Got this yesterday from the NMDOH, FWIW. They are taking it pretty seriously.See full DOH message below.
Sporadic cases of swine flu have been detected in California and Texas. All providers are asked to participate in enhanced surveillance for flu-like illness.
All patients presenting with influenza-like illness should have a nasopharyngeal swab for respiratory viruses. If Influenza A is detected, then providers should obtain viral cultures and call the Epidemiology and Response Division epidemiologist on-call at 505-827-0006 for further instruction. Institute droplet precautions and respiratory hygiene for all coughing patients.
!!! NM Dept of Health General Notification Message !!!
Message ID 912 Sent 4/23/2009 6:17:36 PM Mountain Time
THIS A NEW MEXICO HEALTH ADVISORY
Swine Influenza Cases Confirmed in United States
This information is being sent to infection
control practitioners, hospitals, physicians,
primary care contacts and facilities,
occupational medicine clinics, long-term care
facilities, student health clinics, schools,
first responders, emergency managers, IHS
contacts and facilities, CHRs, environmental and public health contacts.
*** PLEASE DISTRIBUTE THIS INFORMATION FREELY. ***
=== TO SCHOOL HEALTH ADVOCATES AND SCHOOL
SUPERTINTENDENTS: You are reminded to forward
this notification to the school nurses in your region/district. ===
===TO COUNTY FIRE AND EMS OFFICIALS: You are
reminded to forward this notification to the
district/volunteer departments/services in your county. ===
===============================================
Summary:
Swine influenza cases have been confirmed in the
United States in five children and two adults.
===============================================
Detailed Message:
NEW MEXICO SWINE INFLUENZA HEALTH ADVISORY
- As of April 23, 2009, five California
residents (three children and two adults) and two
Texas residents (two children) have been
diagnosed with swine influenza A (H1N1) virus
infection. The California cases are from San
Diego and Imperial counties while the Texas cases
are from the San Antonio area. All had a febrile
illness and were sick enough to have received
medical evaluation. All have resolved clinically.
One was hospitalized and has been discharged. No
deaths have occurred. Illness onsets range from
March 28th to April 13th 2009. There are no known
epidemiologic links between the California and
Texas cases. There were also no known exposures
to swine within the incubation period for any of
the seven cases. These facts suggest that there
is likely human-to-human transmission that is ongoing.
- The viruses from the seven cases are
closely related genetically and contain a unique
combination of gene segments that have not
previously been reported in the United States or
elsewhere. Preliminary testing showed the
viruses in the first two patients were
susceptible to oseltamivir and zanamivir, but
resistant to amantadine and
rimantadine. Antiviral susceptibility on viruses
from the additional five cases is pending, but is anticipated to be the same.
- Seasonal human influenza vaccine usually
does not protect against swine influenza A H1N1
viruses, which are very different in their
antigens from human H1N1 viruses; but studies on
whether this season's influenza vaccine may offer
some cross-protection are ongoing.
- Swine influenza (swine flu) is an endemic
respiratory disease of pigs caused by type A
influenza virus, typically H1N1 and H3N2 strains.
- Swine influenza viruses do not normally
infect humans. However, sporadic human infections
with swine flu do occur. From January, 2005
through February, 2009, 12 human cases of swine
flu were detected in other parts of the United States; all patients recovered.
- Most commonly, these cases occur in persons
with direct exposure to pigs (e.g., workers in
the swine industry). Although it has been
documented, human-to-human transmission of swine
flu is rare. However, the current situation in
California and Texas suggests that human-to-human
transmission may be occurring.
HEIGHTENED SURVEILLANCE FOR POSSIBLE SWINE INFLUENZA
- Because of concern about possible
human-to-human transmission of swine flu,
enhanced statewide influenza surveillance in New
Mexico is necessary to identify if cases are occurring here.
- HOSPITALIZED PATIENTS: Until otherwise
notified, we ask that specimens be collected (see
below) from patients who meet the definition for
influenza-like illness and are hospitalized in
New Mexico with suspect or confirmed influenza.
o Influenza-Like Illness Definition
(ILI): Fever greater or equal to 37.8°C (100°F) AND a cough and/or sore throat
- INFLUENZA SENTINEL PROVIDERS: We also ask
that influenza sentinel surveillance providers in
New Mexico collect specimens from outpatients who
meet the definition for influenza-like illness above.
- ALL OTHER HEALTH CARE PROVIDERS: If your
patient meets the definition for influenza-like
illness above and has a rapid influenza test
positive for influenza A, we ask that you collect
a nasopharyngeal swab for viral culture and call
the Epidemiology and Response Division epidemiologist on-call at 505-827-0006.
SPECIMEN COLLECTION AND STORAGE
- Please collect one nasopharyngeal swab from
each patient with ILI, placing the swab in a
standard container with 2-3 ml of viral transport
media. If the patient is hospitalized with
pneumonia, specimens for viral culture from the
lower respiratory tract (e.g., tracheal aspirate,
bronchoalveolar lavage) should also be obtained.
Specimens should be collected within the first
24-72 hours of onset of symptoms and no later
than 5 days after onset of symptoms.
- Specimen storage: The specimens should be
kept refrigerated at 4ºC and sent on cold packs
if they can be received by the Scientific
Laboratory Division (SLD) of the New Mexico
Department of Health (NMDOH) within five days of
the collection date. If samples will be received
by the laboratory in five or more days from
collection, they should be frozen at -70ºC or below and shipped on dry ice.
- Specimens should be shipped to: Scientific
Laboratory Division, 700 Camino De Salud NE
Albuquerque, NM 87131 (505) 841-2500.
INFECTION CONTROL PRECAUTIONS
- Healthcare workers providing care for
patients with ILI who are not known contacts of a
laboratory-confirmed swine flu case, should use
droplet precautions (i.e., wear a surgical or
procedure mask for close contact), in addition to
standard precautions. Standard precautions
include hand hygiene and the use of eye
protection if splashing or spraying of blood or
body fluids (including respiratory secretions) is anticipated.*
- Healthcare workers providing care for a
laboratory-confirmed swine flu case or an ill
close contact of a laboratory-confirmed swine flu case should:
1) Wear a fit-tested N95 respirator,
disposable gloves, gown, and eye protection (face shield or goggles).
2) Before and after contact with the
patient, clean hands thoroughly with soap and
water or an alcohol-based hand gel.
- Suspect swine flu patients (ill close
contact of a laboratory-confirmed swine flu case)
should be asked to wear a surgical mask and
should be promptly isolated in an airborne
infection isolation room, if available, or in a
single room with a door that closes.
* Splashing or spraying of body fluids
may be anticipated when collecting a nasopharyngeal or throat swab.
There will be follow-up messages when further information becomes available.
CDC information on swine flu is available at:
http://www.cdc.gov/flu/swine/investigation.htm===============================================
Health alerts are messages from the New Mexico
Department of Health that contain important
information for responding to a health
emergency. Health alerts are sent to health care
providers, emergency responders, first
responders, and other affiliated professionals.
There are four types of messages that come from the Health Alert Network (HAN):
ALERT: Conveys the highest level of importance;
warrants immediate action or attention.
ADVISORY: Provides important information for a
specific incident or situation; may not require immediate action.
UPDATE: Provides updated information regarding
an incident or situation; unlikely to require immediate action.
TEST: Tests the alerting system technologies,
the ability to reach the intended recipients, or
provides simulated alerts for exercise purposes.
If you have questions about the Health Alert
Network, please contact the HAN at health.alert@cw.nmhealth.org.