Health Advisory
NEW AND UPDATED GUIDANCE RELATED TO NOVEL H1N1 FLU

Delaware Division of Public Health (DPH) would like to share the following new and updated guidance from the Centers for Disease Control and Prevention (CDC) related to H1N1 influenza with the Delaware community.

As of May 27, 2009 there are 112 laboratory-confirmed cases of H1N1 in Delaware. Of the 112 cases, 95 are in New Castle County, 12 in Kent County and 4 in Sussex County. There have been two short hospitalizations related to H1N1 but all cases have recovered, or are recovering, without complications. The ages of the laboratory-confirmed cases ranges from 1 to 41 years.

Influenza illness, including illness associated with the novel influenza A H1N1 virus is ongoing in the United States. The May 22 FluView Report shows that influenza activity is decreasing in the United States; however, levels of influenza-like illness are higher than normal for this time of year. At this time, the majority of influenza viruses isolated in the United States are now novel H1N1 viruses.

It’s uncertain at this time how severe this novel H1N1 outbreak will be in terms of how many people infected have severe complications or death related to novel H1N1 infection. While nation-wide influenza-like-illness surveillance is trending downward, localized outbreaks are ongoing and it’s likely that such outbreaks will continue over the summer. It’s uncertain how the novel H1N1 virus will affect the upcoming 2009-2010 influenza season.

The Centers for Disease Control and Prevention continues its response to the novel H1N1 Flu outbreak. CDC's goals continue to be to reduce the spread and severity of illness and to provide information to assist health care providers, public health officials, and the public address the challenges posed by this emergency. To this end, CDC continues to develop and update guidance documents and provide other information.

New on the CDC Web Site:

Interim Guidance for Correctional and Detention Facilities on Novel Influenza A (H1N1) Virus

• This interim guidance is specific to correctional facilities  to ensure continuation of essential public services and protection of the health and safety of inmates, staff and visitors in the context of a novel influenza A (H1N1) virus outbreak.

Guidelines for the Submission of Tissue Specimens for the Pathologic Evaluation of Influenza Virus Infections

• This guidance has been updated to refine the specimen sampling recommendations and to provide more detailed shipping instructions.

Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission

• This document provides updated interim guidance on the use of facemasks and respirators for decreasing exposure to novel influenza A (H1N1) virus.

FluView Report

• The Epidemiology and Prevention Branch in the Influenza Division at CDC collects, compiles and analyzes information on influenza activity year round in the United States and produces a weekly report published each Friday called “FluView” at http://www.cdc.gov/flu/weekly/

Antiviral Use:

As a reminder to clinicians, CDC recommends that influenza antiviral treatment be given to all hospitalized patients with confirmed, probable, or suspected novel influenza A (H1N1) and any patient with confirmed, probable or suspected novel influenza A (H1N1) who is at higher risk for seasonal influenza complications. All hospitalized patients should be carefully monitored and treated with antiviral medications as soon as possible after admission, including patients who seek treatment more than 48 hours after onset of symptoms. The drugs recommended for treatment are either oseltamivir or zanamivir. The novel H1N1 viruses are resistant to amantadine and rimantadine.

Testing Guidelines:

Not all people with suspected novel influenza (H1N1) infection need to have the diagnosis confirmed, especially if the person resides in an affected area or if the illness is mild, such as in Delaware.

Clinicians should test persons who have an acute febrile respiratory illness or sepsis-like syndrome and 1) require hospitalization or 2) are at high-risk for severe disease (as listed below). As always, clinicians should use their clinical judgment, in addition to this guidance when deciding when to test for novel influenza A (H1N1). The full CDC recommendation can be found here: http://www.cdc.gov/h1n1flu/identifyingpatients.htm.

Specimen storage and transportation information can be found here:  http://www.dhss.delaware.gov/dhss/dph/php/alerts/dhan177.html

Groups at higher risk for seasonal influenza complications include:

• Children less than 5 years old
• Persons aged 65 years or older
• Children and adolescents (< 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza infection
• Pregnant women
• Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)
• Residents or nursing homes or other chronic-care facilities

For more information please contact the Bureau of Epidemiology at: 1-888-295-5156 or 302-744-4541

CDC specific information regarding H1N1 Flu can be found here: http://www.cdc.gov/h1n1flu/

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