For: FH Physicians admitting or managing patients with Severe Respiratory Illness in FH Hospitals.
Re: Increase Influenza Testing of Hospitalized Severe Respiratory Illness
Please test for influenza all patients admitted to hospital with acute respiratory illness (i.e., fever and new or worse cough). Write “HOSPITALIZED” on requisition to BCCDC.
Context
Identification and investigation of hospitalized cases of influenza is needed to assess the effect of Swine-origin influenza A/H1N1 virus (S-OIV) in BC. The BC College of Physicians also sent an email on July 2, 2009 to all physicians from the Provincial Health Officer that included this request to test for influenza. S-OIV continues to circulate in BC and in recent weeks, provinces have noted increasing numbers of hospitalization due to S-OIV
Guidelines for testing
TEST all patients admitted overnight (or longer) to hospital with a history of recent acute respiratory illness (i.e., history of fever and new or worse cough/breathing difficulty, with or without other flu-like symptoms such as sore throat, rhinorrhea, sneezing, myalgia, arthralgia, headache, fatigue, etc.);
Test as soon as possible on admission to increase likelihood of virus detection;
Test even if the etiology appears to be bacterial;
Specimen collection for influenza testing may include a nasopharyngeal (NP) swab or bronchoalveolar lavage (BAL). If patient presents with a rapidly progressive acute respiratory illness that is negative by NP swab for influenza A/H1N1, additional testing should be performed on tracheal or other pulmonary samples, if clinicians suspect influenza pneumonia diagnosis. NP samples should be collected on viral swabs (ideally, COPAN flocked swabs);
Specimens should be submitted to BCCDC Public Health Microbiology & Reference Laboratory, with “hospitalized” written in large letters on the requisition;
The requisition form, along with detailed instructions, can be found online at
http://www.phsa.ca/bccdcpublichealthlab (click on “Forms & Requisitions” on the left-hand panel, then choose “H1N1 Flu Virus: Virus Culture Form”);
Start antivirals according to clinical judgment without waiting for test results. Antivirals are most effective when administered within 48 hours of illness onset.
Reporting of Cases
Lab-confirmed S-OIV cases who are admitted to hospital must be reported to the Public Health Unit in the area where the patient lives. Public health staff will follow-up with detailed investigation of hospitalized, lab-confirmed S-OIV cases.
