April 30, 2009
SWINE FLU UPDATE
On March 9, 2009, the first of hundreds of people in La Gloria, Mexico,
became ill with symptoms suggestive of influenza. Since then we have
learned that thousands of people in Mexico City have been infected with
swine origin Influenza A (S-OIV). Over the past two weeks, this strain has
spread to the United States as well as other parts of the world. As of
1:00 pm yesterday, there were 91 laboratory confirmed cases in 14 states.
It is likely that this number will grow over the upcoming weeks, with
additional areas of the country being involved. In the Dayton area, there
are a number of cases that are currently being investigated as probable
swine flu infections.
We experienced our usual yearly outbreak of influenza between the third
week of January and the last week of April. During that time we confirmed
over 700 isolates of influenza, equally split between types A and B. Over
the past 10 days, we have had 9 isolates, including 2 influenza A and 7
influenza B isolates. Thus, one would expect moving forward, that the
presence of influenza A isolates in the community, especially if the
frequency increases, is likely to reflect the appearance and spread of
What we’re doing
Information resources: There is a great deal of information available on
the current outbreak through the CDC, the ODH and the AAP. The websites
for these organizations have detailed information, useful to parents and
clinicians. The content is changing frequently, sometimes several times a
day. There is no need to repeat the information that exists on those
sites. Instead, I want to share some of the steps that we have taken.
Specimen testing: Based upon the recommendations of the CDC, we will no
longer obtain respiratory specimens for testing for influenza at our
off-site laboratory testing facilities in Beavercreek, Vandalia or
Springboro, as well as Warren County and the Kettering Testing Center. We
will not process specimens that are sent there for evaluation. Instead,
any samples that arrive at the testing center will be sent to the hospital
lab. This allows us to test all samples under a biosafety cabinet (BSC).
These BSCs are not available at our off- site facilities. Except for
influenza testing, the labs are still fully functional.
So what do you do with a child who presents to your office and who needs
to have testing done to rule out infection due to influenza A?
There are two choices.
• First, if you have already seen the child, you can obtain the
nasopharyngeal specimens necessary for testing (please send us a nasal
wash kit for rapid influenza testing as well as a vial of viral transport
media inoculated with secretions obtained by using a swab that has an
aluminum or plastic shaft and a synthetic tip). Do not use a swab with a
wooden shaft, cotton tip or calcium alginate swab. Contact our courier
service at 937-641-4305 to arrange transport. The courier is available
Monday through Friday from 9:30 am until 8:00 pm and from 9:30 am to
3:30pm on Saturdays. We will come get the specimen, perform the testing
and call the results to you. Please be sure we have a good number to reach
you, especially after hours. It will take us at least an hour after we
receive the specimen to complete the test. Call the courier line to order
additional supplies. We may still be able to arrange pick-up off hours,
so please call the courier, even off hours.
• Second, if you prefer to send the patient to us for specimen collection,
it is essential that we limit their movement through the campus. Here is
the process for patients coming to Dayton Children’s:
1. Give them an order for testing (please use one of our lab order forms.
If you don’t have a lab order form, use a prescription and we will obtain
confirmation from you the same or next business day).
2. Give them a mask to wear upon presentation to Dayton Children’s.
3. Tell patient families:
a. To park in the emergency department lot.
b. Enter the door to the emergency department under the sign EMERGENCY.
c. Inform the staff at the triage desk that they are there for influenza
4. We will immediately escort them to one of our negative pressure rooms,
meet them and obtain the samples needed.
5. We will then release them home.
6. The results will be called to the ordering physician once completed.
7. Make sure we know how to contact you with the results.
8. In the event that the patient is clinically unstable or appears ill to
our staff, the ED physician will evaluate the patient. The ED physician
will notify you if this occurs.
9. Any prescription for treatment should be written by you, or
arrangements made with the patient to obtain prescriptions, based upon the
results of the evaluation.
10. We will make our courier service available as much as possible to
facilitate getting samples here. If by chance, you have obtained the
specimens when the courier is not routinely available, please call the
courier line (937-641-4305). We may still be able to dispatch a commercial
carrier to pick up the sample. If not, we will ask that you have the
family transport the specimens to the Dayton Children’s emergency
department just as we have outlined above. We will transport the samples
from the ED to the lab and process the specimens. We would like to keep
the patients from walking about the hospital looking for the lab, etc.
Prescriptions for Tamiflu can be filled at local pharmacies. Dosages are
now available all the way down to infants younger than 3 months of age.
You can find these dosages by accessing the CDC website, click on swine
flu and then on Emergency Use Authorization. This includes the dosages for
treatment or prophylaxis. Beware that while treatment is authorized for
infants younger than 3 months of age, prophylaxis is indicated only for
those infants 3 months of age and older.
In the hospital, we are preparing to admit and care for any patients who
need inpatient care. I want to emphasize that we do not yet know if this
virus is more or less virulent than the strains that circulated this past
winter. About 35,000 people died this winter from influenza and/or its
complications. There are about 90 pediatric deaths yearly. The virulence
of this virus will be determined in the next few weeks.
We will continue to use our home page as well as Flash Fax to keep you
updated on items that are particularly relevant to us in this area. I
encourage you to access other websites for detailed recommendations and
guidelines from the CDC, ODH and AAP.
Questions? Please feel free to call Dr. Sherman Alter at 937-641-3329 or
Dr. Tom Murphy at 937-641-5871.
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