Two Cases of Swine Flu Identified in BC

UPDATE: Two Cases of Swine Flu Identified in BC - New Recommendations are BOLDED

Two cases of swine influenza have been identified in the Lower Mainland. Preliminary test results indicate that these individuals have the same swine flu virus that has caused illness in the United States and Mexico. The specimens will be sent to the National Microbiology Laboratory for additional testing. One of the cases lives in Fraser Health. Fortunately, neither individual had a serious illness nor required hospitalization. Both are recovering at home. Four other swine flu cases have been confirmed in Nova Scotia, all with mild disease. 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 and we are not recommending that patients receive seasonal influenza vaccine for protection against swine flu. Guidelines are under review and we will update you regularly as new information becomes available.

REVISED advice for 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 OR IN CONTACT WITH SUCH INDIVIDUALS:
• 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 who are within 2 metres of the patient should use N95 masks, gloves, eye protection, and if any possibility of spray or splash, also wear gowns.  
• Patients with mild illness do not need to undergo diagnostic testing (i.e. a nasopharyngeal swab), nor do they need to be reported to Public Health.
• Consider oseltamivir treatment if within 48 hours of symptom onset.
• Advise the case to self-isolate for 7 days or until fever resolves, whichever is longer. Cases should inform their close contacts and advise them to self-isolate if they also become ill.
• For any such patient who is SERIOUSLY ILL:
• Put a nasopharyngeal swab in viral transport media (if NP impossible, do nasal and throat swabs.)  If bronchoalveolar lavage is done, submit a BAL sample.  For biopsy/autopsy cases, submit paired sera and lung tissue.  Please put details of any travel in Mexico or high risk exposures on the BCCDC lab requisition.
  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.
• Please report all patients with severe illness or those who are hospitalized to Public Health; during regular hours to the Health Unit where the patient lives, and after hours to the Medical Health Officer on call.
• Disinfection of surfaces: visit BCCDC for information on the Selection and Use of Disinfectants

Other:  Mexico-bound travellers should consider getting influenza vaccine because regular seasonal influenza is still circulating in Mexico (in addition to the newly identified swine flu), wash/sanitize hands regularly, cough/sneeze into the upper arm/sleeve, and avoid others when ill. Travellers can purchase vaccine from travel clinics. Publically-funded influenza vaccine is not provided for travellers unless they are eligible for it for other reasons.

For operational and logistical information please phone your local Health Unit at the numbers below. FH Medical Health Officers are available for clinical consultations at 604-587-3828 or in Fraser East at 1-877-342-6467.