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Novel H1N1 Influenza A Investigation

Novel H1N1 Influenza A Investigation

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Novel H1N1 Influenza A Investigation

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  1. Novel H1N1 Influenza A Investigation

  2. Background • Novel H1N1 Influenza A Virus (referred to as “swine flu” early on) is a new virus causing illness in people • This virus was first detected in the US in April 2009 • It can spread from person-to-person through respiratory contact (coughs/sneeze) much the same way that regular seasonal influenza viruses spread • Currently, it is estimated that the majority (~90%) of the positive influenza cases in Miami are now the novel strain and not the previous influenza strain

  3. July 14, 2009 • Worldwide • 94,512 cases • 429 deaths United States • 37,246 cases • 211 deaths • State of Florida • 2,033 cases • 8 deaths • Miami-Dade County • 688 cases • 5 deaths

  4. By Florida law, cases of Novel H1N1 Influenza are reportable to the Department of Health

  5. Epi staff fax clinician guidelines for testing and treatment for Novel H1N1 Influenza to all 6,000+ physicians in Miami-Dade County • Emails and faxes are also sent to all Hospital Infection Control Practitioners (ICP) to update each hospital on new guidelines

  6. Specimen Collection • Collecting the specimen correctly is the most important first step in order to determine if the patient has Novel H1N1 Influenza • Specimen collection guidelines are faxed to health care providers • Epidemiology, Disease Control and Immunization Services can help providers facilitate transport of specimens • Providers/hospitals must order their own influenza test kits

  7. Providers/hospitals must have their own equipment for transporting specimens to the lab (coolers) and must follow guidelines for proper shipment

  8. Step 1: Lab Confirmation • Lab specimens can be tested at Department of Health Laboratories (Jacksonville, Tampa, Pensacola, Miami) • The private laboratory Focus/Quest Diagnostics is also able to test specimens for Novel H1N1 Influenza

  9. Step 1: Lab Confirmation • It generally takes 3 – 5 days for each specimen to be processed • Once the specimen is confirmed, the lab staff enters the patients’ labs in Merlin, the State of Florida disease electronic reporting system • Additionally, the Regional Epidemiologist located in the Miami Lab updates our office daily about new laboratory confirmed cases

  10. Step 2: Faxing Lab to Provider • Epi staff are the first to find out the lab results and so the lab form must be printed from Merlin and faxed to the health care provider (hospital, private doctor, etc) • The provider is expected to contact the patient to give them the results of a positive Novel H1N1 Influenza

  11. Step 3: Creating a Case in Merlin • All reportable diseases in Florida are stored in a comprehensive electronic system called Merlin • Epi staff must attach the appropriate electronic labs and create a case for each person with general demographic information • Epi staff then select to “Report the case to the Department of Health” and at that point it becomes an official case

  12. Step 4: Conducting an Interview with the Patient • Epi staff call the case and must ask 60 • questions about: • - demographics • - medical history/symptoms • - treatment • - contact with other persons • - activities/travel history • - additional information • This report form is entered in Merlin in • a special Outbreak Module • and is reported to CDC for analysis

  13. Step 5: Quality Control of Cases • Epi supervisors must go through each case one by one to verify the information and that it was entered correctly and that all labs and hospital information are attached

  14. Step 6: File Case Forms in Storage • The manual files are stored in a cabinet so that they can be pulled out in case further investigation is necessary at a later date

  15. Steps to Outbreak Investigation • 1. Contact the facility where there is a suspected outbreak • 2. Verify that the ill persons have a lab-confirmed diagnosis of Novel H1N1 influenza • 3. Send recommendation letter and CDC guidelines for prevention of further spread

  16. CDC Guidelines for Specific Groups • Parents and Caregivers • Pregnant Women • Day and Residential Camps • Child Care Programs, Schools, Colleges and Universities • Travelers and Travel Industry • Clinicians • Laboratories • Adults with HIV Infection • People With Cardiovascular Disease • Tribal Nations • Businesses and Employers • Deaf and Hard of Hearing

  17. 4. Ask staff to fill out a “Line List” with key exposure and demographic characteristics • 5. Contact the facility daily to monitor new cases • 6. An investigation is considered closed after one week of no new cases

  18. Additional Novel H1N1 Influenza Activities • Answer phone calls from the public and health care providers (regular on-call staff or any surveillance staff) • Analyze data to provide the media with information regarding the cases

  19. Thank you!