Microsoft word - medical alert_swine flu_27apr09.doc
LINDA LINGLE CHIYOME L. FUKINO, M.D. STATE OF HAWAII DEPARTMENT OF HEALTH MEDICAL ALERT: SWINE FLU UPDATE AND DIAGNOSTIC ADVISORY
The U.S. Centers for Disease Control and Prevention (CDC) has confirmed at least 40
cases of swine influenza A (H1N1) infection with illness onsets starting from March 28, 2009 in southern California, the Mexico border area of Texas, Kansas, Ohio, and New York City. Investigations by CDC and the respective state and local health departments are ongoing. No cases have yet been identified in Hawaiʻi.
None of the confirmed cases have had swine exposure, so transmission likely occurred
via human-to-human. To date, all U.S. cases have had self-limited, uncomplicated respiratory illness with symptoms including fever, lethargy/malaise, myalgias, and cough. Additional symptoms reported by some of the U.S. cases included headache, rhinorrhea, sore throat, vomiting, and diarrhea. The mild nature of the U.S. cases is in contrast to the concurrent severe respiratory epidemic in Mexico where swine flu infection has also been confirmed. CDC has reported that the U.S. viruses are the same as those identified from Mexico cases.
The viruses contain a unique genetic combination not reported previously among swine
or human influenza viruses in the United States or elsewhere. These H1N1 viruses are resistant to amantidine and rimantidine but susceptible to oseltamivir and zanamivir. The seasonal influenza vaccine is not expected to provide protection against the swine influenza H1N1 viruses, and no specific vaccine is yet available.
Given the dynamic and evolving situation, the Department of Health (DOH) advises all
clinicians to consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness (fever >37.8°C [100°F] plus cough or sore throat) AND who, in the 7 days preceding their illness onset,
1) have been in contact with persons with confirmed swine flu, OR 2) traveled to Mexico or the mainland United States, OR 3) were in contact with persons who had febrile respiratory illness and were in Mexico or the
For all patients who meet the above criteria, clinicians should obtain a nasopharyngeal swab for influenza testing by reverse transcriptase-polymerase chain reaction (RT-PCR) testing.
Healthcare providers should consider, as much as possible, cohorting well visit
appointments separate from ill visit appointments. For managing a patient fulfilling the above criteria, the patient should be provided a surgical mask to limit spread of respiratory droplets. Providers who are likely to have close or direct contact with the patient should follow standard contact and droplet precautions and wear N95 mask, goggles, gown, and gloves as per CDC guidelines (http://www.cdc.gov/swineflu/guidelines_infection_control.htm).
The illness and transmission characteristics of the current swine flu cases in both the
mainland United States and Mexico are still being investigated. However, DOH requests that clinicians strongly encourage their patients with febrile respiratory illness to stay home from work or school and avoid group gatherings or travel for 7 days or until they have recovered from their illness. Please continue to advise general hygiene recommendations including frequent and appropriate handwashing and covering coughs and sneezes.
Antiviral treatment with oseltamivir or zanamivir should be prescribed judiciously for
those patients with laboratory confirmed influenza to conserve the current supply. Use of antivirals as prophylaxis should be reserved for high risk (e.g. immunocompromised) patients or outbreak contacts only. In the latter case, direction will be given by DOH Disease Outbreak Control Division.
With regard to DOH investigations of probable cases and/or disease clusters, healthcare
providers are requested to facilitate these investigations by providing all clinical and laboratory data when requested and as required by law in Hawaiʻi Administrative Rules, Title 11, DOH, Chapter 156, Communicable Diseases. If you have any questions, please refer to the CDC website at http://www.cdc.gov/swineflu/ or call DOH at the numbers below:
Oahu (Disease Investigation Branch) . (808) 586-4586 Maui District Health Office . (808) 984-8213 Kauai District Health Office . (808) 241-3563 Big Island District Health Office (Hilo) . (808) 933-0912 Big Island District Health Office (Kona) . (808) 322-4877 After hours on Oʻahu . (808) 566-5049 After hours on neighbor islands
1(800) 360-2575 (toll free for all islands)
We appreciate the medical community’s collaboration in safeguarding the health of the residents and visitors of Hawaiʻi. Sincerely,
www.fbf.com.bo CÓDIGO DE PROCEDIMIENTO DISCIPLINARIO DEPORTIVO DE LOS PROCEDIMIENTOS EN GENERAL REGLA Y PRINCIPIOS GENERALES (NINGUNA SANCIÓN SIN PROCESO) .- Nadie será sancionado sin haber sido oído y juzgado de conformidad con el Estatuto Orgánico de la FBF; el Reglamento del Estatuto; la Reglamentación propia de sus miembros; los Reglamentos especiales ; Resoluciones,
Estudios Irlandeses , Number 2, 2007, pp. 93-106 __________________________________________________________________________________________ AEDEI The Quiet Man and Angela’s Ashes : Hollywood Representations of Irish Emigration By Cornelis Martin Renes Copyright (c) 2007 by Cornelis Martin Renes. This text may be archived and redistributed both in electronic form and in hard copy,