Swine Flu

MMS Flu Advisory: May 8, 2009

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 9th, 2009 by MMS – Comments Off on MMS Flu Advisory: May 8, 2009

MMS Flu Advisory Sign Up Friday morning the Mass. Department of Public Health confirmed 12 additional cases in Massachusetts,
which brings the total case count to 83.  Each of the new cases is
expected to fully recover and 2 of the newly confirmed cases were
hospitalized but has been discharged.

The next update on confirmed cases in Massachusetts will take place on Monday, May 11, 2009, at 11:00 a.m.

For more information on H1N1 flu (swine flu) please visit www.mass.gov/dph

Download Confirmed Cases as of 5-8-09

New England Journal of Medicine Releases New Research; Mass. Confirms 26 New Cases

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 7th, 2009 by MMS – 1 Comment

MMS Flu Advisory Sign Up The New England Journal of Medicine today published a comprehensive online-only package of research articles and commentary on the H1N1 (swine) flu virus.

They can be found at http://h1n1.nejm.org/

The articles are:

Original Article: Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Fatima S. Dawood, Centers for Disease Control and Prevention, Atlanta, GA

Original Article: Human Infections with Triple-Reassortant Swine Influenza A (H1) Viruses in the United States, 2005-2009
Vivek Shinde, M.D., M.P.H., Centers for Disease Control and Prevention, Atlanta, GA

Editorial: H1N1 Influenza A Disease — Information for Health Professionals
Lindsey R. Baden, M.D., the New England Journal of Medicine, Boston, MA

Editorial: Implications of the Emergence of a Novel H1 Influenza Virus 
Robert B. Belshe, M.D., St. Louis University, St. Louis, MO

Perspective: The Signature Features of Influenza Pandemics – Implications for Policy
Mark A. Miller, M.D., National Institutes of Health, Bethesda, MD

Perspective: Digital Disease Detection – Harnessing the Web for Public Health Surveillance
John S. Brownstein, Ph.D., Children’s Hospital, Boston, MA

* * * *

Separately, the Mass. Department of Public Health announced this morning the confirmation of 26 new cases of H1N1 in Massachusetts, bringing the state’s total to 71.

DPH noted on its blog, "The increase in cases in Massachusetts, similar to what is being seen in other states, was expected given the intensity of surveillance for new cases, and the broad testing program for specimens early in the outbreak. DPH’s testing strategy, consistent with CDC guidelines, will change over time to focus on more seriously ill patients."

MMS Flu Advisory: May 6, 2009

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 6th, 2009 by MMS – Comments Off on MMS Flu Advisory: May 6, 2009

MMS Flu Advisory Sign Up The Massachusetts Department of Public Health (MDPH) is now performing confirmatory testing for H1N1 influenza at the Hinton State Laboratory Institute.

The lab estimates that it will take between 24-36 hours to confirm samples submitted for testing. Beginning today, MDPH will begin updating the Massachusetts H1N1 case counts at 11 a.m. for the previous day’s confirmatory results. This schedule will allow DPH staff to make all the necessary notifications as part of their public health case investigation.  In addition, it will be consistent with current CDC policy to update the national case counts at 11 a.m. each day. Data includes the date of confirmation, the county where the case is located, and whether or not the case is hospitalized. Updated Case Counts are available on the MDPH website, www.mass.gov/dph/swineflu.

As of 11:00 a.m. today, MDPH is reporting 45 total cases, including 11 confirmed yesterday, May 5. A chart with age breakdown is posted below the case listing.

CDC Revises Guidelines on School Closures

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 5th, 2009 by MMS – Comments Off on CDC Revises Guidelines on School Closures

The CDC today revised its initial recommendations on school closures.

"School closure is not advised for a suspected or confirmed case of
novel influenza A (H1N1)," the CDC now says. "In general, [closing a school] not advised unless there
is a magnitude of faculty or student absenteeism that interferes with
the school’s ability to function."

It noted, "The primary means to reduce spread of influenza in schools focus on
early identification of ill students and staff, staying home when ill,
and good cough and hand hygiene etiquette."

Read the full text of the recommendation here.

With New Testing Capabilities, Massachusetts Confirms 28 New Cases of H1N1

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 4th, 2009 by MMS – Comments Off on With New Testing Capabilities, Massachusetts Confirms 28 New Cases of H1N1

MMS Flu Advisory Sign Up The Massachusetts Department of Public Health tonight announced that it has confirmed 28 new cases of the H1N1 (swine) flu, bringing the total confirmed cases in the state to 34. In keeping with patterns nationwide, half of the cases were in patients under age 18.

The large increase announced tonight was anticipated. Previously, all suspected cases of H1N1 had to be sent to the CDC in Atlanta for testing. This resulted in a large backlog of suspected cases, which the state cleared up today after getting approval to do H1N1 tests on suspected cases at its labs in Boston.

State officials said none of the new cases are hospitalized and all are expected to recover. The cases in Massachusetts so far have been moderate in severity.

Following is a table of new and previously confirmed cases in Massachusetts.

Date Confirmed

Age*

County*

Symptom 0nset

 

Hospitalized (Y/N/U)

Wednesday,
April 29, 2009

13

Middlesex

4/22/2009

N

Wednesday,
April 29, 2009

9

Middlesex

4/26/2009

N

 

 

 

 

 

Friday,
May 1, 2009

14

Middlesex

4/22/2009

Y (discharged)

Friday,
May 1, 2009

47

Middlesex

4/26/2009

N

Friday,
May 1, 2009

9

Middlesex

4/25/2009

Y (discharged)

Friday,
May 1, 2009

33

Plymouth

4/25/2009

N

 

 

 

 

 

Monday,
May 4, 2009

28

Bristol

4/29/2009

N

Monday,
May 4, 2009

19

Hampshire

4/26/2009

N

Monday,
May 4, 2009

20

Hampshire

4/28/2009

N

Monday,
May 4, 2009

16

Middlesex

4/27/2009

N

Monday,
May 4, 2009

47

Middlesex

4/24/2009

N

Monday,
May 4, 2009

2

Middlesex

4/27/2009

N

Monday,
May 4, 2009

37

Middlesex

4/27/2009

N

Monday,
May 4, 2009

3

Middlesex

4/26/2009

N

Monday,
May 4, 2009

14

Middlesex

4/27/2009

N

Monday,
May 4, 2009

4

Middlesex

 

Y
(discharged)

Monday,
May 4, 2009

37

Middlesex

4/28/2009

N

Monday,
May 4, 2009

17

Middlesex

 

N

Monday,
May 4, 2009

47

Middlesex

4/25/2009

N

Monday,
May 4, 2009

32

Middlesex

4/28/2009

N

Monday,
May 4, 2009

7

Middlesex

 

Monday,
May 4, 2009

31

Middlesex

 

N

Monday,
May 4, 2009

12

Middlesex

4/27/2009

N

Monday,
May 4, 2009

10

Middlesex

4/30/2009

N

Monday,
May 4, 2009

17

Middlesex

 

Monday,
May 4, 2009

16

Middlesex

4/25/2029

N

Monday,
May 4, 2009

8

Middlesex

4/30/2009

N

Monday,
May 4, 2009

17

Norfolk

4/27/2009

N

Monday,
May 4, 2009

57

Norfolk

4/25/2009

N

Monday,
May 4, 2009

7

Norfolk

4/19/2009

Monday,
May 4, 2009

20

Plymouth

4/24/2009

N

Monday,
May 4, 2009

24

Suffolk

4/26/2009

N

Monday,
May 4, 2009

25

Suffolk

4/25/2009

N

Monday,
May 4, 2009

26

Suffolk

4/27/2009

Earlier today, the state began distributing federal stock of antiviral medications and masks to hospitals. By the end of the week, the state's allocation of supplies will have been distributed to hospitals, emergency medical providers, and clinics at colleges and universities.

MMS Flu Advisory: Mass. DPH Modifies Guidelines for Testing and Treatment of H1N1 Virus

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 4th, 2009 by MMS – Comments Off on MMS Flu Advisory: Mass. DPH Modifies Guidelines for Testing and Treatment of H1N1 Virus

MMS Flu Advisory Sign Up The Massachusetts Department of Public Health has revised its guidelines for prior testing and treatment of the H1N1 virus, "given the relatively mild course the disease has demonstrated so far."

CDC is expected to recommend that testing and treatment be focused on those with severe respiratory illness and those at highest risk of complications from influenza. Mass DPH said it is issuing its own guideline "pending CDC issuance of new recommendations for testing and treatment. "

In a memo to clinicians, DPH added, "We hope that these revised guidelines will ease the pressure for antiviral medications and reduce patient expectation for treatment. We appreciate your commitment to excellent clinical care and the thoughtful feedback on the challenges you have faced in implementing recommendations over the past week."

Following is the text of the Mass. DPH guideline:

Individuals with mild illness should be advised to stay at home. They do NOT need to be tested or treated unless they meet one of the high-risk criteria listed below.

TESTING: Do not perform rapid flu diagnostic tests routinely on all individuals with mild illness.  Collection of clinical specimens in high risk patients to be submitted to Mass. DPH’s William A. Hinton State Laboratory Institute (HSLI) should be restricted so that testing is only done on the following individuals:

  • Those with flu-like febrile respiratory illness or sepsis-like syndrome requiring hospitalization
  • Those at high risk of complications with influenza, including:
  • Children less than 2 years old;
  • Persons aged 65 years or older;
  • Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
  • Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
  • Pregnant women;
  • Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy who might be at risk for experiencing Reye syndrome after influenza virus infection;

TREATMENT

Treatment should be reserved for individuals meeting the above criteria for testing, or for probable and confirmed cases of swine-origin H1N1 influenza A.

PROPHYLAXIS

Prophylaxis is recommended for:

  • Household-type close contacts of those with probable or confirmed swine-origin H1N1 influenza A who are at higher risk of the complications of influenza (see list above); and
  • Health care workers exposed to the respiratory secretions of probable or confirmed cases of swine-origin H1N1 influenza A without use of recommended precautions.  

SPECIMEN COLLECTION IN HIGH RISK PATIENTS FOR DIAGNOSIS AT THE HSLI

If patients meet the testing criteria described above, clinicians who suspect swine influenza virus infections in humans should contact an Mass. DPH epidemiologist immediately at 617-983-6800 (available 24/7) who will provide guidance about specimen collection and arrange transportation to the HSLI.

Please collect 2 NP swabs using a flexible fine shafted aluminum swab with a synthetic tip such as nylon or Dacron® (do not use a calcium alginate swab or a cotton tip swab with a wooden shaft.)  Place them in 2-3 ml of viral transport media. [If the patient is hospitalized with pneumonia, specimens from the lower respiratory tract (e.g., tracheal aspirate, bronchoalveolar lavage) should also be obtained.]  Should also be obtained and placed in 2-3 ml of VTM.

Specimens should be collected within the first 24-72 hours of onset of symptoms ideally and no later than 5 days after onset of symptoms, but can be collected later.

The specimens should be kept refrigerated at 4ºC and sent on cold packs if they can be received by HSLI within five days of the collection date. If samples will be received by the HSLI in five or more days from collection, they should be frozen at -70 ºC or below and shipped on dry ice.  Be sure to label all tubes and complete a state laboratory specimen submission form for each specimen. The HSLI specimen submission form can be found at: http://www.mass.gov/Eeohhs2/docs/dph/laboratory_sciences/general_submission_form.pdf

When influenza A is detected in your clinic by rapid testing methods, send an aliquot (1-2 ml) of the original suspension (not exposed to test kit reagents) in viral transport media or PBS.  The NP swab is the preferred, primary specimen.

If you have any questions about swine influenza, its presentation, diagnosis or control, please call the Mass. DPH Division of Epidemiology and Immunization at 617-983-6800. 

Mass. DPH website: www.mass.gov/dph/swineflu
CDC information: http://www.cdc.gov/h1n1flu/

MMS Flu Advisory: May 3, 2009

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 3rd, 2009 by MMS – Comments Off on MMS Flu Advisory: May 3, 2009

Mass. Department of Public Health (MDPH) Confirmed H1N1 Influenza (swine flu)

As of May 1, 2009 at 5:00pm

Date Confirmed

County

Age

Hospitalized?

(as of date of confirmation)

Friday, May 1, 2009

Middlesex

47

No

Friday, May 1, 2009

Middlesex

9

Yes (Ready for Discharge)

Friday, May 1, 2009

Middlesex

14

No

Friday, May 1, 2009

Plymouth

34

No

 

 

 

 

Wednesday, April 29, 2009

Middlesex

13

No

Wednesday, April 29, 2009

Middlesex

9

No

Total Number of Cases:              6

**Please note there was an error is CDC’s reporting yesterday. CDC incorrectly stated there were 8 confirmed cases in MA, which is incorrect. CDC inadvertently included duplicate test information.

National: 160 confirmed cases / 1 death per CDC daily update at 11:00 am

CDC at http://www.cdc.gov/h1n1flu/. The Federal Government and manufacturers have begun the process of developing a vaccine against this new virus. The CDC has posted Interim Guidance for Heart Disease, Stroke or Cardiovascular Disease. (May 2, 2009)

International: As of 6:00 a.m. GMT, 3 May 2009, 17 countries have officially reported 787 cases of influenza A(H1N1) infection. Mexico has reported 506 confirmed human cases of infection, including 19 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens.

WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.

The Mass. DPH website has been updated to include:

    * An FAQ regarding specimen collection and submission under guidance for professionals
    * A document called H1N1 virus (Swine Flu) Information for Parents
    * Home Isolation document posted in Spanish and Portuguese
    * Swine Flu Fact Sheet is now posted in Somali; Arabic; Thai; Korean and Russian

Sources: Massachusetts Department of Public Health (May 2, 2009), World Health Organization (May 3, 2009), Centers for Disease Control and Prevention (May 3, 2009)

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MMS Flu Advisory: Four More H1N1 Cases Confirmed in Massachusetts (Updated)

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 1st, 2009 by MMS – Comments Off on MMS Flu Advisory: Four More H1N1 Cases Confirmed in Massachusetts (Updated)

The state Department of Public Health announced late this afternoon that it has confirmed four new, unrelated cases of the H1N1 (swine) flu in Massachusetts, bringing the state's total to six. All four patients are recovering.

The DPH said two of the cases were school-age children in Middlesex County, a 47-year-old resident of Middlesex County, and a 34-year-old resident of Plymouth County. One of the children was hospitalized and is ready for discharge. The children did not attend school during any point during their illness.

Without being specific, Auerbach said it's likely that there will be more confirmations of H1N1 cases in Massachusetts.

Auerbach also urged clinicians to continue to be vigilant in identifying patients who may have the H1N1 virus.

Al DeMaria, M.D., the state’s chief epidemiologist, said state residents should
continue to practice preventive measures, such as handwashing and cough etiquette.
He also said, “If you’re sick, stay home.”

MMS Flu Advisory: May 1, 2009

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 1st, 2009 by MMS – Comments Off on MMS Flu Advisory: May 1, 2009

MMS Flu Advisory Sign Up The Massachusetts
Department of Public Health (DPH) yesterday released the
following:

Revised
Update on the Outbreak of Swine Influenza and Interim Recommendations for
Diagnosis and Control
, which includes:

  • New definition of
    suspected cases
  • Revised testing
    recommendations
  • Revised treatment
    guidelines, including dosing for children and pregnant
    women
  • New recommendations
    for prophylaxis of health care workers

The update asks
providers to report all suspect cases immediately to 617-983-6800 and collect
clinical specimens for special diagnostic testing.

Also released:

 In addition, the MDPH
swine flu website has been updated
to include the following:

Mass. DPH fact sheets and
guidance for professionals can be found at www.mass.gov/dph/swineflu.

The April 30, 2009 edition of the Morbidity and Mortality Weekly Report (MMWR) include the following articles:

CDC Issues Updated Guidelines for Patient Infection Control, Emergency Personnel and Antiviral Drugs

Posted in Flu, Flu Advisory, H1N1, Swine Flu on April 30th, 2009 by MMS – Comments Off on CDC Issues Updated Guidelines for Patient Infection Control, Emergency Personnel and Antiviral Drugs

The CDC yesterday issued updated guidelines in three important areas.

Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting

  • Implementation of Respiratory Hygiene/Cough Etiquette
  • Implementation of facility contingency plans
  • Interim Infection Control Recommendations
  • Infection Control of Ill Persons in a Healthcare Setting

Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection

  • Interim Recommendations
  • Infectious Period
  • Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV)
  • Recommendations for 9-1-1 Public Safety Answering Points (PSAP)
  • Recommendations for EMS and Medical First Responder Personnel Including Firefighter and Law Enforcement First Responders

Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts

  • Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV)
  • Antiviral Resistance
  • Antiviral Treatment
  • Antiviral Chemoprophylaxis
  • Dosing Recommendations
  • Children Under Age 1 and Pregnant Women
  • Adverse Events and Contraindications