Order of the Health Officer to all Providers of Influenza Medications - May 6, 2009

posted May 11, 2009, 1:07 PM by Santa Clara County Public Health Dept   [ updated May 11, 2009, 1:08 PM ]

PURSUANT TO THE AUTHORITY IN CALIFORNIA HEALTH AND SAFETY CODE SECTION 101040 AND GOVERNMENT CODE SECTION 8558, THE HEALTH OFFICER OF THE COUNTY OF SANTA CLARA, HEREBY ISSUES THE FOLLOWING ORDER(S).

ALL LICENSED HEALTH CARE PROFESSIONALS* AND PHARMACISTS WHO ARE LOCATED WITHIN SANTA CLARA COUNTY MUST USE INFLUENZA ANTIVIRAL MEDICATIONS FROM THE SANTA CLARA COUNTY STOCKPILE FOR TREATMENT OR PROPHYLAXIS OF INFLUENZA-LIKE ILLNESS ACCORDING TO THE FOLLOWING PROTOCOL:

Antiviral Treatment

Healthcare providers in Santa Clara County are hereby directed to utilize oseltamivir (Tamiflu) and/or zanamivir (Relenza) from the Santa Clara County stockpile for treatment strictly in accordance with the following guidelines:

Treatment should be considered for patients with confirmed, probable, or suspected novel influenza A (H1N1) virus infection who are:

  • Experiencing a potentially life-threatening complication; or
  • Hospitalized for evaluation and treatment of influenza-like illness (ILI); or
  • At high risk for complications with influenza; or
  • Judged severely ill by the treating physician (e.g., toxic appearance, altered mental status, tachypnea, hypotension, significant hypoxia, etc.).

Antiviral prophylaxis

Healthcare providers in Santa Clara County are hereby directed to utilize oseltamivir (Tamiflu) and/or zanamivir (Relenza) from the Santa Clara County stockpile for prophylaxis strictly in accordance with the following guidelines:

Antiviral chemoprophylaxis should be considered for the following individuals:

  • People at high risk of complications from influenza who have had close contact (within six feet) with a person with a confirmed, probable, or suspected novel influenza A (H1N1) case during the infectious period (one day before until seven days following illness onset); or
  • Healthcare workers at high risk of complications from influenza who have had close contact (within six feet) with a person with a confirmed, probable, or suspected novel influenza A (H1N1) case during the infectious period (one day before until seven days following illness onset) AND who were not wearing appropriate personal protective equipment, including wearing a surgical mask, during that close contact; or
  • Travelers to Mexico who are at high risk of complications from influenza.

For CDC antiviral dosing recommendations, see www.cdc.gov/h1n1flu/recommendations.htm. Specific CDC guidelines on antiviral use in patients with cardiovascular disease, HIV-infected adults and adolescents, pregnant women, and young children are available under “Clinician Guidance for Specific Audience” at www.cdc.gov/h1n1flu/guidance.

Definitions

Influenza-Like Illness (ILI): Fever >37.8°C [100°F] AND at least two of the following: rhinorrhea or nasal congestion, sore throat or cough.

Case Definitions:

  • A confirmed case of novel influenza A (H1N1) virus infection is defined as a person with ILI with laboratory confirmed swine-origin influenza A (H1N1) virus infection by real-time RT-PCR or viral culture.
  • A probable case of novel influenza A (H1N1) virus infection is defined as a person with ILI who is either positive for influenza A, but negative for H1 and H3 by influenza RT-PCR; or has an epidemiologic link in the last 7 days to a confirmed or probable case of novel influenza A (H1N1) virus infection.
  • A suspected case of novel influenza A (H1N1) virus infection is defined as a person with ILI in Santa Clara County.

High Risk for Complications of Influenza

Persons at high risk for complications of influenza include any of the following:

  • Persons aged < 5 years or ≥ 65 years;
  • Pregnant women;
  • Persons with chronic diseases such as diabetes mellitus, asthma, heart disease (excluding hypertension), kidney disease, severe anemia, and cancer, or who are immunocompromised due to immunosuppressive medications (e.g., corticosteroids, anti-TNF alpha medicines,) or HIV infection;
  • Children aged six months to 18 years who are on long-term aspirin therapy;
  • Persons with any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration;
  • Residents of nursing homes and other chronic care facilities.

Appropriate Personal Protective Equipment

Appropriate personal protective equipment (PPE) for healthcare workers interacting with patients with ILI is PPE required for Standard and Droplet precautions, including a surgical mask. For complete information on appropriate PPE, please see www.sccphd.org.

This order must be prominently posted in locations where influenza-like illness is evaluated and treated, and in places visible to the general public. If you have any questions regarding this order, please call the Public Health Information Line at 408.885.3980.

THIS ORDER TAKES EFFECT IMMEDIATELY AND REMAINS IN EFFECT UNTIL RESCINDED BY THE HEALTH OFFICER. IT IS SO ORDERED.

* Licensed Health Care Professional is defined as: Persons Licensed and Certified Pursuant to Division 2 (Commencing with Section 500) of The Business and Professions Code, The Osteopathic Initiative Act or The Chiropractic Initiative Act, or Division 2.5 (Commencing with Section 1797) of The Health and Safety Code.

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Santa Clara County Public Health Dept,
May 11, 2009, 1:08 PM
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Santa Clara County Public Health Dept,
May 11, 2009, 1:08 PM
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Santa Clara County Public Health Dept,
May 11, 2009, 1:08 PM
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