{"id":10133,"date":"2025-03-01T14:02:51","date_gmt":"2025-03-01T19:02:51","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan175\/"},"modified":"2025-03-02T00:48:21","modified_gmt":"2025-03-02T05:48:21","slug":"dhan175","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan175\/","title":{"rendered":"php\/alerts\/dhan175 ~  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\/dhan175.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\"]-->175 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->May 2, 2009 3:44 pm <!--[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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Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; 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The onset of the first case was April 24. In addition, more than 500 symptomatic University of Delaware Students were treated\n\n\n  for antiviral agents at the University Health Center or a Division of Public Health clinic between April 29 and May 1.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Testing\n\n\n<\/h3>\n\n\n<p>\n\n\n  Because swine influenza is confirmed in University of Delaware students, DPH is not recommending routine testing of University of\n\n\n  Delaware students for clinical purposes. Symptomatic students should be treated empirically.\n\n\n<\/p>\n\n\n<p>\n\n\n  Clinical decisions may need to be made empirically or on the basis of influenza rapid antigen test. However, these tests have unknown\n\n\n  sensitivity and specificity to detect human infection with swine-origin influenza A (H1N1) virus in clinical specimens, and have\n\n\n  suboptimal sensitivity to detect seasonal influenza viruses. Therefore, a negative rapid test could be a false negative and should not be\n\n\n  assumed a final diagnostic test for swine-origin influenza infection.\n\n\n<\/p>\n\n\n<p>\n\n\n  For the purposes of disease surveillance, DPH is recommending that persons other than University of Delaware students with influenza-like\n\n\n  symptoms be tested if they present with a fever >100\u00b0 F <strong><em>and<\/em><\/strong> cough or sore throat.\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>Preferred respiratory specimens:\u00a0 The following should be collected as soon as possible after illness onset: nasopharyngeal\n\n\n  swab\/aspirate or nasal wash\/aspirate. If these specimens cannot be collected, a combined nasal swab with an oropharyngeal swab is\n\n\n  acceptable. For patients who are intubated, an endotracheal aspirate should also be collected. Specimens should be placed into sterile\n\n\n  viral transport media (VTM) and immediately placed on ice or cold packs or at 4\u00b0C (refrigerator) for transport to the laboratory.\n\n\n  <\/li>\n\n\n  <li>Swabs:\u00a0 Ideally, swab specimens should be collected using swabs with a synthetic tip (e.g. polyester or Dacron\u00ae) and an\n\n\n  aluminum or plastic shaft. Swabs with cotton tips and wooden shafts are not recommended. Specimens collected with swabs made of calcium\n\n\n  alginate are not acceptable. The swab specimen collection vials should contain 1-3ml of viral transport medium (e.g. containing, protein\n\n\n  stabilizer, antibiotics to discourage bacterial and fungal growth, and buffer solution), such M4RT or the <a href=\"http:\/\/www.bd.com\/ds\/productCenter\/220240.asp\">BD Universal Viral Transport System<\/a>.\n\n\n  <\/li>\n\n\n  <li>Storing Clinical Specimens:\u00a0 All respiratory specimens should be kept at 4\u00b0C until they can be placed at -70\u00b0C.\u00a0 If\n\n\n  a -70\u00b0C freezer is not available, specimens should be kept at 4\u00b0C, preferably no longer than 1 week.\n\n\n  <\/li>\n\n\n  <li>Transport to DPH Laboratory:\u00a0 DPH is finalizing arrangements in which clinicians will be able to drop off specimens to the DPH\n\n\n  Laboratory at locations throughout the state. These arrangements should be announced on Monday, May 4. In the interim, clinicians should\n\n\n  store clinical specimens as identified above.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  The DPH Laboratory will perform Real-time RT-PCR for influenza A, B, H1, H3. Currently, swine-origin influenza A (H1N1) virus will test\n\n\n  positive for influenza A and negative for H1 and H3 by real-time RT-PCR. If reactivity of real-time RT-PCR for influenza A is strong, it\n\n\n  is more suggestive of a novel influenza A virus, such as the Swine-origin influenza virus. Confirmation as swine-origin influenza A\n\n\n  (H1N1) virus is performed at CDC currently, but may be available in state public health laboratories soon.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Treatment\n\n\n<\/h3>\n\n\n<p>\n\n\n  The swine-origin influenza virus is susceptible to both oseltamivir and zanamivir. It is resistant to amantadine and rimantadine. Interim\n\n\n  guidance on antiviral treatment for swine-origin influenza A (H1N1) can be found at:\n\n\n<\/p>\n\n\n<p>\n\n\n  Antiviral treatment should be considered for confirmed, probable or suspected cases of swine-origin influenza A (H1N1) virus infection.\n\n\n  Treatment of hospitalized patients and patients at higher risk for influenza complications should be prioritized.\n\n\n<\/p>\n\n\n<p>\n\n\n  Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of symptoms. Evidence for\n\n\n  benefits from treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset.\n\n\n  However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of\n\n\n  hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Recommended duration of treatment\n\n\n  is five days. Recommendations for use of antivirals may change as data on antiviral susceptibilities and effectiveness become available.\n\n\n  Antiviral doses recommended for treatment of swine-origin influenza A (H1N1) virus infection in adults or children 1 year of age or older\n\n\n  are the same as those recommended for seasonal influenza. Oseltamivir use for children < 1 year old was recently approved by the U.S.\n\n\n  Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA), and dosing for these children is age-based.\n\n\n<\/p>\n\n\n<p>\n\n\n  Availability: DPH is aware that prescriptions for antiviral medications may be difficult to fill. Experience to date in Delaware and\n\n\n  nationally suggests that the vast majority of illness is uncomplicated and recovery is complete without treatment. Both the availability\n\n\n  of antiviral medications and our understanding of the ususal course of the illness are evolving.\n\n\n<\/p>\n\n\n<p>\n\n\n  Additional therapy such as antibacterial agents, should be used at the discretion of the clinicians given the patients clinical\n\n\n  presentation. For antibacterial treatment of pneumonia, clinical guidance for community-acquired pneumonia should be followed and can be\n\n\n  accessed at\u00a0<a href=\"http:\/\/www.journals.uchicago.edu\/doi\/pdf\/10.1086\/511159?cookieSet=1.\">http:\/\/www.journals.uchicago.edu\/doi\/pdf\/10.1086\/511159?cookieSet=1.<\/a>\n\n\n<\/p>\n\n\n<p>\n\n\n  For hospitalized patients with severe community-acquired pneumonia (CAP) requiring intensive care unit admission, menthicillin-resistent\n\n\n  <em>Staphylococcus aureus<\/em> (MRSA) infection should be suspected and treated empirically in addition to other causes of CAP if they\n\n\n  have 1) necrotizing or cavitary infiltrates or 2) empyema.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Chemoprophylaxis of contacts\n\n\n<\/h4>\n\n\n<p>\n\n\n  For antiviral chemoprophylaxis of swine-origin influenza A (H1N1) virus infection, either oseltamivir or zanamivir are recommended.\n\n\n  Duration of antiviral chemoprophylaxis post-exposure is 10 days after the last known exposure to an ill confirmed case of swine-origin\n\n\n  influenza A (H1N1) virus infection. Post exposure prophylaxis should be considered for contact during the infectious period (e.g., one\n\n\n  day before until 7 days after the case\u2019s onset of illness).\u00a0 If the contact occurred more than 7 days earlier, then\n\n\n  prophylaxis is not necessary. Antiviral chemoprophylaxis with either oseltamivir or zanamivir is <strong>recommended<\/strong> for the\n\n\n  following individuals:\n\n\n<\/p>\n\n\n<ol>\n\n\n  <li>Household, intimate partners, or other close contacts who are at high-risk for complications of influenza (e.g., persons with certain\n\n\n  chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed or probable case\n\n\n  (see below for definition of \u201cclose contact\u201d and \u201chigh-risk for complications\u201d).\n\n\n  <\/li>\n\n\n  <li>Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with\n\n\n  an ill confirmed, probable, or suspect case of swine-origin influenza A (H1N1) virus infection during the case\u2019s infectious period.\n\n\n  See guidelines on <a href=\"http:\/\/www.cdc.gov\/h1n1flu\/guidelines_infection_control.htm\">personal protective equipment<\/a> .\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<p>\n\n\n  Antiviral chemoprophylaxis with either oseltamivir or zanamivir can be <strong>considered<\/strong> for the following:\n\n\n<\/p>\n\n\n<ol>\n\n\n  <li>Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions,\n\n\n  persons 65 years or older, children younger than 5 years old, and pregnant women) of a suspected case.\n\n\n  <\/li>\n\n\n  <li>Children attending school or daycare who are at high-risk for complications of influenza (children with certain chronic medical\n\n\n  conditions) and who had close contact (face-to-face) with a confirmed, probable, or suspected case.\n\n\n  <\/li>\n\n\n  <li>Health care workers who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions,\n\n\n  persons 65 or older, and pregnant women) who are working in an area of the healthcare facility that contains patients with confirmed\n\n\n  swine-origin influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.\n\n\n  <\/li>\n\n\n  <li>Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions,\n\n\n  persons 65 or older, children younger than 5 years old, and pregnant women). (Note: A <a href=\"http:\/\/wwwn.cdc.gov\/travel\/contentSwineFluMexico.aspx\">travel warning<\/a> is currently in effect indicating that nonessential travel to\n\n\n  Mexico should be avoided.\n\n\n  <\/li>\n\n\n  <li>First responders who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons\n\n\n  65 or older, children younger than 5 years old, and pregnant women) and who are working in areas with confirmed cases of swine-origin\n\n\n  influenza A (H1N1) virus infection.\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<p>\n\n\n  <strong><em>Close contact<\/em><\/strong> is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of\n\n\n  swine-origin influenza A (H1N1) virus infection during the case\u2019s infectious period.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Persons at High-Risk for Medical Complications\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>all children aged 6 months&#8211;4 years (59 months);\n\n\n  <\/li>\n\n\n  <li>all persons aged <span style=\"text-decoration: underline\">><\/span>50 years;\n\n\n  <\/li>\n\n\n  <li>children and adolescents (aged 6 months&#8211;18 years) who are receiving long-term aspirin therapy and who might be at risk for\n\n\n  experiencing Reye syndrome after influenza virus infection;\n\n\n  <\/li>\n\n\n  <li>women who will be pregnant during the influenza season;\n\n\n  <\/li>\n\n\n  <li>adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic,\n\n\n  hematological, or metabolic disorders (including diabetes mellitus);\n\n\n  <\/li>\n\n\n  <li>adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);\n\n\n  <\/li>\n\n\n  <li>adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other\n\n\n  neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk\n\n\n  for aspiration; and\n\n\n  <\/li>\n\n\n  <li>residents of nursing homes and other chronic-care facilities.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h3>\n\n\n  More information:\n\n\n<\/h3>\n\n\n<p>\n\n\n  <a href=\"http:\/\/www.cdc.gov\/h1n1flu\/guidance\/\">http:\/\/www.cdc.gov\/h1n1flu\/guidance\/<\/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 #175 May 2, 2009 3:44 pm 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-10133","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10133","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=10133"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10133\/revisions"}],"predecessor-version":[{"id":11309,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10133\/revisions\/11309"}],"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=10133"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}