Updates on Human Swine Influenza (H1N1)

The number of cases of H1N1 (swine) in Canada has now increased to 140. To date, all cases have been mild except for one in Alberta requiring hospitalization. Worldwide, 1085 cases have been reported in 21 countries. The pandemic alert remains at Phase 5, reflecting human to human spread in at least two countries. The WHO criterion for phase 6 requires community level outbreaks in at least one other country in a different WHO region. The most recent WHO updates can be found at http://www.who.int/en/. Recommendations will change based on epidemiology and the physician is directed to the websites listed below for updates.

Laboratory Testing Recommendations for H1N1 (swine):
Testing of patients with influenza-like illness in the ambulatory setting is recommended if symptoms started within 7 days of travel to Mexico or if there has been close contact with a known case of H1N1 (swine). Testing is not currently recommended without history of travel to Mexico or close contact with a known case.

If the patient meets criteria for testing, the physician should collect and send a nasopharyngeal swab in viral transport medium. In addition to the nasopharyngeal swab, optional specimens include blood collected in a red top tube and one in a purple top tube, which should be collected by the physician, if logistically possible, to minimize contact of the patient with other patients and healthcare workers. If diarrhea is present, stool may be sent in a sterile container. These tests are performed at the Public Health Laboratory.

The following clinical information is mandatory and must be provided on the PHL laboratory requisition:

Hospitalized or outpatient
Travel history
Upper respiratory or lower respiratory infection
Presence of fever and other symptoms (eg. diarrhea)
Write “High Priority”

As of May 3, 2009, the Ontario Agency for Health Protection and Promotion no longer requires the physician to complete the OAHPP Influenza Laboratory Surveillance Form.

To obtain nasopharyngeal swabs and transport media, complete the PHL Supply Requisition Form and send to your local public health laboratory. The Supply form and contact numbers are available at http://www.oahpp.ca

Other Laboratory Tests:
For routine laboratory tests performed at LifeLabs (for example routine culture), clearly indicate on the OHIP requisition if the patient is a suspected or confirmed case of H1N1 (swine).

For patients that are ill, defer collection of routine, non-urgent laboratory tests (eg cholesterol) in the Patient Service Centers until they are well. If the patient requires laboratory testing, consider minimizing exposure by collecting blood and other specimens in your office and arranging for pick-up if logistically feasible or, alternatively, consider arranging a home care visit.

For further information refer to:

Ontario Ministry of Health and Long-Term Care: http://www.health.gov.on.ca/english/providers/program/emu/ihn.html

Information for Healthcare Professionals UPDATE May 3, Vol 6, Issue 6

Guidance for Influenza-like Illness (ILI) Management in Long-Term Care (LTC) (May 2, Vol 6, Issue 5)

Clinical Guidelines for Management of Patients with ILI in Emergency Departments and in Ambulatory Settings (April 29, Vol 6, Issue 3)

Information for Healthcare Professionals: Management of Patients Presenting with Influenza-Like illness (ILI) in the Ambulatory Care setting (April 26, 2009; Vol 6, Issue 2)

Information for Healthcare Professionals: Clusters of Severe Respiratory Illness in Mexico (April 23, 2009; Vol 6, Issue 1)

Ontario Agency for Health Protection and Promotion: http://www.oahpp.ca/publichealthlabstracts.php

Labstract on H1N1 Flu Virus (human swine influenza) – Updated Guidance for Laboratory Testing, Ambulatory Setting, May 3, 2009

Provincial Infectious Diseases Advisory Committee Best Practice Manuals: http://www.health.gov.on.ca/english/providers/program/infectious/pidac/pidac_mn.html