Health Alert
FIRST CASE OF LAB CONFIRMED INFLUENZA A FOR THE 2012-2013 SEASON

Confirmed cases of influenza and influenza-associated mortality should be immediately reported to DPH, Bureau of Epidemiology at 1-888-295-5156.

Delaware Division of Public Health (DPH) reports the state’s first laboratory-confirmed case of influenza A (H3N2) for the 2012-2013 season. On October 23, 2012, the Delaware Public Health Laboratory (DPHL) confirmed a case of Influenza A (H3N2) in a 78 year-old female from Wilmington. The patient was not hospitalized.

Influenza vaccination is the best way to protect yourself and your family against the flu. Everyone 6 months of age and older should get vaccinated against influenza.

Background:

Beginning in October each year, DPH monitors the occurrence of influenza and influenza-like illness using sentinel physician network. Sentinel physicians are recruited and appointed by DPH and report weekly the percentage of influenza-like illness (ILI) seen during office visits. Sentinel physicians also provide specimens for Polymerase Chain Reaction (PCR) testing at the DPHL. ILI is also reported by hospital emergency departments, federally qualified health centers, selected long-term care facilities, selected colleges and universities, the Department of Corrections, and selected day care providers. Generally, ILI reports have not increased in Delaware suggesting that influenza, while present, has not yet been widely circulated this flu season.

Recommendations:

Preventing transmission of influenza virus within healthcare settings requires a multi-faceted approach. The spread of influenza virus can occur among patients, healthcare providers, and visitors. Healthcare providers can also acquire influenza from household or community contacts and, in turn, transmit the virus to patients. The core strategies for preventing the spread of influenza are:

1. Administer influenza vaccine to patients and staff.
2. Implement respiratory hygiene and cough etiquette, such as covering your mouth and nose with a tissue while coughing.
3. Manage all ill healthcare providers and staff by monitoring the symptoms, wearing facemasks while in activities, giving antiviral medication, not reporting to work till the resolution of the symptoms, and etc.
4. Adhere to infection-control precautions for all patient care activities, especially and aerosol-generating procedures.
5. Implement environmental and engineering infection control measures which can be found at: http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
6. Use respiratory hygiene recommendations below.

Respiratory Hygiene Recommendations

1. When there is increased respiratory infection activity in the community (increased school/work absenteeism, increased office visits for respiratory illness), offer masks to anyone who is coughing.
2. When space permits, encourage anyone who is coughing to sit at least three feet away from others in waiting areas.
3. Advise healthcare staff to use droplet precautions (wear a surgical or procedure mask for close contact) in addition to standard precautions when examining a patient with symptoms of a respiratory infection, especially if fever is present. These precautions should be maintained for seven days after patient’s illness onset or for 24 hours after the resolution of the fever and respiratory symptoms (whichever is longer) while a patient is in a healthcare facility.
4. Healthcare staff should wear respiratory protection equivalent to a fitted N95 respirator during aerosol-generating procedures such as bronchoscopy, sputum induction, intubation and extubation, autopsies, and open suctioning of airways.

Rapid Diagnostic Tests

Reliability and interpretation of results

1. Sensitivity (the probability that the test says a person has the flu when in fact they do have the disease) is approximately 50-70% when compared with viral culture or reverse transcription polymerase chain reaction (RT-PCR), and the specificity (the probability that the test says a person does not have the flu when in fact they are disease free) is approximately 90-95%.
2. False-positive results are more likely to occur when disease prevalence in the community is low and are generally found at the beginning and at the end of the flu season.
3. False-negative results are more likely to occur when disease prevalence is high in the community.

Minimize False Results By:

1. Using rapid diagnostic tests with high sensitivity and specificity.
2. Collecting specimens as early in the illness as possible (within four to five days of symptom onset).
3. Following manufacturer’s instructions, including proper collection and handling of specimens.
4. Considering sending specimens for viral culture or PCR to confirm positive results of rapid tests, especially when community prevalence of influenza is low.

Vaccination Development

Each year, experts from Food and Drug Administration (FDA), World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC) and other institutions study virus samples collected from around the world. They identify the influenza viruses that are the most likely to cause illness during the upcoming flu season so that people can be protected against them through vaccination.

On February 23, 2012 the WHO recommended that the Northern Hemisphere’s 2012-2013 seasonal influenza vaccine be made from the following three vaccine viruses:

• A/California/7/2009 (H1N1)pdm09-like virus;
• A/Victoria/361/2011 (H3N2)-like virus; &
• B/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of viruses).

While the H1N1 virus used to make the 2012-2013 flu vaccine is the same virus that was included in the 2011-2012 vaccine, the recommended influenza H3N2 and B vaccine viruses are different from those in the 2011-2012 influenza vaccine for the Northern Hemisphere due to this year’s flu forecast.

Vaccination Information

The Division of Public Health has launched the “Get It” campaign to encourage Delawareans to become immunized. In accordance with CDC recommendations, everyone age six months and older should be immunized unless there are medical counter indications. People who have the following should talk to their medical provider if they are seeking a vaccination:

1. A severe allergy to chicken eggs
2. A history of severe reaction to a flu vaccination
3. A moderate-to-severe illness with a fever (you should wait until you are better to get the vaccine)
4. A history of Guillain–Barré Syndrome (a severe paralytic illness, also called GBS)

Division of Public Health seasonal flu shot clinics are offered statewide and only intended for those who have no healthcare provider or whose insurance does not cover flu and pneumonia vaccinations. For further information, call 800-282-8672.

Antiviral Drug Treatment

Current guidance can be found at: http://www.cdc.gov/flu/antivirals/index.htm

Reporting

Confirmed cases of influenza and influenza-associated mortality should be immediately reported to DPH, Bureau of Epidemiology at 1-888-295-5156.

For more information, visit or go to:

1. DPH Bureau of Epidemiology 1-888-295-5156 or 302-744-1033
2. Delaware Public Flu Clinic Schedules call 1-800-282-8672 or visit http://www.dhss.delaware.gov/dhss/dph/fluclinics.html
3. DPH website at http://www.flu.delaware.gov
4. CDC website: http://www.cdc.gov/flu/professionals/index.htm
5. Delaware’s influenza data: http://dhss.delaware.gov/dhss/dph/epi/influenzawkly.html
6. National influenza data: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm
7. General and updated federal influenza information: www.Flu.Gov

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