Pandemic Influenza Plan - Questar III

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Appendix 5-E Case Detection and Clinical Management during the Interpandemic and <strong>Pandemic</strong> Alert Periods Situation: No human cases of novel influenza are present in the community. Human cases might be present in another country or another region of the United States. Severe illness Mild to moderate illness If no to any, treat as clinically indicated, but re-evaluate if suspicion Clinical Criteria An illness with all of the following: • Temperature >38° C, and • Cough, sore throat, or dyspnea, and • Requiring hospitalization Clinical Criteria An illness with all of the following: • Temperature >38° C, and • Cough, sore throat, or dyspnea If no to any, treat as clinically indicated, but re-evaluate if suspicion AND Epidemiologic Criteria The clinician should ask the patient about the following within 10 days of symptom onset: 1. History of recent travel to an affected area 2 , or 2. Employment in an occupation at particular risk for novel influenza virus, such as: • A health care worker in direct contact with a suspected or confirmed novel influenza case, or • A worker in a laboratory that contains live novel influenza virus, or • A worker in a poultry farm, live poultry market, or poultry processing operation with known or suspected avian influenza infection AND Epidemiologic Criteria The clinician should ask the patient about the following within 10 days of symptom onset: 1. History of recent travel to an affected area 2 and at least one of the following: • Direct contact with poultry or poultry products 3 , or • Close contact with a person with suspected or confirmed novel influenza 4 , or • Close contact with a person who died or was hospitalized due to severe respiratory illness 3 2. Employment in an occupation at particular risk for novel influenza virus, such as: • A health care worker in direct contact with a suspected or confirmed novel influenza case, or • A worker in a laboratory that contains live novel influenza virus, or • A worker in a poultry farm, live poultry market, or poultry processing operation with known or suspected avian influenza infection If no to both criteria, treat as clinically indicated, but re-evaluate if suspicion Novel influenza positive by culture or RT-PCR • Continue Standard and Droplet Precautions 5 • Continue antivirals 10 • Do not cohort with seasonal influenza patients • Treat complications, such as secondary bacterial pneumonia, as indicated 13 • Provide clinical updates to health department If yes to either criterion Seasonal influenza positive by culture or RT-PCR If yes to either criterion • Initiate Standard and Droplet Precautions 5 • Treat as clinically indicated 6 • Notify local health department or state about the case 7 • Initiate general work-up as clinically indicated 8 • Collect and send specimens for novel influenza virus testing to the Wadsworth Center 9 • Begin empiric antiviral treatment 10 • Help identify contacts, including HCWs 11 • Continue Standard and Droplet Precautions 5 • Continue antivirals for a minimum of 5 days 10 • Do not cohort with seasonal influenza patients • Treat complications, such as secondary bacterial pneumonia, as indicated 13 If no to both criteria, treat as clinically indicated, but re-evaluate if suspicion All influenza testing negative 12 • Continue infection control precautions, as clinically appropriate 5 • Treat complications, such as secondary bacterial pneumonia, as indicated 13 • Consider discontinuing antivirals, if considered appropriate 10 February 7, 2006 1
DRAFT Appendix 5-E Footnotes to Appendix E: 1. Further evaluation and diagnostic testing should also be considered for outpatients with strong epidemiologic risk factors and mild or moderate illness. (See Appendix B). 2. Updated information on areas where novel influenza virus transmission is suspected or documented is available on the CDC website at www.cdc.gov/travel/other/avian _flu_ah5n1_031605.htm and on the WHO website at www.who.int/en/. 3. For persons who live in or visit affected areas, close contact includes touching live poultry (wellappearing, sick or dead) or touching or consuming uncooked poultry products, including blood. For animal or market workers, it includes touching surfaces contaminated with bird feces. In recent years, most instances of human infection with a novel influenza A virus having pandemic potential, including influenza A (H5N1), are thought to have occurred through direct transmission from domestic poultry. A small number of cases are also thought to have occurred through limited personto-person transmission or consumption of uncooked poultry products. Transmission of novel influenza viruses from other infected animal populations or by contact with fecally contaminated surfaces remains a possibility. These guidelines will be updated as needed if alternate sources of novel influenza viruses are suspected or confirmed. 4. Close contact includes direct physical contact, or approach within 3 feet (1 meter) of a person with suspected or confirmed novel influenza. 5. Standard and Droplet Precautions should be used when caring for patients with novel influenza or seasonal influenza (Appendix I and Section 4, Infection Control). Information on infection precautions that should be implemented for all respiratory illnesses (i.e., Respiratory Hygiene/Cough Etiquette) is provided at: www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm 6. Hospitalization should be based on all clinical factors, including the potential for infectiousness and the ability to practice adequate infection control. If hospitalization is not clinically warranted, and treatment and infection control is feasible in the home, the patient may be managed as an outpatient. The patient and his or her household should be provided with information on infection control procedures to follow at home (Appendix C). The patient and close contacts should be monitored for illness by local public health department staff. 7. Guidance on how to report suspected cases of novel influenza is provided in Section 2, Surveillance and Laboratory Testing. 8. The general work-up should be guided by clinical indications. Depending on the clinical presentation and the patient’s underlying health status, initial diagnostic testing might include: • Pulse oximetry • Chest radiograph • Complete blood • Blood cultures count (CBC) with differential • Sputum (in adults), tracheal aspirate, pleural effusion aspirate (if pleural effusion is present) Gram stain and culture • Antibiotic susceptibility testing (encouraged for all bacterial isolates) • Multivalent immunofluorescent antibody testing or PCR of nasopharyngeal aspirates or swabs for common viral respiratory pathogens, such as influenza A and B, adenovirus, parainfluenza viruses, and respiratory syncytial virus, particularly in children February 7, 2006 2
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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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Section 4: Infection Control I. Ove
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Section 4: Infection Control I. Ove
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Section 4: Infection Control A. Bas
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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 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 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-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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