September 4, 2009
Influenza 2009 Update: Since September 1, 2009, our laboratory has reported at least seven children who are positive for Influenza A, either by culture, by rapid screen or both. Two of the seven have been admitted. I am very confident that these are all H1N1 strains. If you have followed the news, there have been outbreaks reported at a number of universities (Miami of Ohio, The USAF Academy, Georgia Southern University, Xavier). There is a good possibility that this represents the early start of the influenza season for 2009-2010. Until two weeks ago, the CDC had reported a consistent downward trend in the number of confirmed cases, starting in mid June. New data are due out later today.
It is also true that over the past few months, there have been a number of publications by the CDC and others that have either modified or recommended modification of some of the early recommendations made last April, guiding management of patients. As you know, the guidelines for school closures have changed. The guidelines for returning to work or school after an influenza like illness have changed. The guidelines for confirming isolates as H1N1 have changed.
Sherman Alter, MD, is chairing a group of Dayton Children's staff. This group will recommend strategies that we can implement at DCMC to respond to an influenza epidemic caused by H1N1. This group will consider many scenarios including occasional sporadic cases, as well as a major epidemic that is likely to increase by twofold or more the number of children seeking care here. As of today, here is what we are doing:
- We will begin administering vaccine directed against seasonal influenza strains (Not H1N1 strains) next week to our high risk patients, staff and volunteers. This will follow the same model we use every year, but it is starting earlier. Hopefully you are doing the same in your practice.
- We have pre-registered with the ODH as a provider planning to give vaccine directed against H1N1 when it becomes available this fall (hopefully by October). Unless you are registered with the ODH, you will not be able to obtain vaccine for your patients.
- We are preparing to evaluate and treat increased numbers of children in the ED with illness due to influenza. Please keep in mind that the definition of an influenza like illness (ILI) is fever with either cough or sore throat. Note that this does not include afebrile respiratory illnesses.
- If you wish to admit a child today with a febrile respiratory illness that meets the above definition, please order diagnostic testing for influenza. This will help us cohort patients in specific areas of the hospital, as much as possible. Please advise families that placement in a private room is only one option. Cohorting of children with the same infection and even placement of multiple children in the same room might become necessary if private rooms are not available and space for cohorting becomes limited.
- As of today, we are following the recommendations proposed by The Society for Healthcare Epidemiology of America (SHEA) that address the use of surgical masks. We are waiting for new information from the CDC (expected next week) as well as the Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC) being held next week in San Francisco.
This is going to be a very rapidly changing environment. We will do our best to provide regular, succinct updates. If you have questions, call Hila Collins at 937-641-3000, extension 3868, or Sherman Alter, MD, at 937-641-3329.
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