April 29th, 2009
Husband got this letter by email from the College of Physicians and Surgeons of British Columbia. I am reproducing it here in its entirety for you, unedited:
The BCMA and the College of Physicians and Surgeons have been working with the BC Ministry of Health Services, Regional Health Authorities and the BC Centre for Disease Control on communication to you about the emerging swine Influenza A H1N1 outbreak. This letter is to reinforce information you may have received from your local Medical Health Officer about this issue.
Current Situation: The novel swine influenza virus recently detected in Mexico and several US states has now been detected in additional states and countries including Canada. To date, Canada has 19 laboratory-confirmed cases including six in BC. All cases that have been identified in Canada have had travel to Mexico. There have been no hospitalizations and no deaths in Canada. Given a spectrum of illness including mild cases, and given that the earliest cases in Mexico date back to mid-March, it is likely that there are more unrecognized cases in the community. For this reason, general recommendations to minimize the impact of influenza have been reinforced for all members of the community even while we are on special look-out for cases among returning travellers from Mexico.
Surveillance: The health care system has been asked to conduct enhanced surveillance for severe respiratory illness (SRI) with recent travel to Mexico within seven days of symptom onset. Nasopharyngeal swabs for laboratory testing should be obtained in the diagnostic workup of patients with SRI as would normally be done. These must be sent to the BCCDC laboratory not a commercial lab. In cases of SRI a history of travel to Mexico should be noted on the laboratory requisition. Similarly, the BC Centre for Disease Control is conducting laboratory-based surveillance for swine influenza among respiratory specimens collected at clinician discretion among members of the community who may present with illness and have travel to Mexico indicated on the travel requisition. Requests for such testing have significantly increased, but we are not actively stimulating that. In addition, BC has a longstanding and year-round sentinel physician network that is designed to detect if circulation of this virus becomes widespread.
Advice to Patients: Patients with Influenza-like-illness (ILI) should be encouraged to stay at home and avoid attending physicians’ offices or the ER unless their symptoms progress and they require medical attention. Patients who don’t know whether their condition would warrant an emergency room visit can first call HealthLink BC at 8-1-1 to obtain non-emergency health advice 24 hours a day, seven days a week. Patients should be advised to practice frequent hand washing, good respiratory hygiene including covering their mouth with a tissue when coughing or sneezing, disposing of the tissue immediately and washing their hands or using alcohol based hand rubs (ABHR). People should avoid going to work or interacting in crowded settings when they or their family members are ill with ILI. They should adhere to these measures for seven days or until their symptoms resolve.
To avoid the risk of transmitting infection to others, patients with mild illness are not asked to present specifically for diagnostic testing. They should be instructed to self isolate at home for seven days and consult a physician if their symptoms are not improving.
If sending a patient to hospital, alert the receiving ward or ER, as well as the ambulance attendants if transferring by ambulance. In hospital, alert Infection Control and Occupational Health.
Please report all patients with severe respiratory illness and links to Mexico to Public Health; during regular hours to the Health Unit where the patient lives, and after hours to the Medical Health Officer on call.
Emergency Department and office settings: Signs should be posted at the entrances to ERs and medical offices along with a supply of surgical masks asking patients with symptoms of ILI (fever, cough, malaise) to put on a mask and inform the receptionist of their symptoms. They should also be encouraged to wash their hands if a sink is available or use ABHRs. ABHRs are effective against influenza and other respiratory viruses. Physicians and staff should wear masks when dealing with ILI patients. These patients should be treated in the usual way as with seasonal ILI. If possible the initial assessment should be conducted in a separate room to help avoid transmitting the virus in the care setting. Try to minimize the time they spend in waiting areas and if possible keep two metre separation between people in the waiting area. Equipment used on the patient and the surfaces they contact should be cleaned and disinfected before use or contact by another patient. Regular office cleaning solutions are effective against influenza and other respiratory viruses.
Antivirals: The swine influenza A H1N1 virus is currently susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza), however, there are not current recommendations for changes to current practice for the treatment of ILI. There are no current recommendations to provide antiviral prophylaxis to individuals exposed to ILI. Physicians should use their clinical judgment on whether to treat a patient with ILI with neuraminidase inhibitors based on considerations such as underlying illness and potential for complications from influenza as they would for seasonal influenza. Oseltamivir is most effective and currently only indicated if it can be started within 48 hours of onset of illness.
Travel: The Public Health Agency of Canada has issued a travel advisory informing travellers of the situation in Mexico and recommending they avoid all unnecessary travel to Mexico.
Further Updates: National guidelines for management of this new influenza virus are under development and updates will be provided as they become available in this rapidly evolving situation.
We encourage physicians to contact their local public health office for advice on or to report specific cases (see links below) and to monitor the College, BCMA and BCCDC websites for updates.
http://www.fraserhealth.ca/Pages/default.aspx
Thank you.
P.R.W. Kendall, MD
Provincial Health Officer
British Columbia