Microsoft word - centra cvhd med staff letter flu 2009.doc

Centra/VDH 2009 Pandemic Influenza Response Panel From: J. Scott Wade, MD, Chair Centra Infection Control Committee Kerry Gateley, MD, Director Central Virginia Health District, Virginia Dept. of Health As you are aware, the novel H1N1 Influenza A strain has continued to cause cases of influenza-like illness on a worldwide basis; the Central Virginia area has certainly been affected over the last several months. There is concern that larger influenza outbreaks could occur this fall and winter as seasonal influenza surfaces again and new cases of the novel strain continue to occur. Centra Health and Central Virginia Health District (CVHD) are working closely together along with other regional healthcare representatives to develop a community-wide response program as we approach the new influenza season this fall. We would encourage you to refer to the excellent clinician resources for both inpatient and outpatient care available on the CDC and Virginia Department of Health (VDH) websites: and There is also updated information under the H1N1 icon on the centrapeople website as well. We would like to make a few points as we approach the new influenza season: Remember that the sensitivity of the rapid influenza antigen assays for the novel strain is low; if clinical suspicion for influenza is high, then antiviral therapy and appropriate infection control measures may need to be initiated regardless of rapid assay results. In special situations, such as in severely ill patients, PCR tests approved for the novel H1N1 influenza are available. We will be keeping you up to date on appropriate infection control measures. Remember to screen patients for febrile respiratory illnesses upon entry to your facilities and offer surgical masks to symptomatic patients. Hospitalized patients with confirmed or suspected cases of novel H1N1 influenza A should be treated with oseltamivir or zanamivir. This should also be started in those with high risk of complications from influenza but is unnecessary in non-hospitalized patients with mild illness. Once seasonal influenza strains have been identified again this fall or winter and oseltamivir resistance is a greater issue, then oseltamivir should be combined with amantadine or rimantidine, or zanamivir should be used as an alternative. Seasonal flu vaccine will be available later this month and should be offered to all children between the ages of 6 mos. and 18 years, all healthcare workers, all adults over 50 years, and adults with chronic medical conditions or caring for individuals in high-risk groups. The availability of novel H1N1 vaccine (exactly when and how much) is up in the air. Please watch for guidance from the CDC on priorities for using this vaccine. If the supply of vaccine is less than was anticipated, the vaccine will probably first be offered to the following groups: pregnant women, children between 6mos and 4 years of age, children between 5-18 years with chronic medical conditions, healthcare and emergency personnel providing direct patient care, and adults caring for children less than 6 mos. of age. Other targeted high-risk groups when more vaccine is available would include children and adults between ages 5-24, and adults ages 25—64 with chronic medical conditions. Physician offices may preregister for the delivery of the novel H1N1 vaccine by contacting the VDH via their website. CVHD has been also been working closely with our school systems in planning for vaccination strategies and school responses to influenza over the coming year. Again, remember that infection control precautions are critical in limiting the spread of seasonal and novel influenza. This includes adherence to precautions implemented in health care facilities, including using N95 or surgical masks, use of consistent hand hygiene, and appropriate cough etiquette. Stay at home, and enforce this policy for your employees, when sick with a fever or influenza-like symptoms. Again, thanks for your attention and cooperation with influenza control and planning efforts. The influenza situation will continue to remain fluid. There are clinicians both at Centra and VDH dedicated to monitoring influenza information on a daily basis – something most busy physicians can’t be expected to do. We will keep you posted on new developments; keep an eye on the websites mentioned above, but especially look out for direct communications from us. Please call us with your questions.



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