Pandemic Influenza Plan - Questar III

Section 5: Clinical Guidelines
II.
Objectives
• Ensure the availability of current information to aid in education of clinicians and
diagnosis of novel influenza viruses.
• Provide guidance on the clinical management of suspect and confirmed novel
influenza virus cases.
• Facilitate laboratory testing of specimens on suspect and confirmed novel
influenza cases.
• Provide consultation on atypical presentations of disease and follow up on
possible drug resistant strains of virus.
III.
Clinical Guidelines for the Interpandemic and Pandemic Alert Periods
During the Interpandemic and Pandemic Alert Periods, the primary goal of rapid
detection is to quickly identify and contain cases of novel influenza. To limit the need to
evaluate an overwhelming number of patients, the screening criteria should be specific,
relying on a combination of clinical and epidemiologic features. Although febrile
respiratory illnesses are one of the most common indications for medical evaluation,
particularly during the winter, during the interpandemic and pandemic alert period,
human cases of novel influenza are expected to be quite rare; laboratory diagnosis will
most likely be sought for those with severe respiratory illness, such as pneumonia. The
main features of detection and clinical management during the Interpandemic and
Pandemic Alert Periods are outlined in Appendix 5-E.
A. Criteria for evaluation of patients with possible novel influenza
The following criteria are based on the features of recent avian influenza A (H5N1) cases
but are intended for use in evaluating suspected cases of infection with any novel
influenza A virus strain. During the Pandemic Alert Period, human infections with novel
influenza A viruses will be an uncommon cause of influenza-like illness (temperature of
>38˚C plus either sore throat, or cough with dyspnea as an additional criteria); therefore,
both clinical and epidemiologic criteria should be met. The criteria will be updated
when needed as more data are collected.
1. Clinical criteria
Any suspected cases of human infection with a novel influenza virus must first meet the
clinical criteria:
• Severe illness: hospitalized with severe ILI, including pneumonia or ARDS
• Mild to moderate illness:
o Fever (temperature >38° C or 100.4° F) and
o Either sore throat, cough, or dyspnea
2. Epidemiologic criteria
Epidemiologic criteria for evaluation of patients with possible novel influenza focus on
the risk of exposure to a novel influenza virus with pandemic potential. Although the
February 7, 2006 5-3