From:
Michael Musicant MD, Chief of Staff
Gonzalo Ballon-Landa MD, Medical Director of
Infection Prevention
Diagnostic Testing: The San Diego County
Public
Health Department ("SDPHD") will no longer test for
swine influenza A (H1N1) on outpatients who present
with influenza-like illness (ILI); they have adequate
surveillance samples.
Antiviral Treatment/Prophylaxis (pending
information
regarding availability of antivirals):
· People who are experiencing
uncomplicated ILI should not be receiving anti-viral
treatment.
· Given the limited supply of antivirals,
priority will be given to treatment over
chemoprophylaxis.
· To avoid the development of resistance in
any individuals please do not deviate from the
standard dosage protocols and encourage patients to
complete prescribed courses.
Treatment (in order of priority):
1) Hospitalized confirmed or probable cases
of swine influenza who are admitted to an intensive
care unit or have evidence of respiratory failure. For
hospitalized patients where influenza is highly
suspected but swine flu not yet confirmed, consider
treatment with oseltamavir + an amantadine (for
seasonal influenza A, where oseltamavir resistance is
high) OR zanamivir.
2) Hospitalized confirmed or probable cases
of swine influenza who are at high-risk for influenza
complications.
3) Any hospitalized confirmed or probable
case of swine influenza.
Non-hospitalized confirmed or probable cases of
swine influenza who are at high-risk for influenza
complications
4) Other non-hospitalized confirmed cases of
swine influenza if treatment can be started within 48
hours of symptom onset.
5) Close contacts of a confirmed or probable
case of swine influenza with ILI who are at high-risk
for influenza complications
6) Health care workers or public health
workers with ILI who have had close contact with a
confirmed or probable case of swine influenza.
7) Any close contact with ILI of a confirmed
or probable case of swine influenza.
8) Duration of treatment: the CDC
recommend of oseltamivir or zanamivir for 5 days.
Chemoprophylaxis:
1) Household close contacts who are at
high-risk for complications of influenza of a confirmed
or probable case.
2) School children who are at high-risk for
complications of influenza who had close contact
with a confirmed or problem case.
3) Health care workers or public health
workers who had unprotected close contact with an
ill confirmed case of swine influenza A (H1N1) virus
infection.
4) Duration of chemoprophylaxis per CDC
recommendation: 10 days; the dosage is one-half the
dose needed for therapy.
Footnotes:
Influenza like illness
(ILI): temperature >100.ºF, rhinorrhea, cough,
sore throat,
chills, headaches, fatigue, mylagias, sometimes
nausea, vomiting, diarrhea.
CDC
Definitions:
Probable case of swine flu: as a person with ILI who
is: a) positive for influenza A, but negative for H1 and
H3 by influenza RT-PCR, or b) 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: a person
with ILI with onset a) within 7 days of close contact
with a person who is a confirmed case of swine
influenza or b) within 7 days of travel to community
either within the United States or internationally where
there are one or more confirmed swine influenza
cases, or c) resides in a community where there are
one or more confirmed swine influenza
cases.
High-risk individuals include:
· All children aged 6 months to 4 years.
· Children and adolescents receiving long-
term ASA and who might be at risk for experiencing
Reye syndrome after influenza virus infection
· Women who are pregnant
· Adults and children with chronic
pulmonary, cardiovascular (except hypertension),
renal, hepatic, hematological, or metabolic disorders
(including diabetes mellitus)
· Adults and children with
immunosuppression (HIV or other types of
immunocompromised states)
· Adults and children with any conditions
that could compromise respiratory function.
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.
