Health Update
SWINE INFLUENZA A (H1N1) UPDATE: DELAWARE

SITUATION UPDATE

The Delaware Division of Public Health provides the following situation update on the ongoing Swine Influenza investigation. The situation continues to evolve and additional information will be released as it becomes available. There are no confirmed cases in Delaware.

As part of an ongoing investigation into an outbreak of swine influenza A (H1N1) in the United States and Mexico, public health officials believe that more cases will be identified over the next several weeks based on the rapid spread of the virus thus far. Case counts are updated daily and available at: http://www.cdc.gov/swineflu/investigation.htm.

The U.S. cases have had self-limited febrile respiratory illness and were seen on an out-patient basis only. As of April 27^th at 1:00 p.m., Centers for Disease Control and Prevention (CDC) reported 40 confirmed cases from five states (CA, KS, NY, OH, and TX). None had any exposure to swine and all had viruses with identical genetic sequences that contain a unique combination of gene segments previously not seen in humans or swine in the United States. The viruses that were tested were resistant to Amantadine and Rimandatine, but sensitive to Oseltamivir and Zanamivir.

INFORMATION FOR CLINICIANS

Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who:

• Live in an area where human cases of swine influenza A (H1N1) has been identified or;
• Have traveled to an area where human cases of swine influenza A (H1N1) has been identified; or
• Have been in contact with ill persons from these areas in the seven days prior to their illness onset.

If swine flu is suspected, clinicians should obtain a respiratory swab for Swine Influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact the Delaware Public Health Laboratory at (302) 223-1520 to facilitate transport and timely diagnosis.

Please refer to CDC website for the swine case definition for the Swine Flu: http://www.cdc.gov/swineflu/casedef_swineflu.htm. For more information about swine flu: call the Delaware Division of Public Health’s Bureau of Epidemiology at (302) 744-4541 or log on to http://www.cdc.gov/swineflu. Additional information is also available by calling 1-800-CDC-INFO (1-800-232-4636).

CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

• Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A and B virus infection in people one year of age and older.
• Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus infection in people 7 years and older and to prevent influenza A and B virus infection in people 5 years and older.

Recommendations for using antiviral drugs for treatment or prevention of swine influenza will change as we learn more about this new virus.

Clinicians should consider treating any person with confirmed or suspected swine influenza with an antiviral drug. Visit: http://www.cdc.gov/swineflu/recommendations.htm for specific recommendations.

Laboratory Information

The Delaware Public Health Laboratory (DPHL) is requesting specimens from suspect Influenza-like illness cases with a history of travel to Mexico or exposure to known or suspected cases of Swine Flu.

INFORMATION FOR LABORATORIANS

Due to the recent cases of a novel Swine Influenza as noted above, please send positive influenza samples to DPHL. DPHL needs your help to assess the influenza subtype(s) that may be present in our communities. Therefore, when your laboratory obtains a positive rapid A influenza result, including PCR (or culture-positive), please send an appropriate sample to DPHL Appropriate sample types are listed below.

What sample type to submit to DPHL:

• Preferred specimen is a combination throat/nasal pharyngeal swab or oral pharyngeal swab; most other routine respiratory specimens will be acceptable.
• When influenza is detected in your laboratory by RAPID TESTING methods, please send an aliquot (1-2 ml) of the original suspension (not exposed to test kit reagents) in viral transport media or sterile diluent; or if an additional original specimen is available, that is preferable.
• When influenza is detected in your laboratory by VIRAL CULTURE, please send the actively growing viral culture tube with 2 ml of viral maintenance media.
• If you have questions regarding specimen collection, please call Rebekah Parsons at (302) 223-1520.
• If you need swabs for specimen collection,  e-mail labsupplies@delaware.gov.
• If you need a specimen test request form,  go to the DPHL web site http://www.dhss.delaware.gov/dhss/dph/lab/files/testreq.pdf

General Information for Prevention:

There are every day actions people can take to stay healthy:

• Cover the nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after use.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Try to avoid close contact with sick people. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

New guidance is available at:

• http://www.cdc.gov/swineflu/recommendations, including:
  • Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts
  • Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home
  • Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected
  • Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers
  • Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting
  • Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases

For more information, please contact the Delaware Division of Public Health at (302) 744-4541.