H1N1 Update

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					                                          H1N1 Update
                                           Date: 07/20/09

H1N1 Report for July 20, 2009
from notes from Dr. Susan Kellie

Global:
      The WHO has announced a transition from individual case counting to monitoring disease activity
        using tools used in the monitoring of seasonal influenza. Their statement reads, “The increasing
        number of cases in many countries with sustained community transmission is making it
        extremely difficult, if not impossible, for countries to try and confirm them through laboratory
        testing. Moreover, the counting of individual cases is now no longer essential in such countries
        for monitoring either the level or nature of the risk posed by the pandemic virus or to guide
        implementation of the most appropriate response measures.”
      Detailed information will only be required from newly affected countries: “WHO will continue to
        request that newly affected countries report the first confirmed cases and, as far as feasible,
        provide weekly aggregated case numbers and descriptive epidemiology of the early cases.”
      WHO has now moved reporting and commentary on H1N1 to its regional reporting network,
        providing region-specific guidance.
U.S.
      40,617 cases and 263 deaths were reported as of July 17, 2009.
      Influenza activity ranges from widespread to sporadic in different states, with all states reporting
        some influenza activity.
      Typing shows that all typed strains are related to the A/California/07/2009 (H1N1) strain
        identified by WHO as the potential candidate for the H1N1 pandemic vaccine.
      In a CDC press conference Friday July 17, CDC officials predicted that H1N1 would probably
        return in force earlier than usual this year, saying that they expected it to erupt as soon as
        schools open rather than in October and November. H1N1 is still circulating in the United States,
        especially in summer camps, even though hot weather has arrived and the regular influenza
        season ended months ago, “so we expect challenges with people return to school, when kids are
        congregating together,” said Dr. Anne Schuchat, director of respiratory diseases at CDC (New
        York Times, Saturday July 18).
New Mexico
      Influenza activity is reported as local.
      TriCore Reference Laboratories requests for virus detection in the week from 07/04/09 to
        07/10/09:
        Respiratory viruses - 72 requests with 8 positives.
        2 - Adenovirus
        3 - Influenza A
              0-2 yo - 1
              3-5 yo - 0
              6-11 yo - 0
              12-18 yo - 1
              19-64 yo - 1
              > 65 yo - 0
        3 – HPMV

Vaccination:
Per CDC, it is unknown if the pandemic influenza vaccine being tested now will be available at the
beginning of the anticipated influenza season. Supplies will be directed to those at greater risk of
complications of influenza, such as pregnant women, and those most likely to encounter patients with
influenza, such as healthcare workers.

Treatment:
CDC anticipates that most illness will be mild and patients will recover without specific treatment.
Oseltamivir is reserved for those at higher risk of complications.
Clinicians should familiarize themselves with the following guidance that CDC provides for home care of
presumed influenza patients.



              Home Care Guidance: Physician Directions to Patient/Parent

You will probably be sick for several days with fever and respiratory symptoms. Take
Medications as Prescribed:
    ·       Take all of the antiviral medication as directed.
    ·       Continue to cover your cough and wash your hands often, even when taking antiviral
         medications, to prevent spreading influenza to others.
    ·       Call the office if you (or your child) experience any side effects; i.e. nausea, vomiting, rash,
         or unusual behavior.
    ·       Take medications for symptom relief as needed for fever and pain such as acetaminophen
         (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin ®), and cough medicine. These medicines
         do not need to be taken regularly if your symptoms improve.
    ·       Do not give aspirin (acetylsalicylic acid) or products that contain aspirin (e.g. bismuth
         subsalicylate – Pepto Bismol) to children or teenagers 18 years old or younger.
    ·       Children younger than 4 years of age should not be given over-the-counter cold medications
         without first speaking with a health care provider.

Seek Emergency Care
If your child experiences any of the following:
      ·       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

In adults, emergency warning signs that need urgent medical attention include:
     ·       Difficulty breathing or shortness of breath
     ·       Pain or pressure in the chest or abdomen
     ·       Sudden dizziness
     ·       Confusion
     ·       Severe or persistent vomiting
     ·       Flu-like symptoms improve but then return with fever and worse cough

Follow These Home Care Recommendations:
     ·     Stay home for 7 days after your symptoms begin or until you have been symptom-free for
        24 hours, whichever is longer
     ·     Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to
        keep from being dehydrated.
     ·     Dishes can be done in dishwasher or with hot soapy water.
     ·     Throw away tissues and other disposable items used by the sick person in the trash. Wash
        your hands after touching used tissues and similar waste.
     ·     Have everyone in the household wash hands often with soap and water, especially after
        coughing or sneezing. Alcohol-based hand cleaners are also effective.
     ·     Avoid touching your eyes, nose and mouth. Germs spread this way.

For more detailed information about novel H1N1 home care, visit www.cdc.gov/h1n1flu or call 1-800-
CDC-INFO.

				
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