{"id":10075,"date":"2025-03-01T14:02:38","date_gmt":"2025-03-01T19:02:38","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan120\/"},"modified":"2025-03-02T00:46:49","modified_gmt":"2025-03-02T05:46:49","slug":"dhan120","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan120\/","title":{"rendered":"php\/alerts\/dhan120 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan120.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->120 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->June 8, 2006 11:43 AM <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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To contact DPH\n\n\n  about this Health Advisory, call 1-888-295-5156. This number is answered during normal business hours, and during non-business hours for\n\n\n  emergencies.\n\n\n<\/p>\n\n\n<h2 class=\"text-center\">\n\n\n  This is an official<br>\n\n\n  CDC Health Update\n\n\n<\/h2>\n\n\n<p>\n\n\n  Distributed via Health Alert Network<br>\n\n\n  June 07, 2006, 19:50 EDT (07:50 PM EDT)<br>\n\n\n  CDCHAN-00246-06-06-07-UPD-N\n\n\n<\/p>\n\n\n<h3 class=\"text-center\">\n\n\n  Updated Interim Guidance for Laboratory Testing of Persons with<br>\n\n\n  Suspected Infection with Avian Influenza A (H5N1) Virus in the United States\n\n\n<\/h3>\n\n\n<h4>\n\n\n  CDC Health Update\n\n\n<\/h4>\n\n\n<p>\n\n\n  This update provides revised interim guidance for testing of suspected human cases of avian influenza A (H5N1) in the United States and\n\n\n  is based on the current state of knowledge regarding human infection with H5N1 viruses. The epidemiology of H5N1 human infections has not\n\n\n  changed significantly since February 2004. Therefore, CDC recommends that H5N1 surveillance in the United States remain at the enhanced\n\n\n  level first established at that time. However, this revised interim guidance provides an updated case definition of a suspected H5N1\n\n\n  human case for the purpose of determining when testing should be undertaken and also provides more detailed information on laboratory\n\n\n  testing. Effective surveillance will continue to rely on health care providers obtaining information regarding international travel and\n\n\n  other exposure risks from persons with specified respiratory symptoms as detailed in the recommendations below. This guidance will be\n\n\n  updated as the epidemiology of H5N1 changes. Note: CDC is revising its interim guidance for infection control precautions for avian\n\n\n  influenza A (H5N1). These will be issued as soon as they are available.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Current Situation\n\n\n<\/h4>\n\n\n<p>\n\n\n  The avian influenza A (H5N1) epizootic (animal outbreak) in Asia has expanded to wild birds and\/or poultry in parts of Europe, the Near\n\n\n  East and Africa. Sporadic human infections with H5N1 continue to be reported and have most recently occurred in China, Egypt, Indonesia,\n\n\n  Azerbaijan, Cambodia, and Djibouti. In addition, rare instances of probable human-to-human transmission associated with H5N1 viruses have\n\n\n  occurred, most recently in a family cluster in Indonesia. So far, however, the spread of H5N1 virus from person to person has been rare,\n\n\n  inefficient, and unsustained. The total number of confirmed human cases of H5N1 reported as of June 7, 2006 has reached 225. The case\n\n\n  fatality rate for these reported cases continues to be approximately 50 percent. As of this date, H5N1 has not been identified among\n\n\n  animals or humans in the United States.\n\n\n<\/p>\n\n\n<p>\n\n\n  The epizootic in Asia and parts of Europe, the Near East and Africa is not expected to diminish significantly in the short term and it is\n\n\n  likely that H5N1 infection among birds has become enzootic in certain areas. It is expected that human infections resulting from direct\n\n\n  contact with infected poultry will continue to occur in affected countries. Since no sustained human-to-human transmission of influenza\n\n\n  H5N1 has been documented anywhere in the world, the current phase of alert, based on the World Health Organization (WHO) global influenza\n\n\n  preparedness plan, remains at Phase 3 (Pandemic Alert).*\u00a0 In addition, no evidence for genetic reassortment between human and avian\n\n\n  influenza A virus genes has been found. Nevertheless, this expanding epizootic continues to pose an important and growing public health\n\n\n  threat. CDC is in communication with WHO and other national and international agencies and continues to monitor the situation closely.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Reporting and Testing Guidelines\n\n\n<\/h4>\n\n\n<p>\n\n\n  CDC recommends maintaining the enhanced surveillance efforts practiced currently by state and local health departments, hospitals, and\n\n\n  clinicians to identify patients at increased risk for avian influenza A (H5N1). Guidance for enhanced surveillance was first described in\n\n\n  a HAN update issued on February 3, 2004 and most recently updated on February 4, 2005.\n\n\n<\/p>\n\n\n<p>\n\n\n  Testing for avian influenza A (H5N1) virus infection is recommended for:\n\n\n<\/p>\n\n\n<p>\n\n\n  A patient who has an illness that:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>requires hospitalization or is fatal; AND\n\n\n  <\/li>\n\n\n  <li>has or had a documented temperature of \u2265 38\u00b0C (\u2265 100.4\u00b0 F); AND\n\n\n  <\/li>\n\n\n  <li>has radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which\n\n\n  an alternate diagnosis has\u00a0not been established; AND<br>\n\n\n  <\/li>\n\n\n  <li>has at least one of the following potential exposures within 10 days of symptom onset:\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<ol class=\"upper-alpha\">\n\n\n  <li>History of travel to a country with influenza H5N1 documented in poultry, wild birds, and\/or humans, \u2020 AND had at least one of\n\n\n  the following potential exposures during travel:<br>\n\n\n    \u2022 direct contact with (e.g., touching) sick or dead domestic poultry;<br>\n\n\n    \u2022 direct contact with surfaces contaminated with poultry feces;<br>\n\n\n    \u2022 consumption of raw or incompletely cooked poultry or poultry products;<br>\n\n\n    \u2022 direct contact with sick or dead wild birds suspected or confirmed to have influenza H5N1;<br>\n\n\n    \u2022 close contact (approach within 1 meter [approx. 3 feet]) of a person who was hospitalized or died due to a severe unexplained\n\n\n    respiratory illness;\n\n\n  <\/li>\n\n\n  <li>Close contact (approach within 1 meter [approx. 3 feet]) of an ill patient who was confirmed or suspected to have H5N1;\n\n\n  <\/li>\n\n\n  <li>Worked with live influenza H5N1 virus in a laboratory.\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<p>\n\n\n  Testing for avian influenza A (H5N1) virus infection can be considered on a case-by-case basis, in consultation with local and state\n\n\n  health departments, for:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>A patient with mild or atypical disease\u2021(hospitalized or ambulatory) who has one of the exposures listed above (criteria A, B,\n\n\n  or C); OR\n\n\n  <\/li>\n\n\n  <li>A patient with severe or fatal respiratory disease whose epidemiological information is uncertain, unavailable, or otherwise\n\n\n  suspicious but does not meet the criteria above (examples include: a returned traveler from an influenza H5N1-affected country whose\n\n\n  exposures are unclear or suspicious, a person who had contact with sick or well-appearing poultry, etc.)\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  Clinicians should contact their local or state health department as soon as possible to report any suspected human case of influenza H5N1\n\n\n  in the United States.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Specimen Collection and Testing Guidelines\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>Oropharyngeal swab specimens and lower respiratory tract specimens (e.g., bronchoalveolar lavage or tracheal aspirates) are preferred\n\n\n  because they appear to contain the highest quantity of virus for influenza H5N1 detection, as determined on the basis of available data.\n\n\n  Nasal or nasopharyngeal swab specimens are acceptable, but may contain less virus and therefore not be optimal specimens for virus\n\n\n  detection.\n\n\n  <\/li>\n\n\n  <li>Detection of influenza H5N1 is more likely from specimens collected within the first 3 days of illness onset. If possible, serial\n\n\n  specimens should be obtained over several days from the same patient.\n\n\n  <\/li>\n\n\n  <li>Bronchoalveolar lavage is considered to be a high-risk aerosol-generating procedure. Therefore, infection control precautions should\n\n\n  include the use of gloves, gown, goggles or face shield, and a fit-tested respirator with an N-95 or higher rated filter. A loose-fitting\n\n\n  powered air-purifying respirator (PAPR) may be used if \u00a0 fit-testing is not possible (for example, if the person has a beard).\n\n\n  Detailed guidance on infection control precautions for health care workers caring for suspected \u00a0 influenza H5N1 patients is\n\n\n  available.||\n\n\n  <\/li>\n\n\n  <li>Swabs used for specimen collection should have a Dacron tip and an aluminum or plastic shaft. Swabs with calcium alginate or cotton\n\n\n  tips and wooden shafts are not recommended.\u00a7 Specimens should be placed at 4\u00b0C immediately after collection.\n\n\n  <\/li>\n\n\n  <li>For reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, nucleic acid extraction lysis buffer can be added to specimens\n\n\n  (for virus inactivation and RNA stabilization), after which specimens can be stored and shipped at 4\u00b0C. Otherwise, specimens should\n\n\n  be frozen at or below -70\u00b0C and shipped on dry ice. For viral isolation, specimens can be stored and shipped at 4\u00b0C. If specimens\n\n\n  are not expected to be inoculated into culture within 2 days, they should be frozen at or below -70\u00b0C and shipped on dry ice. Avoid\n\n\n  repeated freeze\/thaw cycles.\n\n\n  <\/li>\n\n\n  <li>Influenza H5N1-specific RT-PCR testing conducted under Biosafety Level 2 conditions\u00b6 is the preferred method for diagnosis. All\n\n\n  state public health laboratories, several local public health laboratories, and CDC are able to perform influenza H5N1 RT-PCR testing,\n\n\n  and are the recommended sites for initial diagnosis.\n\n\n  <\/li>\n\n\n  <li>Viral culture should NOT be attempted on specimens from patients suspected to have influenza H5N1, unless conducted under Biosafety\n\n\n  Level 3 conditions with enhancements.\u00b6\n\n\n  <\/li>\n\n\n  <li>Commercial rapid influenza antigen testing in the evaluation of suspected influenza H5N1 cases should be interpreted with caution.\n\n\n  Clinicians should be aware that these tests have relatively low sensitivities, and a negative result would not exclude a diagnosis of\n\n\n  influenza H5N1. In addition, a positive result does not distinguish between seasonal and avian influenza A viruses.\n\n\n  <\/li>\n\n\n  <li>Serologic testing for influenza H5N1-specific antibody, using appropriately timed specimens, can be considered if other influenza\n\n\n  H5N1 diagnostic testing methods are unsuccessful (for example, due to delays in respiratory specimen collection). Paired serum specimens\n\n\n  from the same patient are required for influenza H5N1 diagnosis: one sample should be tested within the first week of illness, and a\n\n\n  second sample should be tested 2-4 weeks later. A demonstrated rise in the H5N1-specific antibody level is required for a diagnosis of\n\n\n  H5N1 infection. Currently, the microneutralization assay, which requires live virus, is the recommended test for measuring H5N1-specific\n\n\n  antibody. Any work with live wild-type highly pathogenic influenza H5N1 viruses must be conducted in a USDA-approved Biosafety Level 3\n\n\n  enhanced containment facility. Visit <a href=\"http:\/\/www.cdc.gov\/flu\/h2n2bsl3.htm\" title=\"http:\/\/www.cdc.gov\/flu\/h2n2bsl3.htm\">http:\/\/www.cdc.gov\/flu\/h2n2bsl3.htm<\/a> for more information about procedures and facilities\n\n\n  recommended for manipulating highly pathogenic avian influenza viruses.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  Laboratory testing results positive for influenza A (H5N1) in the United States should be confirmed at CDC, which has been designated as\n\n\n  a WHO H5 Reference Laboratory. Before sending specimens, state and local health departments should contact CDC\u2019s on-call\n\n\n  epidemiologist at (404) 639-3747 or (404) 639-3591 (Monday \u2013 Friday, 8:30 AM &#8211; 5:00 PM) or (770) 488-7100 (all other times).\n\n\n<\/p>\n\n\n<h4>\n\n\n  Travel Health Notice\n\n\n<\/h4>\n\n\n<p>\n\n\n  CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1. However, CDC does recommend that\n\n\n  travelers to these countries avoid poultry farms and bird markets or other places where live poultry are raised or kept. For details\n\n\n  about other ways to reduce the risk of infection, see <a href=\"http:\/\/www.cdc.gov\/travel\/other\/avian_influenza_se_asia_2005.htm\" title=\"http:\/\/www.cdc.gov\/travel\/other\/avian_influenza_se_asia_2005.htm\">http:\/\/www.cdc.gov\/travel\/other\/avian_influenza_se_asia_2005.htm<\/a>.\n\n\n<\/p>\n\n\n<h4>\n\n\n  More Information\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>Department of Health and Human Services at: <a href=\"http:\/\/www.pandemicflu.gov\" title=\"http:\/\/www.pandemicflu.gov\/\">http:\/\/www.pandemicflu.gov<\/a>\n\n\n  <\/li>\n\n\n  <li>World Health Organization at World Organization for Animal Health (OIE) at: <a href=\"http:\/\/www.oie.int\/eng\/en_index.htm\" title=\"http:\/\/www.oie.int\/eng\/en_index.htm\">http:\/\/www.oie.int\/eng\/en_index.htm<\/a>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  *For the current WHO Pandemic Phase, see http:\/\/www.who.int\/csr\/disease\/avian_influenza\/phase\/en\/index.html\n\n\n<\/p>\n\n\n<p>\n\n\n  \u2020 For a listing of influenza H5N1-affected countries,\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>visit the CDC website at <a href=\"http:\/\/www.cdc.gov\/flu\/avian\/outbreaks\/current.htm\" title=\"http:\/\/www.cdc.gov\/flu\/avian\/outbreaks\/current.htm\">http:\/\/www.cdc.gov\/flu\/avian\/outbreaks\/current.htm<\/a>\n\n\n  <\/li>\n\n\n  <li>the OIE website at <a href=\"http:\/\/www.oie.int\/eng\/en_index.htm\" title=\"http:\/\/www.oie.int\/eng\/en_index.htm\">http:\/\/www.oie.int\/eng\/en_index.htm<\/a>\n\n\n  <\/li>\n\n\n  <li>and the WHO website at <a href=\"http:\/\/www.who.int\/csr\/disease\/avian_influenza\/en\/\" title=\"http:\/\/www.who.int\/csr\/disease\/avian_influenza\/en\/\">http:\/\/www.who.int\/csr\/disease\/avian_influenza\/en\/<\/a>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  \u2021 For example, a patient with respiratory illness and fever who does not require hospitalization, or a patient with significant\n\n\n  neurologic or gastrointestinal symptoms in the absence of respiratory disease.\n\n\n<\/p>\n\n\n<p>\n\n\n  || Interim recommendations for infection control in health-care facilities caring for patients with known or suspected avian influenza\n\n\n  are available at <a href=\"http:\/\/www.cdc.gov\/flu\/avian\/professional\/infect-control.htm\" title=\"http:\/\/www.cdc.gov\/flu\/avian\/professional\/infect-control.htm\">http:\/\/www.cdc.gov\/flu\/avian\/professional\/infect-control.htm<\/a>.\n\n\n<\/p>\n\n\n<p>\n\n\n  \u00a7 Specimens can be transported in viral transport media, Hanks balanced salt solution, cell culture medium, tryptose-phosphate\n\n\n  broth, veal infusion broth, or sucrose-phosphate buffer. Transport media should be supplemented with protein, such as bovine serum\n\n\n  albumin or gelatin, to a concentration of 0.5% to 1%.\n\n\n<\/p>\n\n\n<p>\n\n\n  \u00b6 Information regarding Laboratory Biosafety Level Criteria can be found at <a href=\"http:\/\/www.cdc.gov\/od\/ohs\/biosfty\/bmbl4\/bmbl4s3.htm\" title=\"http:\/\/www.cdc.gov\/od\/ohs\/biosfty\/bmbl4\/bmbl4s3.htm\">http:\/\/www.cdc.gov\/od\/ohs\/biosfty\/bmbl4\/bmbl4s3.htm<\/a>.\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #120 June 8, 2006 11:43 AM Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10075","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10075","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10075"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10075\/revisions"}],"predecessor-version":[{"id":11251,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10075\/revisions\/11251"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10075"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}