H1N1
Flu (Swine Flu)
Last updated
May 2,
2009, 1:30 pm ET
Source & Resource: Centers for
Disease Control and Prevention (CDC); 1600 Clifton Rd. Atlanta,
GA 30333, USA;
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day - cdcinfo@cdc.govWebsite:
http://www.cdc.gov/h1n1flu/index.htm
CDC continues to take aggressive
action to respond to an expanding outbreak caused by H1N1 (swine flu).
CDC’s response goals are to:
Reduce
transmission and illness severity, and
Provide
information to help health care providers, public health officials and the
public address the challenges posed by this emergency.
CDC continues to issue and update interim guidance (please
see below) daily in response to the rapidly evolving situation. This includes
guidance on when to close schools and how to care for someone who is sick at
home. Supplies from CDC’s Division of the Strategic National Stockpile (SNS)
are being sent to all 50 states and U.S.
territories to help them respond to the outbreak. In addition, the Federal
Government and manufacturers have begun the process of developing a vaccine
against this new virus.
Response actions are aggressive, but they may vary across
states and communities depending on local circumstances. Communities,
businesses, places of worship, schools and individuals can all take action to
slow the spread of this outbreak. People who are sick are urged to stay home
from work or school and to avoid contact with others, except to seek medical
care. This action can avoid spreading illness further.
What
You Can Do to Stay Healthy
Stay informed.This
website will be updated regularly as information becomes available.
Influenza is thought to spread mainly
person-to-personthrough coughing or sneezing of
infected people.
Take everyday actions to stay
healthy.
Cover your nose and mouth with a tissue when you
cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially
after you cough or sneeze. Alcohol-based hands cleaners are also
effective.
Avoid touching your eyes, nose or mouth. Germs spread
that way.
Stay home if you get sick. CDC recommends that you
stay home from work or school and limit contact with others to keep from
infecting them.
Follow public health adviceregarding
school closures, avoiding crowds and other social distancing measures.
Develop a family emergency planas
a precaution. This should include storing a supply of food, medicines,
facemasks, alcohol-based hand rubs and other essential supplies.
Call 1-800-CDC-INFO for more information.
Additional Links
PandemicFlu.gov
FDA Press
Release: FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic
Test in Response to Swine Flu Outbreak in Humans
GenBank
Influenza Virus Resource (swine influenza A (H1N1) sequences)
WHO
- Reducing excess mortality from common illnesses during a severe
influenza pandemic
WHO
- Pandemic influenza preparedness and mitigation in refugee and displaced
populations
WHO
- Additional WHO Influenza Guidance
WHO -
Influenza-Like Illness in the United States and Mexico
WHO
- Protocol for antiviral susceptibility testing by pyrosequencing
WHO
- Sequencing primers and protocol
WHO
- CDC protocol of realtime RTPCR for swine influenza A(H1N1)
Interim
Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected
Swine Influenza A (H1N1) Virus Infection and Close Contacts
April 29, 2009 02:45 PM
ET
Objective:To
provide interim guidance on the use of antiviral agents for treatment and
chemoprophylaxis of swine influenza A (H1N1) virus infection. This includes
patients with confirmed, probable or suspected swine influenza A (H1N1) virus
infection and their close contacts.
Case Definitions for
Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV)
A confirmed caseof S-OIV infection is
defined as a person with an acute febrile respiratory illness with laboratory
confirmed S-OIV infection at CDC by one or more of the following tests:
real-time
RT-PCR
viral
culture
A probable caseof S-OIV infection is defined
as a person with an acute febrile respiratory illness who is positive for
influenza A, but negative for H1 and H3 by influenza RT-PCR
A suspected caseof S-OIV infection is defined
as a person with acute febrile respiratory illness with onset
within
7 days of close contact with a person who is a confirmed case of S-OIV
infection, or
within
7 days of travel to community either within the United
States or internationally where there
are one or more confirmed cases of S-OIV infection, or
resides
in a community where there are one or more confirmed cases of S-OIV
infection.
Infectious
periodfor
a confirmed case of swine influenza A (H1N1) virus infection is defined as 1
day prior to the case’s illness onset to 7 days after onset.
Close contact is defined as: within
about 6 feet of
an ill person who is a confirmed or suspected case of swine-origin influenza A
(H1N1) virus infection during the case’s infectious period.
Acute respiratory
illness is
defined as recent onset of at least two of the following: rhinorrhea or nasal
congestion, sore throat, cough (with or without fever or feverishness)
High-risk groups:A person who is at high-risk
for complications of swine influenza A (H1N1) virus infection is defined as the
same for seasonal influenza (see MMWR: Prevention
and Control of Influenza: Recommendations of the Advisory Committee on
Immunization Practices (ACIP), 2008).
Special Considerations for Children
Aspirin or aspirin-containing
products (e.g. bismuth subsalicylate – Pepto Bismol) should not be administered
to any confirmed or suspected ill case of swine influenza A (H1N1) virus
infection aged 18 years old and younger due to the risk of Reye syndrome. For
relief of fever, other anti-pyretic medications are recommended such as
acetaminophen or non steroidal anti-inflammatory drugs.
Antiviral Resistance
This swine
influenza A (H1N1) virus is sensitive (susceptible) to the neuraminidase
inhibitor antiviral medications zanamivir and oseltamivir. It is
resistant to the adamantane antiviral medications, amantadine and rimantadine.
Antiviral Treatment
Confirmed,
Probable and Suspected Cases of Swine-origin Influenza A (H1N1) Virus Infection
Recommendations for use of
antivirals may change as data on antiviral effectiveness, clinical spectrum of
illness, adverse events from antiviral use, and antiviral susceptibility data
become available.
Antiviral treatment should be
considered for confirmed, probable or suspected cases of swine-origin influenza
A (H1N1) virus infection. Treatment of hospitalized patients and patients at
higher risk for influenza complications should be prioritized.
Only RT-PCR or viral culture can
confirm infection with swine-origin influenza A (H1N1) virus. The test
performance of rapid antigen tests and immunofluorescence tests for detection
of swine-origin influenza A (H1N1) virus is unknown. Persons who might have
swine-origin influenza A (H1N1) virus and who test positive for influenza A
using one of these tests should have confirmatory RT-PCR or viral culture
testing to confirm the presence of swine-origin influenza A (H1N1)
virus. A negative rapid antigen or immunofluorescence test cannot
be used to rule out swine-origin influenza A (H1N1) virus infection.
Antiviral treatment with zanamivir
or oseltamivir should be initiated as soon as possible after the onset of
symptoms. Evidence for benefits from treatment in studies of seasonal influenza
is strongest when treatment is started within 48 hours of illness onset.
However, some studies of treatment of seasonal influenza have indicated
benefit, including reductions in mortality or duration of hospitalization even
for patients whose treatment was started more than 48 hours after illness
onset. Recommended duration of treatment is five days. Recommendations for use
of antivirals may change as data on antiviral susceptibilities and
effectiveness become available. Antiviral doses recommended for treatment
of swine-origin influenza A (H1N1) virus infection in adults or children 1 year
of age or older are the same as those recommended for seasonal influenza.
Oseltamivir use for children < 1 year old was recently approved by the U.S.
Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA),
and dosing for these children is age-based.
Note: Areas that continue to have
seasonal influenza activity, especially those with circulation of
oseltamivir-resistant human A (H1N1) viruses, might prefer to use either
zanamivir or a combination of oseltamivir and rimantadine or amantadine to
provide adequate empiric treatment or chemoprophylaxis for patients who might
have human influenza A (H1N1) infection.
Antiviral Chemoprophylaxis
For antiviral chemoprophylaxis of
swine-origin influenza A (H1N1) virus infection, either oseltamivir or
zanamivir are recommended. Duration of antiviral chemoprophylaxis post-exposure
is 10 days after the last known exposure to an ill confirmed case of
swine-origin influenza A (H1N1) virus infection. Post exposure prophylaxis should
be considered for contact during the infectious period (e.g., one day
before until 7 days after the case’s onset of illness). If the contact
occurred more than 7 days earlier, then prophylaxis is not necessary. For
pre-exposure protection, chemoprophylaxis should be given during the
potential exposure period and continued for 10 days after the last known
exposure to an ill confirmed case of swine-origin influenza A (H1N1) virus
infection. Oseltamivir can also be used for chemoprophylaxis under the EUA.
Antiviral chemoprophylaxis with either
oseltamivir or zanamivir is b>recommendedfor the following individuals:
Household
close contacts who are at high-risk for complications of influenza (e.g.,
persons with certain chronic medical conditions, persons 65 or older,
children younger than 5 years old, and pregnant women) of a confirmed or
probable case.
Health
care workers or public health workers who were not using appropriate
personal protective equipment during close contact with an ill confirmed,
probable, or suspect case of swine-origin influenza A (H1N1) virus
infection during the case’s infectious period. See guidelines on personal
protective equipment.
Antiviral chemoprophylaxis with
either oseltamivir or zanamivir can be considered for the
following:
Household
close contacts who are at high-risk for complications of influenza (e.g.,
persons with certain chronic medical conditions, persons 65 years or
older, children younger than 5 years old, and pregnant women) of a
suspected case.
Children
attending school or daycare who are at high-risk for complications of
influenza (children with certain chronic medical conditions) and who had
close contact (face-to-face) with a confirmed, probable, or suspected
case.
Health
care workers who are at high-risk for complications of influenza (e.g.,
persons with certain chronic medical conditions, persons 65 or older, and
pregnant women) who are working in an area of the healthcare facility that
contains patients with confirmed swine-origin influenza A (H1N1) cases, or
who is caring for patients with any acute febrile respiratory illness.
Travelers
to Mexico who are at high-risk for complications of influenza (e.g.,
persons with certain chronic medical conditions, persons 65 or older,
children younger than 5 years old, and pregnant women). (Note: A travel
warning is currently in effect indicating that nonessential travel to Mexico
should be avoided.
First
responders who are at high-risk for complications of influenza (e.g.,
persons with certain chronic medical conditions, persons 65 or older,
children younger than 5 years old, and pregnant women) and who are working
in areas with confirmed cases of swine-origin influenza A (H1N1) virus
infection.
Source & Resource: http://www.cdc.gov/h1n1flu/recommendations.htm