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Swine Influenza April 30, 2009 Bill Mason, MD Jill Hoffman, MD Dawn England, MPH. Overview. Review what is currently known about Swine Influenza Discuss Infection Control for Swine Influenza. Swine Influenza. Respiratory disease of pigs caused by type A influenza viruses - PowerPoint PPT Presentation
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Swine Influenza
April 30, 2009
Bill Mason, MDJill Hoffman, MD
Dawn England, MPH
Overview
Review what is currently known about Swine Influenza
Discuss Infection Control for Swine Influenza
Swine Influenza
Respiratory disease of pigs caused by type A influenza viruses
Swine influenza A (H1N1) virus is contagious and is spreading from human to human
Not known how easily the virus spreads between people
U.S. Human Cases of Swine Flu Infection
State # lab confirmed cases
Arizona 1 case
California 14 cases
Kansas 2 cases
New York City 51 cases
Ohio 1 case
Indiana 1 case
Nevada 1 case
Michigan 2 cases
Mass. 2 cases
Texas 16 cases
Total Count 91 cases
Signs & Symptoms
Signs & Symptoms: Fever Cough Sore throat Body Aches Headache Chills Fatigue Diarrhea and vomiting in some
Clinical findings of influenza
Adults
Abrupt onset
Fever
Myalgia
Headache
Severe malaise
Cough
Sore throat
RhinitisMMWR 2003; 52#RR8:2-3
ChildrenAbrupt onsetFever 89-94%Cough 60-67%Rhinorrhea 56-66%Vomiting 17-19%Diarrhea 8-9%Headache 23-24%Myalgia 6-15%Otitis media 19-26%Clin Infect Dis 2003;36:299-302
Clinical findings of influenza
Adults
I.P.: 1-4 days
Infectious: day –1 to +5
Children
I.P.: 1-4 days
Infectious: day –4 to + 10
Infectious Period
Persons with swine influenza A should be considered contagious for up to 7 days following onset of illness
Children may be contagious for longer periods
* CDC Guidelines, Interim Guidance for Infection Control for Care of Patients with Confirmed/Suspected Swine Influenza in a Healthcare Setting. April 27, 2009.
Diagnostic Testing
Interim Recommendations for Testing (per LADPH)Clinicians should consider swine influenza infection in the differential diagnosis of patients with:
– Influenza-like illness (ILI) defined as fever ≥37.8ºC (100ºF) and a cough and/or sore throat AND one of the following:
1. Are a contact to a confirmed swine influenza case
2. Are part of a cluster of people reported with ILI
3. Traveled to affected areas in the 7 days preceding illness
4. Were in contact with persons with ILI who were in affected areas during the 7 days preceding illness onset
5. Are hospitalized with ILI or pneumonia
Infection Control of Swine Influenza
Patients suspected or confirmed status will be placed in single patient rooms, on AIRBORNE isolation, with the door closed– Gown/Glove/N95
Patients/Visitors must wear a surgical mask when outside patient room– Encourage hand hygiene, respiratory hygiene
No one under the age of 16 is allowed to visitNo one with s/s of ILI is allowed to enter hospitalRoutine cleaning and disinfection strategies used
*CDC Guidelines, Interim Guidance for Infection Control for Care of Patients with Confirmed/Suspected Swine Influenza in a Healthcare Setting. April 27, 2009.
Infection Control of Swine Influenza
Personnel providing direct patient care for suspected or confirmed cases should wear a N-95 respirator
Hand Hygiene
Respiratory Hygiene
Encourage staff to stay home if showing signs or symptoms
Infection Control of Swine Influenza
Communication– Daily from the CDC, State/Local health
departments on epidemiology and infection control
• Where applicable, emailed to all CHLA staff and posted on Intranet
• Direct care staff receive additional emails
– Conference call with LA County Department of Public Health every day
– Infection Control staff attend daily briefings with ED each morning and update PCS at bed huddle twice daily
Infection Control of Swine Influenza
Communication (continued)– Distribution of CDC, Swine Flu FAQ (Frequently
Asked Questions) flyers to all inpatient units• Available on Intranet
Inventory– Increased number of rapid flu assays in house– Ensure adequate supply of hand gels, soaps,
gowns, gloves and masks on units and in materials management
– Determined counts of Tamiflu in house
Pandemic Planning
Pandemic Influenza
Caused by new influenza viruses that have adapted to humans
Criteria for a pandemic influenza virus:– Novel influenza A strain– Little or no immunity in population– Person-to-person transmission with
disease
Current WHO Phase of Pandemic Alert
Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic will definitely occur.
Impact of influenza pandemics:
1918-1919 Spanish Flu– 20-40 million deaths worldwide– At least 550,000 deaths in US
1957-1958 Asian Flu– ~70,000 US deaths
1968-1969 Hong Kong Flu– ~34,000 US deaths
Potential Impact in the US
Moderate Severe
(1958-59) (1918-like)
Illness 90 million 90 million
Outpatient care 45 million 45 million
Hospitalization 865,000 9,900,000
ICU Care 128,750 1,485,000
Ventilation 64,875 742,500
Deaths 209,000 1,903,000
Questions?