May 6, 2009

Background on the outbreak

The outbreak of novel influenza A (H1N1) virus, which has been reported widely in the news, now affects 19 countries and 38 states. As of May 5, 2009, Santa Clara County has reported a total of 17 probable and confirmed cases, most of whom have not traveled to Mexico or other affected communities. There is evidence of human-to-human transmission within our community. Although seasonal human influenza continues to circulate in the community, anyone with an influenza-like illness might potentially have novel influenza A (H1N1) virus.

Influenza-like illness (ILI) is defined as fever >37.8°C [100°F] AND at least two of the following: runny nose or nasal congestion, sore throat, or cough.

How Influenza A H1N1 is spread

Flu viruses are generally spread from person to person through coughing or sneezing of people with influenza. In addition, sometimes people may become infected by touching something with flu viruses on it and then touching their mouth, nose, or eyes. A person with influenza is contagious beginning one day before the onset of symptoms until seven (7) days after illness onset, or until all symptoms have resolved, whichever is longer.

Measures to control the spread of influenza and other contagious diseases

Students and staff at colleges and universities should be encouraged to observe the following measures to reduce the spread of influenza and other contagious diseases:

• Cough or sneeze into the sleeve or cover the nose and mouth with a tissue when coughing or sneezing. Throw tissues in the trash after use.
• Wash hands often with soap and water, especially after coughing or sneezing. Alcohol-based hand cleaners are also effective.
• Avoid touching eyes, nose or mouth. Germs spread this way.
• Well persons should try to avoid close contact with sick people.

Students and staff who are feeling ill should stay home (or in the dormitory) at least one day to observe how the illness develops and until completely well for 24 hours.

What to do with students and staff who have influenza-like illness

If a student or staff person develops an influenza-like illness (ILI), they should stay home or in the dormitory and not attend classes or school functions where they might expose others, for at least seven (7) days following the onset of illness or until all symptoms have resolved, whichever is longer. During this time, they should limit contact with healthy people. The document “What to do if you’re home with the Flu” on Santa Clara County Public Health Department’s website www.sccphd.org may be applied to the dormitory setting.

If students or staff persons with ILI must enter public areas (e.g., common living areas in a dormitory), they should wear a surgical mask. Use of the surgical mask should continue for at least the seven (7) days following the onset of illness, and until all symptoms have resolved.

Guidance for care at home for patients with influenza, including reasons to contact a medical provider for evaluation and treatment, can be found at: http://www.cdc.gov/swineflu/guidance_homecare.htm, and on the Santa Clara County Public Health Department’s website at http://www.sccphd.org/swine_flu_update.html (click on the link to the Home Care Guide on the right side of the page).

Testing for Novel Influenza A (H1N1) virus

At this time, the Santa Clara County Public Health Department is NOT recommending testing for novel influenza A (H1N1) virus in university students or staff with influenza-like illness.

Current local recommendations for testing for novel influenza A (H1N1) virus are available at www.sccphd.org – please look for the most recent Health Alert for these recommendations.

Treatment for Novel Influenza A (H1N1) virus

Treatment with influenza antiviral medications is not routinely recommended, even for patients with novel influenza A (H1N1) virus, except under certain circumstances. Guidelines for identifying and treating patients with novel influenza A (H1N1) virus can be found at http://www.cdc.gov/h1n1flu/identifyingpatients.htm and http://www.cdc.gov/h1n1flu/recommendations.htm. Additional guidance is available in the most recent Health Alert at www.sccphd.org. This is a dynamic and evolving situation. Clinicians are advised to stay informed and use the most up-to-date guidance from the CDC.

Individuals at high risk for complications of influenza should be advised to contact their medical providers early in the course of an influenza-like illness (ILI) in order to determine the best course of treatment. These individuals include:

• persons aged ≥ 50 years of age;
• children < 5 years of age;
• pregnant women;
• persons with chronic diseases such as diabetes mellitus, asthma, heart disease (excluding hypertension), kidney diseases, severe anemia, cancer, and weakened immune systems due to immunosuppressive medications (corticosteroids, anti-TNF alpha medicines, etc.) 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

If student health services or other health care providers cannot obtain access to antiviral medications through a commercial pharmacy, they may order these medications through the Santa Clara County Public Health Pharmacy. To order antiviral medications, go to www.sccphd.org and select “Click Here for Physician & Provider Information.”

Further questions

Current information on the status of the outbreak at the local, state, and national levels may be found at the following websites:

Santa Clara County Public Health Department: http://swineflu.sccgov.org/
State of California: http://ww2.cdph.ca.gov/Pages/default.aspx
Centers for Disease Control and Prevention: http://www.cdc.gov/h1n1flu/

For further questions, please contact the Public Health Department Emergency Operations Center during regular business hours at 408-794-0700. After hours and on weekends, healthcare providers (but not the general public) may call County Communications at 408-998-3438 and ask to speak with the public health officer on call.