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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

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Swine influenza april 30 2009 bill mason md jill hoffman md dawn england mph

Swine Influenza

April 30, 2009

Bill Mason, MD

Jill Hoffman, MD

Dawn England, MPH


Overview
Overview

  • Review what is currently known about Swine Influenza

  • Discuss Infection Control for Swine Influenza


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



Signs symptoms
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

Rhinitis

MMWR 2003; 52#RR8:2-3

Children

Abrupt onset

Fever 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


Clinical findings of influenza1

Adults

I.P.: 1-4 days

Infectious: day –1 to +5

Children

I.P.: 1-4 days

Infectious: day –4 to + 10

Clinical findings of influenza


Infectious period
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
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:

      • Are a contact to a confirmed swine influenza case

      • Are part of a cluster of people reported with ILI

      • Traveled to affected areas in the 7 days preceding illness

      • Were in contact with persons with ILI who were in affected areas during the 7 days preceding illness onset

      • Are hospitalized with ILI or pneumonia


Infection control of swine influenza
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 visit

  • No one with s/s of ILI is allowed to enter hospital

  • Routine 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 influenza1
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 influenza2
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 influenza3
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
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
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
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
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