Howard County Provider Flu Information

The Howard County Hospital joined with Howard County General Hospital and the Horizon Foundation to present a Physician Summit on H1N1 in September 2009. To view the summit, click here.

The Howard County Health Department wants to provide our county’s health care providers with important information regarding H1N1 (swine flu). Health care providers should consider the possibility of sine influenza virus infections in patients presenting with febrile respiratory illness.

We will update this section as new information becomes available from the Department of Health and Mental Hygiene (DHMH) as well as from the Centers for Disease Control and Prevention (CDC).

Who is most at risk of complications from H1N1?

• Children less than 5 years old;
• Persons aged 65 years or older;
• Children and teens (less than 18 years) who are on long-term aspirin therapy;
• Pregnant women;
• Adults and children who have chronic diseases;
• Adults and children who have HIV or immune system problems;
• Residents of nursing homes and other chronic-care places.

Should I submit patient specimens for testing?

The State Health Department has released the latest version of a novel H1N1 virus testing algorithm for Maryland clinicians. The State Lab is currently accepting testing specimens from hospitalized patients, those identified as part of a public health outbreak investigation, and among deceased patients. The most recent revision addresses acceptable specimens for submission, and can be viewed by clicking here.

Will you help us monitor the flu situation in Howard County?

We need Howard County providers to join the Maryland ILINet. Being a sentinel provider will allow us to better monitor the spread of both seasonal and H1N1 influenza. See www.marylandfluwatch.org to sign up.

How can I help my patients get vaccinated against H1N1?

Providers wishing to receive H1N1 vaccine will be asked to indicate their interest and estimated dose needs by pre-registering with DHMH. See DHMH's H1H1 Registration

The initial release of the vaccine is expected to occur in late September. It will be available in an inactivated formulation, in multidose vials and in single dose syringes, along with limited quantities of the live attenuated vaccine (inhaler sprayers). H1N1 vaccine will be available separate from the seasonal vaccine, and will require a booster dose. H1N1 vaccine and supplies for administration (syringes, needles, sharps containers, alcohol swabs) will be provided free of charge to registered vaccine providers by DHMH.

Clinician Guidance

• 2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness

• Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season

• Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season

• Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests

• 10 Actions Steps for Medical Offices and Outpatient Facilities

• Identifying and Caring For Patients

• Antiviral Recommendations

• Emergency Use Authorization (EUA): Medical Products

• Clinical Data Collection Forms and Templates

• Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak

Clinician Guidance for Specific Audiences

• Patients with Asthma

• Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings

• Patients With Cardiovascular Disease

• HIV-Infected Adults and Adolescents

• Pregnant Women

• Infants and Young Children

• Considerations Regarding Novel H1N1 Flu Virus in Obstetric Settings

• Interim Guidance for Homeless and Emergency Shelters on the Novel Influenza A (H1N1) Virus

• Infection Control for Patients In a Healthcare Setting

• Interim Biosafety Guidance for All Individuals handling Clinical Specimens or Isolates containing 2009-H1N1, including Vaccine Strains

• Infection Control in Outpatient Hemodialysis Centers

Are rapid influenza tests accurate and reliable?

CDC has published a report analyzing national accuracy of rapid influenza testing, which can be viewed in its entirety at: CDC Rapid Testing Guidance

In short, CDC notes that the ability of rapid influenza detection tests to detect an infection (sensitivity) ranges from 10 to 70%, i.e. such testing can miss from 30 to 90% of true positives. The decision to treat a patient for influenza infection should be made based on clinical assessment, presumptive diagnosis, and consideration of risk factors for serious complications (www.cdc.gov/h1n1flu). An algorithm for interpretation of rapid influenza tests is included on the CDC site. The experience in Maryland during extended flu season (H1N1 outbreak period starting April 2009) is that rapid antigen tests are about 80% accurate in detecting influenza infections when compared to compared to rapid reverse transcriptase-polymerase chain reaction (rt-PCR). The overall sensitivity of rapid influenza detection tests to detect novel influenza A (H1N1) was approximately 93%, overall specificity was approximately 70%. These data are consistent with CDC’s recent study of accuracy of rapid influenza testing, released on August 6, 2009.

Where can providers call for additional guidance?

• Between 8 AM and 5 PM, Monday-Friday, call the Howard County Health Department’s Bureau of Communicable Disease at 410-313-6110.

• After regular business hours and on weekends, call the County Call Center at 410-313-2929.

• Members of the public should call the Howard County Health Department’s Flu Information Line at 410-313-6503. Callers will listen to a recorded message about H1N1 and where to go for more information.

Where do I go for more information?

Howard County Health Department – www.hchealth.org The Health Department will update our website regularly about H1N1.

For more information, we recommend that you go to the following websites:

The Centers for Disease Control and Prevention (CDC)

The State of Maryland