Current guidelines for treatment are based on case definitions above and should only be given for suspected cases who test positive for influenza A on the rapid test or whom have high clinical suspicion. It is important to stress to patients that there is no role for treatment when they lack travel history, exposure history, or flu like symptoms. There is no role currently for mass prophylaxis as the antivirals only protect you as long as you are taking them and cases are too sparse and mild to justify this use.
How do I get tested? Where do I send labs?
Again the patients must have symptoms and travel history of concern in order to be tested. If this is the case it is appropriate to obtain a rapid influenza test. Regardless of the results of the rapid test, specimens should be submitted for specific influenza testing. Local laboratory guidance should be sought on what type of specimen to collect for your State. CDC guidelines on lab testing and collection can also be found at - This Page Has Moved
Further information may be found at the following sites:
This Page Has Moved
WHO | Disease Outbreak News