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					NH DHHS-DPHS
NH-HAN #20090519 H1N1 Clinical Guidance – Rev 4                                                        Page 11




                    Algorithm for H1N1 Influenza Testing for a Patient in Clinic/ED
                      New Hampshire Department of Health and Human Services
                                            May 19, 2009

                                                                                            Patient is not
                 INFLUENZA-LIKE ILLNESS CLINICAL CRITERIA                                   suspected to have
   A patient who has recent onset of fever and cough or sore throat with or                 influenza.
                                                                                    No      Testing is not
   without any of the following:
   chills, headache, rhinorrhea, shortness of breath, myalgias, arthralgias,                recommended.
   fatigue, vomiting, or diarrhea
                                                                                            Additional work up and
                                                                                            follow up as clinically
                                                 Yes                                        needed
                          AND
              Does the patient fall in one of the following groups?:
       1.   Community role in which has close contact with citizens and
            this may lead to exposure of a large or vulnerable population.
            Relevant only if contact occurred during infectious period – the
            day prior to or for 7 days following symptoms onset (e.g.,
            healthcare worker)
                     OR                                                              Patient is suspected to have
                                                                               No
       2.   Patient is suspected to be part of a cluster of undiagnosed              influenza, possibly H1N1 flu,
            respiratory illness – in consultation with public health.                but would not require antiviral
                     OR                                                              treatment and Influenza
       3.   Patient is high-risk for influenza complications*                        testing not recommended.
                     OR
       4.   Symptoms/signs severe enough to warrant admission.                       Initiate interim H1N1 influenza
                                                                                     infection control precautions

                                              Yes                                    Additional work up and follow
                                                                                     up as clinically needed
  •   Initiate interim H1N1 influenza infection control precautions.
  •   Notify NH public health professionals who are available 24/7 at                Patient should:
      603-271-4496, or toll-free at 800-852-3345, ext. 4496 to report
                                                                                     •   stay at home **.
      suspect case
                                                                                     •   use hand, respiratory and
  •   Send nasopharyngeal specimens for influenza testing to the NH
      PHL if a rapid influenza test result: 1) is not available, 2) was                  cough hygiene
      negative, or 3) was positive for influenza A                                   •   call if symptoms worsen.
  •   Consider empiric antiviral treatment for patients suspected to have
      H1N1 flu
  •   Help identify contacts, including healthcare workers


  * High risk patients:
  - Children less than 5 years old (risk is highest among children less than 2 years of age),
  - Patient 65 years or older,
  - Pregnant women
  - Adults and children with chronic pulmonary (including asthma) cardiovascular (except hypertension), renal
  hepatic, hematological, neurologic, neuromuscular, metabolic disorders (including diabetes mellitus), or
  immunosuppression (including from medications and HIV), residents of nursing homes and other chronic
  health facilities, children/adolescents receiving chronic aspirin treatment (at risk for Reye syndrome from
  influenza).

  ** Patients with probable/confirmed H1N1 flu, or contact with a probable/confirmed case of H1N1 flu should
  stay at home 7 days from symptoms onset (or longer of symptoms persist). If suspicion for H1N1 Flu is low –
  patients may return to their activities when they are asymptomatic.
NH DHHS-DPHS
NH-HAN #20090519 H1N1 Clinical Guidance – Rev 4                                                       Page 12



                            Algorithm for H1N1 Influenza Triage Calls
                      New Hampshire Department of Health and Human Services
                                          May 19, 2009

                                                                            Patient is not suspected to have
             INFLUENZA-LIKE ILLNESS                                         Influenza.
                 CLINICAL CRITERIA                           No             Testing is not recommended.
 A patient who has recent onset of fever and cough
 or sore throat with or without any of the following:                       Additional work up and follow up
 chills, headache, rhinorrhea, shortness of breath,                         as clinically needed
 myalgias, arthralgias, fatigue, vomiting, or diarrhea


                        AND
                  Yes                                Does the patient fall in one of the following groups?:
                                                1. Community role in which has close contact with citizens and
   Ask the patient:                                this may lead to exposure of a large or vulnerable population.
   “Would you usually seek           No            Relevant only if contact occurred during infectious period – the
   medical care for this illness?                  day prior to or for 7 days following symptoms onset (e.g.,
                                                   healthcare worker)
                                                            OR
                                                2. Close contact with a person who is a confirmed case of H1N1
     Yes                                           influenza within 7 days of symptom onset.
                                                            OR
                                                3. Patient is suspected to be part of a cluster.
                                                            OR
                                                4. Patient is high-risk for influenza complications*


                                          Yes                                            No

                                                         Patient is suspected to have influenza, possibly H1N1 flu,
                                                         but would not require antiviral treatment and Influenza
                                                         testing is not recommended.
   Recommend:
   “Go see your healthcare                               Additional work up and follow up as clinically needed
   provider”
                                                         Patient should:
                                                         •   stay at home**
                                                         •   use hand, respiratory and cough hygiene
                                                         •   call if symptoms worsen.

* High risk patients:
- Children less than 5 years old (risk is highest among children less than 2 years of age),
- Patient 65 years or older,
- Pregnant women
- Adults and children with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal
hepatic, hematological, neurologic, neuromuscular, metabolic disorders (including diabetes mellitus), or
immunosuppression (including from medications and HIV), residents of nursing homes and other chronic
health facilities, children/adolescents receiving chronic aspirin treatment (at risk for Reye syndrome from
influenza).

** Patients with probable/confirmed H1N1 flu, or contact with a probable/confirmed case of H1N1 flu should
stay at home 7 days from symptoms onset (or longer of symptoms persist). If suspicion for H1N1 Flu is low –
patients may return to their activities when asymptomatic.

				
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