On Sunday, April 26, 2009, Acting Health and Human Services (HHS) Secretary Charles Johnson declared a nationwide public health emergency due to confirmation of cases of Swine Influenza A (H1N1).  This declaration, made under section 319 off the Public Health Service Act, may be accessed at http://www.hhs.gov/secretary/phe_swh1n1.html.

Swine influenza is a respiratory disease of pigs caused by type A influenza that does not normally infect humans.  Swine influenza viruses are not transmitted by food, thus, humans cannot get swine influenza from eating pork products. This particular swine influenza is a novel virus that has not been seen before in North America. It is a human-to-human virus.

 The Centers for Disease Control and Prevention (CDC) has confirmed 40 human cases of swine influenza in CA, TX, KS, NY and OH. Twenty-eight of these cases relate to a school in New York City. The oldest confirmed case is a 54 year old.  In contrast to Mexico where there have been a number of deaths, to date, in the U.S. there has been only one hospitalization and no deaths.  At this time, Canada also is experiencing light cases.  According to officials at the CDC, the fact that the U.S. has experienced less severe swine influenza cases does not mean that we will continue to only experience light cases.  Thus, the CDC is acting aggressively.  For the most up-to-date information on the number of Swine Flu cases and where they are, go to the CDC’s website at http://www.cdc.gov/swineflu/.   

 At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses. For now, CDC recommends treatment of confirmed cases and prophylaxis for people who came in contact with confirmed cases.  This swine influenza is resistant to amantadine and rimantadine.

The federal government has released 25% of the states’ allocation of materials, e.g., anti-viral medications, from the Strategic National Stockpile (SNS).  First priority went to the states with confirmed cases and those along the Mexican border. However, this is a national, not localized, emergency and the SNS materials now are on the way to other states. 

In the last few days, The CDC issued a number of interim guidances, including:

• Interim Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus;
• Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home;
• Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts;
• Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected;
• Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting.

The interim guidances are available on the CDC website at http://www.cdc.gov/swineflu/guidance/.   The CDC points out that the recommendations are based on current information and are subject to change based on ongoing surveillance and continuous risk assessment.  AHCA will inform you as we are alerted to changes to these guidelines.

What Facilities Can Do Now

As always with influenza, good hygiene is exceedingly important.  Reminders to health care staff, visitors and residents of the importance of thoroughly washing hands and covering coughs would be particularly useful now.  Flyers and other materials on good health habits are available on the CDC website at http://www.cdc.gov/swineflu/guidance/ (scroll to bottom of page).

This is an excellent time for facilities to review their pandemic plans and to consider, for example, how to keep fully staffed if schools in the community close temporarily.  For assistance with pandemic planning:  

• Planning for a pandemic/Epidemic or Disaster:  Caring for Persons with Cognitive Impairment may be found on AHCA’s website at http://www.ahcancal.org/facility_operations/disaster_planning/Documents/pandemic_dementia_care.pdf;
• Long-Term Care and Other Residential Facilities Pandemic Influenza Planning Checklist on CDC’s website at http://www.pandemicflu.gov/plan/healthcare/longtermcarechecklist.html
• The California Association of Health Facilities (CAHF) Pandemic Workbook for Long Term Care Providers on the CAHF website at http://www.pandemicflu.gov/plan/healthcare/longtermcarechecklist.html. 

The swine influenza outbreak is rapidly evolving and very fluid.  AHCA is on several conference calls each day with government officials. We will continue to keep you closely apprised of the quickly changing situation.