Rhiza Labs FluTracker Forum

Jim O
A pediatric patient with a possible novel influenza A virus was detected in Marin County. The specimen tested positive for an influenza A (H3 variant) and will be sent to appropriate lab for strain-typing. The patient was a resident of Napa county and was treated for mild symptoms.

http://www.marinflu.org/images/stories/ ... _wk_50.pdf

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Novel H3N2 Influenza Health Advisory

PLEASE SHARE WITH ALL MEDICAL STAFF

The emergence of a novel H3N2 influenza A virus (currently referred to as Swine-Origin triple resortment H3N2 or S-Otr-H3N2) has been reported in five states (Pennsylvania, Indiana, Maine, Iowa and West Virginia). Of the eleven reported cases, six had either direct or indirect exposure to swine, while investigation of another five cases has suggested transmission by person-to-person contact. Although three cases with underlying chronic medical illnesses were hospitalized, all cases have recovered. All eleven cases were identified by routine influenza surveillance conducted at public health laboratories, with further characterization conducted by the Centers for Disease Control and Prevention (CDC). The California Department of Public Health requests that California Local Health Jurisdictions increase surveillance testing for influenza, including subtyping, in children under 18 years of age with influenza-like illness (ILI). The primary objective of this testing is to indentify how widely the novel H3N2 influenza (S-OtrH3N2) has spread and to gather information on the transmission potential of this virus.


Actions requested of all clinicians during this period of active surveillance:
1.Be alert to Influenza-like infections (ILI), especially in children under 18 years of age.
2.Test ILI cases under 18 years of age - send naso-pharyngeal swab specimens to Sonoma County Public Health Lab. This surveillance testing is offered at no charge to your patients. Specimens will be tested in batches with results reported out weekly. Please do not wait for test results when making clinical or treatment decisions for a specific patient. Public Health lab specimen collection instructions.

Infection Control

Continue/initiate respiratory hygiene measures. Be prepared to screen patients for signs and symptoms of febrile respiratory illness at entry to your facility. If feasible, use separate waiting and exam rooms for possible flu patients; plan to offer surgical masks to symptomatic patients who are able to wear them (adult and pediatric sizes should be available), provide facial tissues, receptacles for their disposal, and provide hand hygiene products in waiting areas and examination rooms.

Follow standard respiratory precautions when working with patients with ILI, including using N-95 or higher respirators.

Vaccination

Current recommendations are to continue vaccination efforts for your patients through the end of March. All medical personnel are strongly urged to be vaccinated against the flu this and every year. Although S-OtrH3N2 is not specifically included in this year's flu vaccine, it is unknown whether or not immunization with this season's vaccine or exposure to vaccines or flu viruses from past years will provide any level of protection from S-OtrH3N2.

Treatment

S-OtrH3N2, like 2009 H1N1, is sensitive to neuraminidase inhibitors (oseltamivir and zanamivir), but is resistant to adamantanes. Therefore, the current recommendations for treatment of influenza remain unchanged.

For More Information

Please visit the following websites:

"Have You Heard?" CDC Confirms Two Human Infections with Novel Influenza Viruses

CDC Seasonal Flu: Information for Health Professionals

Sonoma County Public Health Influenza Information

http://www.sonoma-county.org/health/ann ... visory.asp

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California Department of Public Health

Increase H3N2v surveillance and sub-typing pediatric cases

http://peds.stanford.edu/chiefsblog/201 ... 20H3N2.pdf

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Commentary

http://www.recombinomics.com/News/01051 ... _Napa.html

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This case will not be in tomorrow's FluView.

CDC checking with California!

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Surveillance
Weekly Influenza Activity: Marin County
NEW! Current Marin Flu Activity

Marin County Department of Health and Human Services tracks influenza activity by collecting information on visits to local emergency departments for influenza-like illness, as well as data on laboratory testing and deaths due to pneumonia. Weekly surveillance updates of influenza activity in Marin county are posted here during flu season, or during flu events like the 2009 H1N1 Flu.

Marin_Flu_Update_2011-12_wk_50.pdf
In Marin County, influenza activity normally occurs during the winter months between late October and early April, usually peaking in late January or early February. Starting in October and continuing until the end of the flu season, we produce a weekly influenza surveillance report providing information on influenza activity in the U.S., California, and Marin County.


Enhanced Avian Influenza Surveillance
There is currently no human or animal Avian Influenza H5N1 activity detected in Marin County. However, Healthcare providers are encouraged to report immediately by telephone any case meeting the H5N1 surveillance case definition.

Immediately report a suspect case of human Avian Influenza H5N1 by telephone:
•During business hours: (415) 473-7805
•After hours: (415) 499-9464 (ask for the on-duty Public Health Officer)

Other Influenza Surveillance Resources:
•CDPH: California Influenza Surveillance Project
•CDC: Surveillance and Flu Activity
•WHO: Global Influenza Surveillance

http://www.marinflu.org/prevention-and- ... rveillance

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TO: Physicians, Infection Control Coordinators
FROM: Jason Eberhart-Phillips, MD, MPH, - Public Health Officer
SUBJECT: Public Health Alert: Novel H3N2 Influenza A
DATE: December 21, 2011
Dear Colleagues:
The emergence of a novel H3N2 influenza A virus (currently referred to as Swine-Origin triple reassortant H3N2 or S-Otr-H3N2) has been
reported in five states since July, including Pennsylvania, Indiana, Maine, Iowa and West Virginia. Of the 11 reported cases, six had
either direct or indirect exposure to swine, while investigation of the other five cases has suggested transmission by person-to-person
contact. Almost all cases have occurred in children. Although three cases with underlying chronic medical illnesses have required
hospitalization, every patient has fully recovered.
All 11 cases were identified by routine influenza surveillance conducted at public health laboratories, with further characterization
conducted by the Centers for Disease Control and Prevention (CDC). The California Department of Public Health has requested that local
health jurisdictions, including ours in Marin County, increase surveillance testing for influenza, particularly in children <18 years of age
with influenza-like illness (ILI). The primary objective of this testing is to identify how widely the novel H3N2 influenza (S-OtrH3N2) virus
has spread and to gather information on its transmission potential.
Infection control recommendations for the influenza season remain unchanged
Follow standard respiratory precautions when working with patents with ILI illness. Be prepared to screen patients for signs and
symptoms of febrile respiratory illness at entry to your facility. If feasible, use separate waiting and exam rooms for possible flu patients,
plan to offer surgical masks to symptomatic patients who are able to wear them, provide facial tissues and receptacles for their disposal,
and provide hand hygiene products in waiting areas and examination rooms.
Vaccination
Current recommendations are to continue vaccination efforts for your patients and staff through the end of March. All medical personnel
are strongly urged to be vaccinated against the flu this year and every year. Although S-OtrH3N2 is not specifically included in this year’s
flu vaccine, it is unknown whether or not immunization with this season’s vaccine or exposure to vaccines or flu viruses from past years
will provide any level of protection from S-OtrH3N2.
Treatment
S-OtrH3N2, like 2009 H1N1, is sensitive to neuraminidase inhibitors (oseltamivir and zanamivir), but is resistant to
adamantanes. Therefore the current recommendations for treatment of influenza remain unchanged.
Please see the following websites for more information:
CDC-Have You Heard December 9, 2011: http://www.cdc.gov/media/haveyouheard/s ... uenza.html
CDC-Seasonal Flu Information for Health Professionals: http://www.cdc.gov/flu/professionals/index.htm
I will keep you informed as we learn more. Updates on this strain, and all flu activity reported locally, in California and in the United
States, will be included in the Marin County Influenza Surveillance report that you are receiving weekly by email throughout the flu
season.
Jason Eberhart-Phillips, MD, MPH
Public Health Officer
County of Marin
899 Northgate Drive, Suite 104

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I have a call and e-mail into Marin County Health for more info.

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Comentary

http://www.recombinomics.com/News/01061 ... Alert.html

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Marin says Napa county was not a case. I have a call in for details.

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