What is Novel H1N1 Influenza (Swine Flu)?
Novel H1N1 (referred to as "swine flu" early on) is a new influenza virus causing illness in people. This new virus was first detected in the United States in April 2009. The World Health Organization (WHO) emphasized that, while the worldwide H1N1 outbreak has now been designated as a "Phase 6 pandemic," the new WHO classification does not mean that illnesses caused by the virus are becoming more severe. It simply means that the virus is becoming more widespread throughout the world. Minnesota will continue monitoring H1N1 closely in the state.
A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide. A worldwide influenza pandemic could have a major effect on the global economy, including travel, trade, tourism, food, consumption and eventually, investment and financial markets.
Influenza is thought to be primarily spread through large droplets (droplet transmission) that directly contact the nose, mouth or eyes. These droplets are produced when infected people cough, sneeze or talk, sending the relatively large infectious droplets and very small sprays (aerosols) into the nearby air and into contact with other people. Large droplets can only travel a limited range; therefore, people should limit close contact (within 6 feet) with others when possible. To a lesser degree, human influenza is spread by touching objects contaminated with influenza viruses and then transferring the infected material from the hands to the nose, mouth or eyes. Influenza may also be spread by very small infectious particles (aerosols) traveling in the air. The contribution of each route of exposure to influenza transmission is uncertain at this time and may vary based upon the characteristics of the influenza strain.
The symptoms of novel H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.
Because a vaccine is not currently available, the most important thing you can do is take some simple precautions to prevent getting it or spreading it.
Standard prevention recommendations for influenza include:
* Cover your nose and mouth with your sleeve when you cough or sneeze.
* Clean your hands frequently and thoroughly - with soap and water or an alcohol-based hand rub solution.
* Clean your hands after shaking hands or having other close contact with other people - before eating or preparing food, or touching your eyes, nose or mouth.
* Limit your contact with others who may be ill.
* Stay home from work or school - and generally avoid going out in public - if you are sick, remain home for seven days, or until 24 hours after your symptoms resolve, whichever is longer.
* Make sure to take enough fluids while you're sick.
* If you are an employer, encourage your employees to stay home if they are sick.
* If you do develop possible flu symptoms and you want to consult your health care provider, call before going in for an office visit. You may not need to go in, and if you do need to be seen, a time should be set up when you will not risk exposing others to influenza in the waiting room.
* People at risk for severe flu or flu complications should contact their health care provider if they have flu symptoms or have been exposed to people with flu symptoms. Those individuals include people with an underlying medical condition, pregnant women, young children (especially under age two) and people 65 or older.
WHO anticipates having some vaccines ready by September 2009, and by mid October for the U.S., but even then they expect that the supply will be limited. Two or three vaccine injections will be required for maximum immunity from both the swine flu and seasonal flu. There is also concern that the virus could mutate later in the year and become more virulent and less susceptible to any new vaccine. This concern is partly due to the memory of the 1918 flu pandemic, which is thought to have killed between 40 million and 100 million people, and was preceded by a wave of milder cases in the spring.
Infection Control Guidance for EMS, First Responders, Fire, and Law Enforcement
Follow the infection control guidance below if the patient meets the case definition for a suspect case of H1N1 novel influenza virus infection.
If signs or symptoms of acute febrile respiratory illness are not present, proceed with normal EMS care.
Standard PLUS Droplet Precautions should be used in the care of patients with acute febrile respiratory illness.
Isolation Precautions
Droplet and Standard Precautions are recommended for all suspected or confirmed novel H1N1 influenza patients
Standard Precautions (hand hygiene plus gloves, gown, face shield/eye protection as indicated by patient care activities and risk of exposure to blood/body fluids) PLUS
Droplet Precautions (surgical mask) should be used for all direct patient care activities
Aerosol-generating procedures:
Aerosol-generating procedures should be avoided during transport, unless medically essential. When medically essential, all EMS personnel engaged in aerosol generating activities (e.g. endotracheal intubation, nebulizer treatment, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation) should follow Airborne Precautions: fit-tested disposable N95 respirator OR powered air purifying respirator [PAPR], disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gown and Standard Precautions.
Consult with local ambulance service medical direction regarding modifications or changes to treatment protocol/guidelines that may be required.
Infection Control Precautions for Patients
Place a surgical mask on the patient. If this is not possible, have the patient cover mouth/nose with tissue when coughing or use another practical method to contain cough Note: Small facemasks are available that can be worn by children, but it may be problematic for children to wear them correctly and consistently. Moreover, no facemasks (or respirators) have been cleared by the FDA specifically for use by children.
Ventilation
Adequate ventilation is important. If you must transport the patient with acute febrile respiratory illness, keep the windows of your vehicle open (if feasible) and set the heating and air-conditioning systems on a non-recirculating cycle.
Notify the receiving healthcare facility so that appropriate infection control precautions may be taken prior to patient arrival.
Follow CDC's Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles at: http://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html.
Resources: OSHA, CDC,WHO, MDH
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