http://www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/index.html
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Sunday 29 December 2013
Monday 23 December 2013
Sunday 22 December 2013
Fwd: PRO/EDR> Influenza (67): USA (TX) H1N1
From: "promed@promedmail.org" <promed@promedmail.org>
Date: 22 December 2013 00:28:25 GMT
To: "promed-post@promedmail.org" <promed-post@promedmail.org>, "promed-edr-post@promedmail.org" <promed-edr-post@promedmail.org>
Subject: PRO/EDR> Influenza (67): USA (TX) H1N1
Reply-To: "promedNOREPLY@promedmail.org" <promedNOREPLY@promedmail.org>
INFLUENZA (67): USA (TEXAS) H1N1
********************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Fri 20 Dec 2013
Source: Texas Department of State Health Services (DSHS) [summ.,
edited]
<http://www.dshs.state.tx.us/news/releases/Influenza-Health-Alert-122013.pdf>
Influenza health alert
----------------------
Statewide influenza-like illness (ILI) activity continues to increase
and is above baseline levels. ILI intensity is high in Texas, and
influenza is now widespread. All Texas regions have reported
laboratory confirmed influenza. Over 90 per cent of positive influenza
tests reported from Texas laboratories have been typed as influenza A.
Of those influenza A viruses that have been subtyped, 90 per cent have
been the 2009 pandemic H1N1 subtype. This subtype of influenza is
included in this season's [2013-14] influenza vaccine. No novel
influenza cases have been reported in Texas. No antiviral resistant
influenza strains have been reported in Texas.
Background
----------
Influenza viruses can be spread by large respiratory droplets
generated when an infected person coughs or sneezes in close proximity
to an uninfected person. Symptoms can include fever, dry cough, sore
throat, headache, body aches, fatigue, and nasal congestion. Among
children, otitis media, nausea, vomiting, and diarrhea are common.
Most people generally recover from illness in 1-2 weeks, but some
people develop complications and may die from influenza. The highest
rates of influenza infection occur among children; however, the risks
for serious health problems, hospitalizations, and deaths from
influenza are higher among people 65 years of age or older, very young
children, and people of any age who have medical conditions that place
them at increased risk for complications from influenza.
Vaccination
-----------
Everyone who is at least 6 months of age should get a flu vaccine this
season [2013-14]. It is not too late for vaccination. There are
several flu vaccine options available for the 2013-2014 flu season.
All these vaccines contain the currently circulating H1N1 strain. DSHS
[Department of State Health Services] does not recommend one flu
vaccine over another, although there are special indications for some
(such as a high-dose inactivated trivalent vaccine approved for
persons age 65 years and older).
Rapid Lab Test
--------------
Rapid influenza diagnostic tests (RIDTs) can be useful to identify
influenza virus infection, but false negative test results are common
during influenza season. Clinicians should be aware that a negative
RIDT result does NOT exclude a diagnosis of influenza in a patient
with suspected influenza. When there is clinical suspicion of
influenza and antiviral treatment is indicated, antiviral treatment
should be started as soon as possible, even if the result of the RIDT
is negative, without waiting for results of additional influenza
testing.
Treatment: oseltamivir and zanamivir are chemically related antiviral
medications known as neuraminidase inhibitors that have activity
against both influenza A and B viruses. Early antiviral treatment can
shorten the duration of fever and illness symptoms, may reduce the
risk of complications and death, and may shorten the duration of
hospitalization. Clinical benefit is greatest when antiviral treatment
is administered early, especially within 48 hours of influenza illness
onset. Decisions about starting antiviral treatment should not wait
for laboratory confirmation of influenza.
Antiviral treatment is recommended as early as possible for any
patient with confirmed or suspected influenza who
- is hospitalized,
- has severe, complicated, or progressive illness,
- is at higher risk for influenza complications.
Persons at higher risk for influenza complications recommended for
antiviral treatment include:
- children aged younger than 2 years,
- adults aged 65 years and older,
- persons with chronic pulmonary (including asthma), cardiovascular
(except hypertension alone), renal, hepatic, or hematological disease
(including sickle cell disease); metabolic disorders (including
diabetes mellitus); or neurologic and neurodevelopment conditions
(including disorders of the brain, spinal cord, peripheral nerve, and
muscle such as cerebral palsy, epilepsy [seizure disorders], stroke,
intellectual disability [mental retardation], moderate to severe
developmental delay, muscular dystrophy, or spinal cord injury),
- persons with immunosuppression, including that caused by medications
or by HIV infection,
- women who are pregnant or postpartum (within 2 weeks after
delivery),
- persons aged younger than 19 years who are receiving long-term
aspirin therapy.
- American Indians/Alaska Natives.
- persons who are morbidly obese (that is, body-mass index is equal to
or greater than 40).
- residents of nursing homes and other chronic-care facilities.
Clinical judgment, on the basis of the patient's disease severity and
progression, age, underlying medical conditions, likelihood of
influenza, and time since onset of symptoms, is important when making
antiviral treatment decisions for high-risk outpatients.
Additional details regarding antiviral treatment can be found at
<http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm>.
In Texas, influenza-associated pediatric mortality is required to be
reported within one work day. Clusters or outbreaks of any disease,
including influenza, should be reported immediately. Reports of
influenza-associated pediatric mortality and influenza or
influenza-like illness outbreak should be made to your local health
department or to 1-800-705-8868.
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[The correspondent has added the following commentary in relation to
the information above. "This outbreak now appears to involve an H1N1
virus. The vaccine inefficacy statement from the County health
authorities press release highlights, coupled with the apparent
unreliability of rapid diagnostic tests cited in media reports,
suggests to me that H1N1 virus circulating in Texas may be a new [more
virulent ?] drifted or reasserted strain. The current Texas state flu
bulletin for week of 7-14 Dec 2013 issued today (20 Dec 2013) does not
seem to discuss this issue
<http://www.dshs.state.tx.us/idcu/disease/influenza/surveillance/2014/>."
It seems likely that the fatalities observed in Texas are due to a
possibly more virulent strain of the seasonal H1N1 influenza virus,
rather than a novel pathogenic agent. Further information is awaited
to substantiate this conclusion. - Mod.CP]
[See Also:
Undiagnosed respiratory illness - USA (02): (TX) fatal, H1N1 influenza
conf
Undiagnosed respiratory illness - USA: (TX) fatal 20131218.2124064]
.................................................cp/mj/s
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Tuesday 10 December 2013
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