(UPDATED 4.30.09)
Please note that the current situation is very fluid and information may change. For the latest updates, please refer to the Centers for Disease Control and Prevention's website at www.cdc.gov. Also see the Web site of Vanderbilt Emergency Preparedness and Planning Office at: http://emergency.vanderbilt.edu
DIAGNOSIS AND TESTING ISSUES
Q: What if one of my patients presents with a fever and respiratory symptoms (cough, runny nose or congestion, sore throat) and has a history of travel to the regions affected by swine flu?
A: In an effort to be as cautious as possible, we would ask that you place a surgical mask on the patient and call the Department of Infection Control & Prevention at 835-1205 (24/7) immediately. Importantly, many patients meeting these criteria may not have swine flu, but we want to be extra careful at this time.
Q: What should I do if my patient has recently traveled to areas affected by the current swine flu outbreak?
A: If they do not have an unexplained fever and respiratory symptoms, then you do not need to take any additional precautions during the care of this patient unless directed by other aspects of their illness (e.g. Contact Precautions if patient has an infection with MRSA).
Q: If swine flu is suspected, what should be done in terms of specimen collection for testing?
A: As noted above, once a suspected case of swine flu is identified, contact the Department of Infection Control and Prevention IMMEDIATELY. They will serve as the contact for the TN Department of Health state laboratory. A nasopharyngeal swab/aspirate or nasal wash/aspirate should be collected. If these specimens cannot be collected, a combined nasal swab with an oropharyngeal swab is acceptable (click here for full details on specimen collection). These should be sent for influenza antigen and culture as per regular processes. Please note on the lab request if swine flu is suspected. Because of the risk to laboratory personnel of culturing novel influenza strains, preliminary molecular testing will be performed but the sample will not be cultured at VMC. Any isolates requested for further testing by the TN Department of Health will be sent there by the VMC virology laboratory.
Q: Is the rapid influenza antigen test effective to diagnose swine flu?
A: Cases in the current outbreak have tested positive on rapid antigen testing, but the sensitivity and specificity of the test for swine flu unclear and may be impacted by a variety of factors. Thus, a negative antigen test in a patient with a fever and respiratory symptoms does not mean that the patient does not have swine influenza.
INFECTION CONTROL ISSUES
Q: What type of isolation precautions should be used for patients with suspected or confirmed swine flu?
A: The CDC is currently recommending that the following practices be followed:
• Place patient in private room with the door kept CLOSED
• Healthcare workers entering the room should wear a fit-tested N-95 RESPIRATOR, GOWN, GLOVES, and EYE PROTECTION
• Wash hands immediately after removing gloves and other equipment and after any contact with respiratory secretions
• Place surgical mask on patient in the event he or she must leave the room
• A negative pressure room is not required for all patients
• Patients who require an aerosol-generating procedure (such as bronchoscopy, induced sputum, or provision of nebulized medications) must be placed in a negative pressure room
Q: When are people with swine flu considered infectious?
A: The infectious period for a confirmed case of swine influenza A virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset.
TREATMENT ISSUES
Q: What is advised in terms of antiviral treatment for suspected or confirmed swine flu?
A: Empiric antiviral treatment is recommended for any ill person suspected to have swine flu infection. Antiviral treatment with either zanamivir alone or with a combination of oseltamivir and either amantadine or rimantadine (to cover sensitive types of seasonal influenza which is still circulating) should be initiated as soon as possible after the onset of symptoms. Recommended duration of treatment is five days. For antiviral treatment of a confirmed case of swine flu infection, either oseltamivir or zanamivir may be administered. Recommended duration of treatment is also five days. For the most current recommendations on antiviral use, please click here.
Q: What is advised in terms of antiviral prophylaxis against swine flu?
A: For antiviral chemoprophylaxis of swine flu infection, either oseltamivir or zanamivir are recommended. Duration of antiviral chemoprophylaxis is 7 days after the last known exposure to an ill confirmed case of swine influenza A. Antiviral dosing and schedules recommended for chemoprophylaxis of swine influenza infection are the same as those recommended for seasonal influenza.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:
• Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.
• School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
• Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
• Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
• Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case’s infectious period.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir can be considered for the following:
• Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
• Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
TRAVEL ISSUES
Q: Are there any restrictions on travel?
A: YES. At this time, CDC recommends that U.S. travelers avoid all nonessential travel to Mexico. No restrictions have been recommended on travel to other affected areas of the country.
Q: I have just returned from Mexico (or other areas affected by swine influenza)? Should I do anything?
A: If you do not have any respiratory symptoms and/or fever, then further evaluation is not warranted. If respiratory symptoms develop, contact your healthcare provider for further evaluation, avoid crowds and public areas, and make sure you practice respiratory hygiene (cover your cough and sneeze) and hand washing.
MISCELLANEOUS ISSUES
Q: What should I do if I (if Vanderbilt faculty or staff) have respiratory symptoms and either recent travel to an affected area or close contact with someone who has had a confirmed case of swine flu?
A: Faculty and staff should contact the Occupational Health Clinic at 936-0955 to determine if further evaluation is needed.
Q: Is there a vaccine for swine flu? Is this year’s seasonal influenza vaccine protective against swine flu?
A: There is currently no vaccine to protect humans from swine flu. In addition, at this point there does not appear to be much, if any, protection from this year’s seasonal flu vaccine against swine flu.
Q: Can I get swine flu from eating or preparing pork?
A: No. Swine flu viruses are not spread by food. You cannot get swine flu from eating pork or pork products. Eating properly handled and cooked pork products is safe.