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Swine Influenza April 30, 2009 Bill Mason, MD Jill Hoffman, MD Dawn England, MPH

Swine Influenza April 30, 2009 Bill Mason, MD Jill Hoffman, MD Dawn England, MPH. Overview. Review what is currently known about Swine Influenza Discuss Infection Control for Swine Influenza. Swine Influenza. Respiratory disease of pigs caused by type A influenza viruses

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Swine Influenza April 30, 2009 Bill Mason, MD Jill Hoffman, MD Dawn England, MPH

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  1. Swine Influenza April 30, 2009 Bill Mason, MD Jill Hoffman, MD Dawn England, MPH

  2. Overview • Review what is currently known about Swine Influenza • Discuss Infection Control for Swine Influenza

  3. Swine Influenza • Respiratory disease of pigs caused by type A influenza viruses • Swine influenza A (H1N1) virus is contagious and is spreading from human to human • Not known how easily the virus spreads between people

  4. U.S. Human Cases of Swine Flu Infection

  5. Signs & Symptoms • Signs & Symptoms: • Fever • Cough • Sore throat • Body Aches • Headache • Chills • Fatigue • Diarrhea and vomiting in some

  6. Adults Abrupt onset Fever Myalgia Headache Severe malaise Cough Sore throat Rhinitis MMWR 2003; 52#RR8:2-3 Children Abrupt onset Fever 89-94% Cough 60-67% Rhinorrhea 56-66% Vomiting 17-19% Diarrhea 8-9% Headache 23-24% Myalgia 6-15% Otitis media 19-26% Clin Infect Dis 2003;36:299-302 Clinical findings of influenza

  7. Adults I.P.: 1-4 days Infectious: day –1 to +5 Children I.P.: 1-4 days Infectious: day –4 to + 10 Clinical findings of influenza

  8. Infectious Period • Persons with swine influenza A should be considered contagious for up to 7 days following onset of illness • Children may be contagious for longer periods * CDC Guidelines, Interim Guidance for Infection Control for Care of Patients with Confirmed/Suspected Swine Influenza in a Healthcare Setting. April 27, 2009.

  9. Diagnostic Testing • Interim Recommendations for Testing (per LADPH)Clinicians should consider swine influenza infection in the differential diagnosis of patients with: • Influenza-like illness (ILI) defined as fever ≥37.8ºC (100ºF) and a cough and/or sore throat AND one of the following: • Are a contact to a confirmed swine influenza case • Are part of a cluster of people reported with ILI • Traveled to affected areas in the 7 days preceding illness • Were in contact with persons with ILI who were in affected areas during the 7 days preceding illness onset • Are hospitalized with ILI or pneumonia

  10. Infection Control of Swine Influenza • Patients suspected or confirmed status will be placed in single patient rooms, on AIRBORNE isolation, with the door closed • Gown/Glove/N95 • Patients/Visitors must wear a surgical mask when outside patient room • Encourage hand hygiene, respiratory hygiene • No one under the age of 16 is allowed to visit • No one with s/s of ILI is allowed to enter hospital • Routine cleaning and disinfection strategies used *CDC Guidelines, Interim Guidance for Infection Control for Care of Patients with Confirmed/Suspected Swine Influenza in a Healthcare Setting. April 27, 2009.

  11. Infection Control of Swine Influenza • Personnel providing direct patient care for suspected or confirmed cases should wear a N-95 respirator • Hand Hygiene • Respiratory Hygiene • Encourage staff to stay home if showing signs or symptoms

  12. Infection Control of Swine Influenza • Communication • Daily from the CDC, State/Local health departments on epidemiology and infection control • Where applicable, emailed to all CHLA staff and posted on Intranet • Direct care staff receive additional emails • Conference call with LA County Department of Public Health every day • Infection Control staff attend daily briefings with ED each morning and update PCS at bed huddle twice daily

  13. Infection Control of Swine Influenza • Communication (continued) • Distribution of CDC, Swine Flu FAQ (Frequently Asked Questions) flyers to all inpatient units • Available on Intranet • Inventory • Increased number of rapid flu assays in house • Ensure adequate supply of hand gels, soaps, gowns, gloves and masks on units and in materials management • Determined counts of Tamiflu in house • Pandemic Planning

  14. Pandemic Influenza • Caused by new influenza viruses that have adapted to humans • Criteria for a pandemic influenza virus: • Novel influenza A strain • Little or no immunity in population • Person-to-person transmission with disease

  15. Current WHO Phase of Pandemic Alert Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic will definitely occur.

  16. Impact of influenza pandemics: • 1918-1919 Spanish Flu • 20-40 million deaths worldwide • At least 550,000 deaths in US • 1957-1958 Asian Flu • ~70,000 US deaths • 1968-1969 Hong Kong Flu • ~34,000 US deaths

  17. Potential Impact in the US Moderate Severe (1958-59) (1918-like) Illness 90 million 90 million Outpatient care 45 million 45 million Hospitalization 865,000 9,900,000 ICU Care 128,750 1,485,000 Ventilation 64,875 742,500 Deaths 209,000 1,903,000

  18. Questions?

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