Flash FAX : 2009-10-08 - H1N1 UPDATE

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Flash FAX

October 8, 2009

      H1N1 UPDATE: The impact of H1N1 on the pediatric population continues to
      grow daily. In the past three days we have seen 175 positive tests. Our ED
      and UCC on-site volume is about 100 patients above baseline for this time
      of year. Having talked to several of you on the phone, your office visits
      are also increasing substantially to reflect the outbreak. Some key points
      for the week:

      • Correction: Our off-site testing centers are performing the rapid
      influenza screening test at the site and sending only the PCRs to us.

      • Who needs to be treated? On September 8, 2009, the CDC published two
      documents addressing treatment and they were consistent with one
      exception. In one document the CDC said that treatment with Tamiflu is
      recommended for children younger than 5 years of age. In the second
      document, the CDC recommends treatment for people with suspected or
      confirmed influenza who are younger than 5 years of age (children under 2
      years old are at higher risk for complications than older children).
On
      September 23, the CDC again recommends treatment for children under 2
      years of age. Children 2 to 4 years of age are noted to be at increased
      risk of hospitalization, but if not severely ill, CDC says that this group
      does not necessarily require treatment. Conclusion: Children over 2 years
      of age who are not severely ill and who do not have a risk factor do not
      necessarily require treatment.
Most recently (October 8), the CDC again
      describes the at risk group of children as children younger than 5 but
      especially younger than 2.
It is this ambivalence that creates confusion.

      • As has been noted previously, individuals without risk factors and who
      are not severely ill do not necessarily require treatment. In my judgment,
      a healthy 4 year old with “mild” disease does not need therapy. Of note,
      we have had two of those in our extended family this past week.

      • Visitation: Please note that we have instituted a visitation policy that
      restricts visitation from other children (unless there are special
      circumstances). If you send a child for direct admission, please encourage
      the family not to bring siblings with them, if at all possible.

      • N-95 fit testing: We have been asked to fit test students (over 150
      on-site) and community physicians. Fit testing is tedious to perform
      (approximately 30 minutes per individual). As of today, we have fit tested
      300+ employees, including ED, PICU, 3 west, residents, staff attending and
      almost all of our AHU staff. As of last evening, you can now direct admit
      a patient with H1N1 to 3 west or to the AHU again. We are systematically
      testing the rest of the direct care givers, but it is likely to take at
      least two more weeks to finish. We do not have the resources to fit test
      community physicians and their staff, or students completing rotations
      with us.

      • Which mask should I wear? This is the most troublesome issue confronting
      us now. The CDC recommends an N-95 mask. The Society for Healthcare
      Epidemiologists, recognizing the limited scientific data and that
      resources and masks are limited, recommends surgical masks. The literature
      is scant at best. A recent study in JAMA showed a clinical attack rate of
      4.0% for seasonal influenza in nurses using surgical masks and 1.2% among
      staff using N-95 masks. It will probably become moot quickly since we are
      being told that there are no additional supplies of N-95 masks and except
      for the PODS, there might not be more until January. So please advise your
      staff to mask the suspect influenza-like ill patients upon arrival,
      isolate them if possible, wear whatever protection is available, WASH YOUR
      HANDS and get immunized.

 

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