The Delaware Division of Public Health is sending these messages in an attempt to disseminate them as widely as possible among the medical community. These messages are also being sent through the Delaware Health Alert Network. Please share as appropriate. Thank you.

Delaware Health Update

Updated Guidance: Patient Testing for Novel Influenza A (H1N1) Virus as of May 15, 2008

The Division of Public Health (DPH) encourages Delaware clinicians to follow guidance issued by the Centers for Disease Control and Prevention (CDC) that not all people with suspected novel influenza (H1N1) infection need to have the diagnosis confirmed, especially if the person resides in an affected area or if the illness is mild, such as in Delaware.

The following guidance issued by DPH on May 8 is no longer in effect: “for the purposes of disease surveillance only, DPH is seeking specimens from persons other than University of Delaware students with influenza-like symptoms if they present with a fever >100° F and cough, sore throat, or nasal congestion.”

Clinicians should test persons who have an acute febrile respiratory illness or sepsis-like syndrome and 1) require hospitalization or 2) are at high-risk for severe disease (as listed below). As always, clinicians should use their clinical judgment, in addition to this guidance when deciding when to test for novel influenza A (H1N1). The full CDC recommendation can be found here: http://www.cdc.gov/h1n1flu/identifyingpatients.htm.

Specimen storage and transportation information can be found here: http://www.dhss.delaware.gov/dhss/dph/php/alerts/dhan177.html

Groups at higher risk for seasonal influenza complications include:

* Children less than 5 years old

* Persons aged 65 years or older

* Children and adolescents (< 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza infection

* Pregnant women

* Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders

* Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)

* Residents or nursing homes or other chronic-care facilities

As of May 15, 61 cases of novel H1N1 influenza have been confirmed in Delaware. Four are from Sussex County, 1 from Kent County, and 56 from New Castle County. The median age of the cases is 18 years. One was hospitalized (and discharged). Only 2 reported travel to Mexico.

For more information please call the Bureau of Epidemiology at:

1-888-295-5156 or 302-744-4541

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Delaware Health Advisory

Novel Influenza H1N1: Guidance for School and Child Care Programs

The Division of Public Health (DPH) is reminding the health and school (K-12) communities of guidance from the Centers for Disease Control and Prevention (CDC) regarding preventing the spread of novel influenza H1N1 ("swine flu") in schools and child care programs.

As of May 20, 2009 the DPH Laboratory has confirmed 91 cases of novel influenza H1N1. As indicated in Table 1, a significant number of cases are of an age expected to attend school or child care programs.

Table 1. Distribution of Confirmed Novel Influenza H1N1 by Age, Delaware,

May 20, 2009.

Age (Years) Number Percentage

1-5 13 14.3

6-10 19 20.9

11-15 27 29.7

16-20 19 20.9

> 20 14 15.4

Total 91 100.0

While this age distribution is probably determined in part by testing practices within the health care community, it does indicate that many young people are infected.

Because most people in the community who are infected with novel influenza H1N1 are not tested, the following guidelines apply to all children, faculty or staff with influenza-like illness.

The successful implementation of these recommendations can only be accomplished if they are consistently applied by both the health care and school communities.

Guidance for School and Child Care Facilities

* Students, faculty or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or child care programs, or go into the community except to seek medical care for at least 7 days even if symptoms resolve sooner.

* Students, faculty and staff who are still sick 7 days after they become ill should continue to stay home from school and child care programs until at least 24 hours after symptoms have resolved.

* Students, faculty and staff should stringently follow sanitary measures to reduce the spread of influenza, including covering their nose and mouth with a tissue when coughing or sneezing (or coughing or sneezing into their sleeve if a tissue isn’t available), frequently washing hands with soap and water, or using hand sanitizer if hand washing with soap and water is not possible.

The full guidance from CDC can be found here: http://www.cdc.gov/h1n1flu/K12_dismissal.htm

Guidance regarding who should be tested

DPH also reminds both the school and health care communities that most children with suspected novel influenza H1N1 symptoms do not need to be tested. Recommendations for who should and should not be tested can be found here: http://www.dhss.delaware.gov/dhss/dph/php/alerts/dhan183.html

For further information

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

* DPH: http://www.dhss.delaware.gov/dhss/dph/index.html

* DPH Bureau of Epidemiology: 1-888-295-5156 or (302) 744-4541

Kae Mason - (Kae.Mason@state.de.us)

Chief, Office of Health and Risk Communications

Delaware Division of Public Health

417 Federal St., Suite 202

Dover, DE 19901-3635

Phone- (302) 744-4704

Fax- (302) 739-1502