News You Need To Know

From the Desk of r. Stephen Lucie, MD, President

May 6, 2009

H1N1 Flu Advisory

Your Duval County Medical Society (DCMS) Board of Directors met on Monday May 4 with officials from the Duval County Health Department (DCHD) and community infectious disease specialists to discuss the novel H1N1 flu virus. Much of what was discussed is actively being reported by sources such as the DCHD, Florida Department of Health (FLDOH) and the Centers for Disease Control (CDC). The DCMS wants to ensure that its members are prepared for this and any future epidemics that require a coordinated response from the medical community.

Health officials remain on high alert after the outbreak of swine flu spread from Mexico to the United States, with five confirmed and twenty-two probable cases in Florida (one of the probable cases is in Clay County). The new influenza strain to which humans have no natural immunity was transmitted from pigs and contains genetic material from previously known pig, bird and human viruses. Thus far, it has not proven to be as deadly as some of the previous animal influenzas, but it could continue to mutate within human hosts. "There is no standard picture for how this will develop" said World Health Organization (WHO) official Keiji Fukuda.

So far in this country, the virus appears to be acting as a typical influenza virus with a syndrome of fever of over 101 degrees, cough, sore throat and myalgia. Suspected cases should be managed as any other influenza, as an outpatient, with supported care and anti-viral drugs as indicated. Point of contact testing is suggested; however, the volumes hitting the CDC may overwhelm the capability of timely testing in short order and the test results may be back after the patient is well from the virus. Hospitalizations are appropriate for the very young, very old or immunocompromised hosts. Normal infectious disease prophylactic measures, such as frequent hand washing, cough control and isolation of persons entering medical offices with flu-like syndromes, remain important. It is a general suggestion that those ill with flu-like syndromes remain out of school or work for the seven-day contagious period.

Many outbreaks come in waves and we could be seeing a mild first wave that will be followed by a more severe one when flu season starts in the fall. "We are probably going to have to live with this virus for some time," said infectious disease specialist Ira Longini. "The name of the game is to slow transmission until a well matched vaccine can be made and distributed."

The DCMS offers the following resources for you to both monitor and manage the current outbreak and adequately prepare your office for such situations:

· Go to DCMS Online http://www.dcmsonline.org/swineFluUpdates.aspx which includes links to the following resources:

o CDC: http://www.cdc.gov/h1n1flu/

o DCHD: 1-800-342-3557 Help Line or http://www.dchd.net/

§ FLDOH Guidance for Hospitals and Clinicians

§ CDC Guidance http://www.cdc.gov/h1n1flu/guidance

§ Patient tools for prevention (e.g., Cover Your Cough, etc.)

· Prepare your practice for potential staffing shortages by encouraging your office to develop contingency plans for school closings or canceling vacations/leave for both staff and physicians.

If you still have questions that are not answered via the help line or online, please contact Jay Millson at the DCMS and we will assist (jmillson@dcmsonline.org or 355-6561, ext. 105).