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 State# lab confirmed cases Arizona1 case California14 cases Kansas2 cases New York City51 cases Ohio1 case Indiana1 case Nevada1 case Michigan2 cases Mass.2 cases Texas16 cases Total Count91 cases

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

6. Clinical findings of influenza Adults Abrupt onset Fever Myalgia Headache Severe malaise Cough Sore throat Rhinitis MMWR 2003; 52#RR8:2-3 Children Abrupt onset Fever89-94% Cough60-67% Rhinorrhea56-66% Vomiting17-19% Diarrhea8-9% Headache23-24% Myalgia6-15% Otitis media19-26% Clin Infect Dis 2003;36:299-302

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

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: 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

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 ModerateSevere ( 1958-59)(1918-like) Illness90 million90 million Outpatient care45 million45 million Hospitalization865,0009,900,000 ICU Care128,7501,485,000 Ventilation64,875742,500 Deaths209,0001,903,000

18. Questions?