Weekend Update: Mexican Serious Respiratory Illness is SWINE FLU – precautions and reporting
Testing has shown that the Serious Respiratory Illness (SRI) in Mexico is a novel reassorted H1N1 swine influenza with gene segments from North American swine and avian influenza, human influenza, and a Eurasian swine influenza. Sequencing is incomplete, but so far is identical to that in 8 California/Texas cases with milder disease. Mexico has increased influenza outbreak control to include closing schools/universities and museums. WHO has activated its strategic health operations centre, in case this turns out to be the start of a pandemic. In BC, our sentinel physicians detect low and dropping circulation of human H1N1 and H2N3, but no swine H1N1.
Clinical information on this SRI from Mexico remains the same:
Initial symptoms: high fever, headache, eye pain, shortness of breath, extreme fatigue
Rapid progression to severe respiratory distress within about 5 days, many needing mechanical ventilation
Most cases are previously healthy young adults (age 25-44), including some health care workers
The outbreak virus is resistant to amantadine but sensitive to oseltamivir. The current seasonal influenza vaccine is not expected to provide much if any protection against this new swine flu virus.
INTERIM REVISED advice for Fraser Health clinicians:
As always, give coughing patients a surgical mask as soon as possible after they arrive
For any patient SICK WITH COUGH AND FEVER STARTING WITHIN 10 DAYS OF BEING IN MEXICO:
Take directly to the least-used examining room; keep the door closed. In the ER, use a negative pressure room if possible; if this is not possible, keep the patient at least TWO metres away from others. Patient and companions should wear surgical masks and wash/sanitize hands.
Physicians and other health care providers should use N95 masks, gloves, eye protection, and if any possibility of spray or splash, also wear gowns.
Put a nasopharyngeal swab in viral transport media (if NP impossible, do nasal & throat swabs.)
Consider oseltamivir treatment.
For any such patient who is SERIOUSLY ILL:
If bronchoalveolar lavage is done, submit a BAL sample. For biopsy/autopsy cases, submit paired sera and lung tissue. Please put the details of the travel in Mexico on the BCCDC lab requisition and phone Public Health so that the lab can be alerted that samples are on the way.
If sending a patient to hospital, alert the receiving ward or ER, as well as the ambulance attendants if transferring by ambulance. In hospital, alert Infection Control and Occupational Health.
In case follow-up of contacts is needed, list the names and phone numbers of people who came with the patients, or shared a waiting or other area with them, or used the washroom after them.
Report hospitalized patients to Public Health: during regular hours to the Health Unit where the patient lives, and after hours to the Medical Health Officer on call.
If you have available: quaternary ammonium compounds (quats) or Virox
Otherwise: 1 part household bleach + 5 parts of water freshly mixed to clean anything contaminated with blood or body fluids (1 part in 49 for other contaminated / 1 part in 99 for general cleaning); 70% isopropyl or ethyl alcohol where bleach can’t be used.
Other: Mexico-bound travellers should get influenza vaccine for the regular seasonal influenza now circulating in Mexico, wash/sanitize hands regularly, cough/sneeze into the upper arm/sleeve, and avoid others when ill. Publically-funded influenza vaccine is not provided for travellers unless they are eligible for it for other reasons.
FH Medical Health Officers are available for consultation at 604-587-3828 or in Fraser East at 1-877-342-6467.
