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Swine Flu Official Letter to Doctors

April 28, 2009

This is a copy of the official letter to doctors in the state of Indiana regarding Swine Flu:

On Tuesday, April 21, the Centers for Disease Control and Prevention reported that two recent cases of febrile respiratory illness in children in southern California had been caused by a novel strain of influenza A (H1N1) which had not been reported in the United States or elsewhere previously. The novel virus contains genetic segments from N. American swine influenza A (H1N1), European/Asian swine influenza A (H1N1), N. American avian and human influenza viruses. By April 24, additional cases were being reported from southern California and Texas. At the same time health authorities in Mexico announced an influenza outbreak from this virus in southern and central Mexico. This message is to provide an update and provide guidance to health care workers in Indiana.

This outbreak is very fluid at the moment and changes are occurring daily. Interim guidance is available on the CDC Web site at http://www.cdc.gov/swineflu/guidance/. The ISDH will be developing a page with information for Indiana health professionals and will provide you with the URL as soon as possible.

Current Situation

· World Health Organization reports that 1000+ cases and approximately 81 deaths have occurred in Mexico due to infection with a novel swine influenza virus twenty three cases have been confirmed as Swine Influenza (H1N1) genetically identical to the CA cases.

· In the US confirmed cases have been identified in CA (7), TX (2), Kansas (2) and suspect cases in NYC (8) and OH (4).

o One of the KS cases had a history of travel to Mexico and had transmitted the virus to a close family member

o Other cases, but not all, had travel history to Mexico

o None of the cases report exposure to swine

o No swine or avian outbreaks with this virus stain have been reported in the U.S. or elsewhere

o Transmission appears to be human-to-human.

· All US cases have been mild cases with one case requiring a brief hospitalization.

· The World Health Organization is meeting to determine if Pandemic Level should be changed

· Increased surveillance for influenza has been initiated by CDC, IN, and other states

· Current seasonal influenza vaccine may not provide protection.

Clinical Information

· Consider the possibility of swine influenza in patients who present with a febrile respiratory illness who:

o Live in an area where swine influenza cases have been confirmed.

o Have traveled to Mexico or areas were virus has been reported.

o Had contact in the past 7 days with ill individuals who had recent history of travel to Mexico, or States reporting swine influenza.

· Clinical symptoms of swine flu in people are similar to those of seasonal influenza and may include:

o Fever (greater than 100 degree F)

o Sore throat

o Cough

o Stuffy nose

o Chills

o Headache and body aches

o Fatigue

o Nausea and vomiting have also been reported

o Severe illness (respiratory distress and pneumonia) have been reported in people with this virus.

Treatment/Guidance

· The virus is sensitive to Tamiflu (oseltamivir) and Relenza (zanamivir) and guidance for the use of those drugs in ill individuals is presented at http://www.cdc.gov/swineflu/recommendations.htm

· Isolation is recommended for those who are ill

· Quarantine for contacts of cases may be used in limited circumstances on a voluntary basis

· Infection control for care of patients confirmed or suspected of having an infection with Swine Influenza A (H1N1) in health care settings can be found at http://www.cdc.gov/swineflu/guidelines_infection_control.htm

· Interim guidance on the use of facemask in community settings can be found at http://www.cdc.gov/swineflu/masks.htm

Resources for Patient Education (some contain printable materials for patients)

· CDC Influenza page: http://www.cdc.gov/flu/

· Taking Care of a Sick Person in Your Home http://www.cdc.gov/swineflu/guidance_homecare.htm

· Seasonal Flu: what to do if you get sick: http://www.cdc.gov/flu/whattodo.htm

* Preventing the Flu: Good Health Habits Can Help Stop Germs: http://www.cdc.gov/flu/protect/habits.htm

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