Health Update
GUIDANCE AND SCREENING TOOL FOR SEASONAL INFLUENZA AND EMERGING INFECTIOUS DISEASES-HEALTHCARE FACILITIES (UPDATED 11-4-2015)

Background

The combination of global travel and travel-related emerging infectious diseases continues to pose a threat to public health here in the US and in Delaware. The 2014-15 Ebola virus disease (EVD) outbreak in West Africa has been the largest EVD outbreak in history with 28,607 people infected and 11,314 dead as of 11/3/2015. The Delaware Division of Public Health (DPH) continues to monitor returned travelers from Guinea and Sierra Leone. In addition, the outbreak of Middle East Respiratory Syndrome coronavirus (MERS-CoV) continues.

As in prior years, seasonal influenza remains a direct public health threat. (There were 28 influenza related fatalities in Delaware last influenza season). The 2015-16 influenza season has begun. Seasonal influenza activity in Delaware and neighboring states remains sporadic at this point (a few cases of laboratory confirmed influenza) but it is still too early to say what the magnitude of influenza activity will be this season.  As always, encourage patients to get the seasonal influenza vaccine

Summary

Early symptoms of many emerging infectious diseases can overlap with those of more common diseases, such as seasonal human influenza. Therefore, in order to prevent an emerging infectious disease outbreak, it is important for health care providers to maintain a high index of suspicion and always take a good social history (including travel history) from all patients presenting to health care facilities.

Ebola Virus Disease, MERS, zoonotic (animal origin) influenza, and other emerging infectious diseases often have non-specific symptoms which may be difficult to differentiate from more common infections, and in many cases, unless a good social and travel history is taken, these high-impact infections may be missed initially, putting many at risk for acquiring the infections.

Because seasonal influenza is easily spread from person to person by droplet spread and through fomites, it is important that steps are taken to minimize the risk of spread of influenza in healthcare settings.

Recommendations for Health Care Providers/Facilities

1. Develop a protocol to ensure that patients presenting to your facility with respiratory symptoms are immediately separated from other patients in the waiting and care areas
2. Develop a protocol to ensure that sick people visiting your facility are screened for travel to destinations outside of the continental U.S., and that they are also screened for unusual exposures (including exposure to sick animals).
3. A sample screening protocol is available on the DPH website at http://www.dhss.delaware.gov/dhss/dph/php/files/emergingandtravelrelatedinfdiseasescreeningtool.pdf.
   • NOTE: this is just a sample of a tool/protocol you may use. We recommend that you adjust this screening tool to meet the particular needs of your facility in order to ensure that your staff use the tool consistently and with all patients and can thus quickly pick up suspect cases.
4. Outpatient facilities: Ensure that your facility’s protocol allows for the immediate separation of suspect patients from common areas. Also ensure that you have at least a few sets of personal protective equipment (PPE) on hand for staff completing examinations to use, should the need arise and that staff are trained in the proper use of PPE. In addition, staff should be familiar with and adhere to appropriate infection control practices at all times to protect both staff and patients.
5. Inpatient facilities: Ensure that patients suspected of harboring a high-impact emerging infectious disease are placed in single occupancy room and that staff follow appropriate protocols for isolation precautions and personal protective equipment (PPE) use. Also ensure that staff receive regular routine training on proper use of PPE and infection control practices.
6. Call the DPH Office of Infectious Disease Epidemiology at 888-295-5156 immediately to report any suspected cases of an emerging infectious disease, particularly if you suspect a disease that is highly contagious.
7. Encourage patients to get the seasonal influenza vaccine
8. Put measures in place to ensure that staff do not become a vehicle for transmission of influenza to patients and other staff. Some such measures might include:
   • Mandating influenza vaccination in the absence of contra-indications; enforcing masking during patient care for staff who choose to not be vaccinated; protocols for the exclusion of sick or convalescing staff; enforcement of proper hand-hygiene and respiratory etiquette in all clinical areas
9. Remember that influenza is a reportable disease. All laboratory confirmed cases of influenza should be reported to the DPH at 888-295-5156

Additional Information

• Call Public Health OIDE at 888-295-5156 to immediately report any suspected cases of a high-impact emerging infectious disease including (but not limited to) Ebola, MERS-CoV
• Continue to report laboratory confirmed influenza cases electronically, through paper forms or by telephone
• If you are an outpatient facility and would like training for your staff on the proper use of PPE, or basic infection control practice, please call DPH at 888-295-5156
• Sample patient screening tool: http://www.dhss.delaware.gov/dhss/dph/php/files/emergingandtravelrelatedinfdiseasescreeningtool.pdf.

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