New guidelines for evaluation and treatment Pandemic Influenza A
Influenza Update 7-6-2009: Pandemic H1N1v
outbreaks of influenza continue throughout
• Children age 4 years and younger, especially children younger than age 2 years
• Adults age 65 and over
• Pregnant women
• Persons younger than 19 years of age and receiving chronic aspirin therapy
• Persons with the following conditions: chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematologic (including sickle cell disease) or metabolic disorders (including diabetes), immunosuppression (including HIV and medication induced), disorders of cognition or neuromuscular function which predispose to aspiration
• Residents of institutions such as nursing facilities
Treatment with antiviral influenza medication (oseltamivir, zanamivir) should be considered in persons at risk for complications if they have an influenza like illness :
• Fever >37.8C (100F)
• Sore throat and or cough
• No other explanation for their symptoms.
• onset of illness <48 hours
• Persons with severe disease thought to be influenza
Antiviral treatment is not indicated in persons who are not at risk for complications. Please discuss potential candidates for treatment with Infectious Diseases.
All persons with possible influenza should avoid contact with others until they are improved (usually about 7 days) and observe careful respiratory and hand hygiene . Persons with possible influenza who are seen in the office should avoid exposing other persons by covering mouth/noses with tissues when coughing and sneezing, wearing surgical masks if available, with and careful hand hygiene using alcohol-based gels or soap-and-water 15 second wash. Health care workers should treat suspected influenza patients in the office and in the hospital with "droplet precaution" isolation and should use appropriate protective measures: gown, gloves, protective eyewear, surgical mask (unless otherwise directed by Public Health or Infectious Diseases), and hand hygiene.
Public health departments have recommended viral testing in persons with severe disease or when the diagnosis is in doubt. Routine viral testing for influenza is not indicated at this time. Persons for whom treatment is begun should have nasopharyngeal viral cultures performed for influenza (see attachment for method for nasopharyngeal viral cultures).
Oseltamivir (Tamiflu®) and zanamivir (Relenza®) remain restricted to consultation with Infectious Diseases . Reports of neuraminidase resistance in H1N1v remain rare, but emphasize the need to treat appropriately.
Jared Spotkov MD
for the SCPMG Regional Infectious Diseases Specialists