Request for precautions and reporting

The recent serious respiratory illness (SRI) reports from Mexico are a good reminder that unusual SRI’s can occur anywhere in the world, reinforcing the importance of protecting yourself, your patients, and your staff.

Mexico is reporting investigation into SRI in south and central Mexico:  Mexico City (23 hospitals, 120 cases/13 deaths), San Luis Potosi (14 cases/4 deaths), Oaxaca (1 death), Baja California Norte (2 deaths).  This is out of a population of over 100 million.  Clinical information:

Initial symptoms:  high fever, headache, eye pain, shortness of breath, extreme fatigue
Rapid progression to severe respiratory distress within about 5 days  
A high proportion of cases required mechanical ventilation (exact percentage unknown)
The case-fatality rate 11% in Mexico City cluster and 29% in San Luis Potosi cluster; 15% overall
 Most cases were previously healthy young adults (age 25-44), with 5 health care workers affected as well
Detected so far:  influenza B and A/H1N1 with no A/H5N1 (i.e., no avian influenza); one parainfluenza
Even though this information is preliminary, given the current popularity of Mexico as a vacation destination for BC residents at this time of year, now is a good time to make sure your infection control practices are in place:

• As always, give coughing patients a surgical mask as soon as possible after they arrive
• For any patient seriously ill with fever and cough starting within 10 days of travel to Mexico (or contact with someone who has such travel and SRI history)
• 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 and throat swab in viral transport media.  When bronchoalveolar lavage is done, submit a BAL sample.  For biopsy/autopsy cases, submit paired sera and lung tissue.  Please label the req “Mexican travel – SRI” to go to the BCCDC laboratory and phone Public Health so that the BCCDC 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 he patients, or shared a waiting or other area with them, or used the washroom after them.
• Disinfection of surfaces:  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 otherwise and where bleach can’t be used.
• 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.
  

Other:  Travel advice for Canadians going to and returning from Mexico is currently being developed.  Mexico-bound travellers should be encouraged to receive this year’s influenza vaccine, practice routine hand washing and sanitizing, cough/sneeze into the upper arm/sleeve, and stay away from others when ill. 

More information is expected in the next few days and we will be posted as available.  

Fraser Health Medical Health Officers are available for consultation at 604-587-3828 or in Fraser East at 1-877-342-6467.