Vermont Health Alert #1
THIS IS AN EXERCISE. THIS IS NOT A REAL EVENT
To: Vermont Hospitals, Ambulatory Care Settings, Healthcare Providers and Vermont Department of Health Personnel
Date: July 17, 2006
This advisory contains the following important information
- The CDC has identified person-to-person transmission of avian influenza A H5N1
- Cases continue to occur in South East Asia
- A case of avian influenza A H5N1 has been confirmed in Toronto Canada
- The Vermont Department of Health Requests Healthcare facilities perform surveillance for persons with symptoms of influenza with epidemiologic risks factors
- Please contact VDH to report persons with a recent travel history (less than 10 days) to Malaysia, Cambodia, Vietnam or Australia who have one or more of the following should be considered for testing in consultation with state and local public health officials:
- temperature of ≥38°C (≥100.4° F) with cough and/or sore throat;
- pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness.
- Persons meeting the above criteria who present to a hospital should be managed with airborne precautions.
Canadian Health Officials Confirm Case of Influenza A H5N1
Canadian Health officials have confirmed a case of influenza A H5N1 in a resident of Toronto. Preliminary information suggests this person may have acquired the infection while traveling in Australia. This is the first confirmed case of H5N1 in North America. The following information is being provided to assist state and local health officials in responding to the continued threat of introduction of influenza A H5N1 into the United States.
Background
In 1997 a new strain of avian influenza A virus – influenza A (H5N1) – emerged. Between then and the fall of 2005 this virus has expanded its geographic range, causing outbreaks among domestic poultry and wild migratory birds in several Asian, European and African countries. In addition, several people have been infected, almost all as a result of having direct contact with infected chickens or their contaminated environments.
In January 2006 the WHO confirmed limited person-to-person transmission in Indonesia. Molecular testing on samples of the virus demonstrated that avian influenza A (H5N1) had developed specific mutations to allow itself to be readily transmitted from person-to-person. Surveillance for additional cases was heightened, and additional cases began to be identified in this country. By July 1, 2006 the countries of Malaysia, Cambodia and Vietnam as well as Australia were reporting widespread outbreaks.
Since the WHO confirmed person-to-person transmission of H5N1 the CDC has been actively engaged in providing health advisories to traveler’s to and from these countries. Additionally CDC has disseminated frequent Health Alerts to state and local health departments advising clinicians to be on the alert for patients with influenza-like illness and a history of travel to these countries. As a result of these efforts a number of suspect cases have been reported to state and local health departments; none so far have been confirmed as H5N1. Similar efforts have been undertaken by Canadian Health officials. This case reported today represents the first confirmed case of H5N1 in North America.
Recommendations
The following recommendations are provided as a reminder to state and local health officials to assist them in the identification of persons at risk for H5N1 infection, to aide in the implementation of measures to prevent the transmission of H5N1, and to aide in the prioritization of use of antiviral medications, currently in limited quantities.
Surveillance for H5N1
Persons with a recent travel history (less than 10 days) to Malaysia, Cambodia, Vietnam or Australia who have one or more of the following should be considered for testing in consultation with state and local public health officials:
- temperature of ≥38°C (≥100.4° F) with cough and/or sore throat;
- pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness.
Additionally, persons with close contact (approach within 1 meter [approx. 3 feet]) to an ill person who was confirmed or suspected to have H5N1 should be considered for testing. Though such persons may not be showing symptoms they still may be infectious and pose a risk for transmission to others.
Control measures for H5N1
Within a hospital - persons meeting any of the above criteria who present to a hospital should be managed with airborne precautions.
Other than a hospital setting – persons meeting any of the above criteria who do not require hospitalization – i.e., persons with mild illness or persons with only a history of exposure to a confirmed or suspect case - can remain at home or in other community-based settings. State and local health officials should be notified of such persons and should take the following actions:
- ensure testing for H5N1 is made available
- ensure persons restrict their interactions with others
- ensure appropriate follow-up is undertaken
PLEASE NOTE:
If avian influenza is suspected, viral culture should not be performed at the hospital laboratory. PCR testing is available to confirm influenza at VDHL. Specimens taken for viral studies should be sent to the VDHL for culture. See instruction on reporting, collecting and shipping specimens distributed by VDHL.
Oropharyngeal swab specimens and lower respiratory tract specimens collected within the first 3 days of illness onset are preferred because they appear to contain the highest quantity of virus for influenza H5N1 detection, as determined based on available data. Unlike human influenza, avian influenza A (H5N1) may have higher viral titers in the throat than in the nose, and hence, analysis of throat swabs or lower respiratory samples may offer more sensitive means of diagnosis. Nasal or nasopharyngeal swab specimens are acceptable, but may contain less virus and therefore not be optimal specimens for virus detection.
Treatment for H5N1
Due to limited quantities, antiviral medications should be restricted for the treatment of persons requiring hospitalization. Antiviral medications should not be used to treat persons who do not require hospitalization nor should they be used for prophylaxis.
Travel Health Notice
The CDC and WHO continue to advise persons against non-essential travel to countries experiencing H5N1 outbreaks. At present CDC does not recommend that persons avoid travel to Canada.