Pandemic Influenza Plan - Questar III

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Section 5: Clinical Guidelines monitor the antigenic evolution of the strains for vaccine strain selection purposes (see Section 2: Surveillance and Laboratory Testing). At the beginning or end of a pandemic outbreak in a community, diagnostic testing might aid cohorting decisions, but may be optional in the setting of high local prevalence. Influenza diagnostic testing should be considered before initiating treatment with antivirals. Guidelines for pandemic influenza virus testing are provided in Section 2: Surveillance and Laboratory Testing. As with seasonal influenza, RT-PCR and virus isolation from tissue culture will be the most accurate methods for diagnosing pandemic influenza. Generally, specimens should include combined nasopharyngeal aspirates or nasal swabs, and throat swabs, stored at 4°C in viral transport media. During the Pandemic Period, BSL-2 conditions should be sufficient for viral culture of clinical specimens from suspected pandemic influenza patients. Rapid diagnostic tests for influenza and immunofluorescence may be helpful for initial clinical management, including cohorting and treatment (see above). However, rapid influenza tests have relatively low sensitivity for detecting seasonal influenza, and their ability to detect pandemic influenza viruses is unknown. The sensitivity of rapid diagnostic tests will likely be higher in specimens collected within two days of illness onset, in children, and when tested at clinical laboratories that perform a high volume of testing. Because during a pandemic a negative rapid test may be a false negative, test results need to be interpreted within the overall clinical context. For example, it may not be optimal to withhold antiviral treatment from a seriously ill high risk patient on the basis of a negative test; however, in a setting of limited antiviral drug availability, treatment decisions in less high risk situations could be based on test results. The risk of a false-negative test also must be taken into account in making cohorting decisions. Rapid diagnostic testing should not preclude more reliable testing, if available. Further information on rapid diagnostic testing can be found in Section 2: Surveillance and Laboratory Testing. 4) Decide on inpatient or outpatient management. The decision to hospitalize a suspected pandemic influenza case will be based on the physician’s clinical assessment of the patient as well as the availability of hospital beds and personnel. Guidelines on cohorting and infection control for admitted patients can be found in Section 4: Infection Control. An unstable patient will be considered a high priority for admission, but patients with high-risk conditions (see Appendix 5-J) might also warrant special attention, such as observation or close follow-up, even if disease is mild. On the other hand, home management with follow-up might be appropriate for well-appearing young children with fever alone. Patients cared for at home should be separated from other household members as much as possible. All household members should carefully follow recommendations for hand hygiene, and tissues used by the ill patient should be placed in a bag and disposed with other household waste (Appendix 5-D). February 7, 2006 5-11
Section 5: Clinical Guidelines Infection within the household may be minimized if a primary caregiver is designated; ideally, someone who does not have an underlying condition that places them at increased risk of severe influenza disease. Although no studies have assessed the use of masks at home to decrease the spread of infection, using a surgical or procedure mask by the patient or caregiver during interactions may be of benefit. Separation of eating utensils for use by a patient with influenza is not necessary, as long as they are washed with warm water and soap (Appendix 5- D). C. Clinical management of pandemic influenza patients See Section 7 for current antiviral information and treatment strategies. In addition to use of antivirals, clinical management of severe influenza should address supportive care and the rapid identification and treatment of secondary complications. During the Pandemic Period, NYSDOH may request virus isolates from persons who fail treatment or antiviral prophylaxis, as these strains may more likely be drug resistant. In addition, randomly collected isolates will be tested for resistance to establish nationwide rates. Children aged
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February206 Pandemic Plan NewYorkSt
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Introduction Pandemic influenza occ
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example, at this time, it is realis
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Acronyms (cont.) IND IHANS IRB ISHS
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Section 1: Command and Control I. O
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Section 1: Command and Control pers
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February 7, 2006 Appendix 1-A
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Appendix 1-B The Public Health Law
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Appendix 1-B communicable diseases
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Appendix 1-C Management Office or t
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Appendix 1-E Suspension of Public M
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Appendix 1-G A Guide to New York St
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Appendix 1-G health commissioner. P
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Appendix 1-G 8. State Institutions
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Appendix 1-G b. Governor May Invoke
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Appendix 1-G may direct, pursuant t
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Appendix 1-G c. Commissioner of Gen
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Appendix 1-G Designation of emergen
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Appendix 1-G physician’s assistan
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Appendix 1-H Summary of Public Offi
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Section 2: Surveillance and Laborat
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Appendix 2-A • Surveillance Crite
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Appendix 2-A • In New York City,
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NYSDOH Novel Influenza Case Report
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Appendix 2-C to health care provide
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Virus Detection History NYS Lab Num
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Section 3: Healthcare Planning and
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Page 183 and 184: DRAFT Appendix 5-E Footnotes to App
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Appendix 6-C Vaccine and Antiviral
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Appendix 6-C 1. Request Phase The r
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Appendix 6-C 3. Receipt and Sign-of
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Appendix 6-C • Work with local he
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Section 7: Antiviral Medication Pro
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Appendix 7-A Characteristics of Ant
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Appendix 7-B a The drug package ins
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Appendix 7-C 7 HCWs in emergency de
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Section 8: Travel-Related Disease C
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Appendix 8-A Home or Community-Base
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Appendix 8-B Contact Identification
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Appendix 8-B • Determine the time
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Appendix 8-C Administrative Data: S
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Appendix 8-D CONTACT DAILY TEMPERAT
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Appendix 8-F Definitions: Intervent
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Appendix 8-F facility. No specific
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Appendix 8-F • Resources Required
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Appendix 8-G Business Pandemic Infl
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Appendix 8-G 4. Allocate resources
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Appendix 8-H CDC guidelines suggest
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Appendix 8-H If I am not masked I
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Appendix 8-H NYSDOH Model Influenza
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Appendix 8-H I understand that if
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Section 9: Communications I. Overvi
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Section 9: Communications and commu
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Section 9: Communications web pages
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Section 9: Communications Local Hea
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Section 9: Communications • A JIC
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Section 9: Communications backup to
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Section 9: Communications • In th
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Appendix 9-A Public Health Risk Com
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Appendix 9-C New York State Departm
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Appendix 9-C PRE-EVENT MESSAGE MAP:
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Appendix 9-C PROTECTIVE MESSAGE MAP
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Appendix 9-C TREATMENT MESSAGE MAP:
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Appendix 9-C BUSINESS CONTINUITY PR
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Section 10: Training and Education
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Appendix 10-A NYSDOH STAFF PRIVATE
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FACILITY- BASED RNs FACILITY- BASED
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Section 11: Workforce Support I. Ov
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Section 11: Workforce Support Pande
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Section 12: Highly Pathogenic H5N1
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Section 12: H5N1 in Non-Human Anima
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Section 13: Public Health Preparedn
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Appendix 13-A NYSDOH Roles Notified
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Appendix 13-B Notifications sent by
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Appendix 13-B HAN posting is used a
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Appendix 13-B notification system t
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Appendix 13-C Overview of the Healt
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Appendix 13-C • Ongoing surveilla
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Table 1. Summary of HERDS Use To da
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Appendix 13-D Commerce Access and A
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Appendix 13-D Table 3. Organization
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