Swine Flu Advisory State of Nebraska

Nebraska Health and Human Services System

HEALTH ALERT NETWORK - Advisory

Over the past week public health officials have confirmed the occurrence of a novel influenza A H1N1 strain in Texas and southern California. This new variant swine influenza (SI) strain appears to have originated in Mexico, where it has been circulating for several weeks. This is a new and unusual hybrid strain of influenza, and contains genetic material from human, swine, and avian sources.

The virus is pathogenic in humans and spreads from person-to-person. While no deaths from this virus have been identified in the United States, based on isolated reports, it appears to have caused severe, fatal illness in Mexico. Much of this information is preliminary and will be updated as soon as scientists and public health investigators generate additional facts. Based on current information we recommend that Nebraska health care providers (HCPs) consider the following:

1. Because seasonal influenza is rapidly waning, HCPs should seriously consider the diagnosis of SI infection in any patient with a fever of 100 or more plus a cough or sore throat, in the absence of a clear alternative diagnosis. Some patients with the SI have had diarrhea and vomiting along with the above symptoms.
2. Because we want to identify the arrival of this virus in our state as soon as possible, HCPs who see patients with influenza-like illness (ILI ) are strongly encouraged to collect a nasopharyngeal specimen for testing at the Nebraska Public Health Laboratory (NPHL). The specimen should be transported in viral transport media on a cold pack. Instructions for how to collect a nasopharyngeal specimen and a copy of the NPHL test requisition can be found at the Nebraska Division of Public Health influenza web site: http://www.hhs.state.ne.us/flu/
3. Because we want to identify the arrival of this virus in our state as soon as possible, HCPs who see patients with influenza-like illness (ILI ) are strongly encouraged to collect a nasopharyngeal specimen for testing at the Nebraska Public Health Laboratory (NPHL). The specimen should be transported in viral transport media on a cold pack. Instructions for how to collect a nasopharyngeal specimen and a copy of the NPHL test requisition can be found at the Nebraska Division of Public Health influenza web site: http://www.hhs.state.ne.us/flu/
4. The new variant SI is resistant to the adamantine drugs (amantadine and rimantadine) but is susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza). Current rapid diagnostic tests for influenza appear capable of detecting the new variant SI.
5. HCPs should use recommended infection control precautions to minimize the risk of transmission in the health care setting. Whenever possible, health care providers should wear an N95-fit tested respirator. Additional infection control guidance is available at the CDC web site: http://www.cdc.gov/swineflu/guidelines_infection_control.htm
6. HCPs should immediately notify their local health department of any patient with ILI plus an epidemiologic history that links them to Mexico, Southern California or Texas, and should proceed to culture and treat the patient in accordance with the advice above. Local health department contact information can be located at the Nebraska Public Health Association website: http://www.publichealthne.org/saccho.htm

Important contact information:

• State Epidemiologist 402-471-1983
• State Public Health Lab 402-559-2440