Wednesday, April 29, 2009

CDC Guidelines for Screening Swine-Origin Influenza A (H1N1)

Interim Guidance for Screening for Swine-Origin Influenza A (H1N1) by State and Local Health Departments, Hospitals, and Clinicians in Regions with Few or no Reported Cases of Swine Influenza A (H1N1)

This document provides interim guidance for state and local health departments, hospitals, and clinicians in regions with few or no reported cases of swine-origin influenza A (H1N1) (S-OIV) regarding which patients to evaluate for possible infection with swine influenza A (H1N1). As of April 29 1:00 PM, there were 91 laboratory confirmed cases of S-OIV infection identified in 14 states in the United States. Human cases of S-OIV infection also have been identified internationally. Based on the rapid spread of the S-OIV thus far, public health officials believe that more cases will be identified over the next several weeks, including in regions that currently have few or no reported cases.

CDC recommends that state and local health departments, hospitals, and clinicians in regions with few or no reported cases of S-OIV consider the following recommendations for testing of the following persons for S-OIV infection with a nasopharyngeal swab by PCR:

Patients presenting to providers participating in the US Outpatient Influenza-like Illness Surveillance Network (ILINet) who meet the case definition of influenza-like illness (ILI), or
Patients with an ILI who have traveled within 7 days to a community either within the United States or internationally where there are one or more confirmed swine influenza A (H1N1) cases, or
Patients admitted to the hospital with an ILI.
ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than influenza.

Specimen Collection and Testing
If swine flu is suspected, clinicians should obtain a respiratory swab for S-OIV testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. State public health laboratories should perform subtype testing on all influenza A positive samples identified. State public health laboratories should submit all specimens that cannot be subtyped as human influenza A (H1N1) or (H3N2) to CDC for identification. Please notify CDC of all pending shipments by email at or if email is not available, by phone at 404-553-7724. Please include shipment tracking information.

Investigation of Cases
Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.

Interim Guidance
Interim Guidance is available, including:
Case definitions to be used for swine influenza A (H1N1) cases
Antiviral recommendations for patients with confirmed or suspected S-OIV infection and close contacts
Infection control for care of persons with confirmed or suspected S-OIV infection in a healthcare setting
S-OIV biosafety guidelines for laboratory workers.

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