Transcript New Hire Orientation (CHLA '06)

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
Swine influenza A (H1N1) virus is
contagious and is spreading from human to
human
Not known how easily the virus spreads
between people
U.S. Human Cases of Swine Flu Infection
State
# lab confirmed cases
Arizona
1 case
California
14 cases
Kansas
2 cases
New York City
51 cases
Ohio
1 case
Indiana
1 case
Nevada
1 case
Michigan
2 cases
Mass.
2 cases
Texas
16 cases
Total Count
91 cases
Signs & Symptoms
Signs & Symptoms:
 Fever
 Cough
 Sore throat
 Body Aches
 Headache
 Chills
 Fatigue
 Diarrhea and vomiting in some
Clinical findings of influenza
Adults
Abrupt onset
Fever
Myalgia
Headache
Severe malaise
Cough
Sore throat
Rhinitis
Children
Abrupt onset
Fever
Cough
Rhinorrhea
Vomiting
Diarrhea
Headache
Myalgia
Otitis media
MMWR 2003; 52#RR8:2-3
Clin Infect Dis 2003;36:299-302
89-94%
60-67%
56-66%
17-19%
8-9%
23-24%
6-15%
19-26%
Clinical findings of influenza
Adults
I.P.: 1-4 days
Children
I.P.: 1-4 days
Infectious: day –1 to +5
Infectious: day –4 to + 10
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.
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:
1. Are a contact to a confirmed swine influenza case
2. Are part of a cluster of people reported with ILI
3. Traveled to affected areas in the 7 days preceding illness
4. Were in contact with persons with ILI who were in
affected areas during the 7 days preceding illness onset
5. Are hospitalized with ILI or pneumonia
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.
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
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
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
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
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.
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
Potential Impact in the US
Illness
Outpatient care
Hospitalization
ICU Care
Ventilation
Deaths
Moderate
Severe
(1958-59)
(1918-like)
90 million
45 million
865,000
128,750
64,875
209,000
90 million
45 million
9,900,000
1,485,000
742,500
1,903,000
Questions?