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?