05/05/2009 Please copy and distribute to ALL physicians at your location.

Transcription

1 Hot Tips A Service of Ventura County Public Health Department 05/05/2009 Please copy and distribute to ALL physicians at your location. Robert M. Levin M.D., Health Officer Hot Tips# of 5 UPDATE # 5: H1N1 IN VENTURA COUNTY Ventura County currently has 5 probable cases and 2 confirmed cases of H1N1, for a total of 2 swine flu cases. Three schools are currently closed but will be reopened as of Wednesday, May 6, 2009 due to the just released CDC Guidance, entitled Update on School (K-12) and Childcare Facilities o Physicians be aware: future specimen acceptance will be limited due to the California Department of Public Health requests that testing be limited to prioritized patients as follows: Hospitalized patients with ILI Direct health care providers with ILI Outpatients with ILI in the following categories should be prioritized for testing: o o First case with ILI in a high-risk setting for transmission (e.g., prison, homeless shelter) Patient is part of an outbreak or cluster of people with ILI (only one patient of the cluster needs lab confirmation. Specimens can be collected from >2 patients to increase the likelihood of detecting S-OIV) The California Department of Public Health has expressed its preference that antiviral treatment be used more sparingly and limited to sicker patients.* An updated guidance document entitled Interim Guidance on Antiviral Recommendations for Swine-origin Influenza A (H1N1) Virus (S-OIV), has been posted; for more information see Updated lab request form for swine flu included in this Hot Tips. All priority specimens should be routed through the LHD. If your patient needs to be prioritized, call Kim Kandarian ( ) or Robert Levin MD ( ) for approval. With great apologies, due to the significant backlog of specimens in our lab, some of the tests you have previously sent may not be processed based on the above prioritization. The initial collection of specimens was most useful as an epidemiological effort to establish that swine flu is in our county. With less of a backlog we can hopefully respond to specimens you send with a more rapid turnover period. Updated information on nasopharyngeal swab collection is available on the swine flu website: Swab Collection.pdf Health care providers will want to prescribe antiviral medication to patients meeting the criteria in the above-mentioned document. Ventura County Public Health has dispensed Tamiflu and Relenza to 2 pharmacies in the Newbury Park area. The pharmacies are: Burt s Pharmacy at 2333 Borchard Road in Newbury Park. Phone number: ; The Medicine Shoppe at 2241 Michael Drive, Newbury Park. Phone number: ; There is NO charge for qualifying patients showing up at these pharmacies with the attached Antiviral Prescription Referral. Those with a third-party payor source, including Medi-Cal, will be asked to utilize that source where the drug is available.

2 * Treatment is only recommended for hospitalized patients and patients at higher risk for severe influenza. LABORATORY TEST REQUEST FORM Influenza PCR to Identify H1N1 (Swine flu) Date Rec d Ventura County Public Health Services 2240 E. Gonzales Rd. Ste #160 Brett Austin, MA, PHM Public Health Laboratory Oxnard, CA Laboratory Director Phone: (805) Fax: (805) brett.austin@ventura.org ALL INFORMATION MUST BE PROVIDED SO THAT SPECIMENS CAN BE PRIORITIZED. Submittals without information may delay testing. PATIENT NAME: LAST FIRST MI DOB SEX / / M STREET ADDRESS APT# CITY STATE ZIP F ORDERING PHYSICIAN (REQUIRED) SUBMITTING PROVIDER (if not ordering physician) PATIENT CHT # (if available) DATE & TIME COLLECTED Physician STREET ADDRESS CITY STATE ZIP Submitting Physician must provide a contact number, or a pager number Phone# ( ) Submitting Facility: Fax# ( ) Influenza-Like_Illness (ILI) defined:a febrile respiratory illness with recent onset with a fever of 100ºF or greater AND at least two of the following: a] rhinorrhea or nasal congestion, b] sore throat, c] cough Testing Guidelines: the following patients are prioritized for testing: Hospitalized patients with ILI, Direct care healthcare providers with ILI, First case with ILI in a high-risk setting for transmission (e.g., jail, school, shelter, long-term care), Patient is part of an outbreak or cluster of people with ILI Clinical Information (fill in or check as pertinent) Date of onset of illness Clinical Findings [ ] Fever to 0 F [ ] Chills Please attach physician summary notes, other clinical findings and/or pertinent laboratory data: [ ] Generalized aches [ ] Joint aches or stiffness Is patient hospitalized? [ ] Yes [ ] No [ ] Malaise [ ] Lymphadenopathy Is patient a health care Provider [ ] Yes [ ] No [ ] Cough [ ] Headache Is patient in a high-risk setting for transmission? [ ] Yes [ ] No [ ] nausea ]diarrhea Is patient part of a cluster of ILI? [ ] Yes [ ] No (Must provide Ventura Communicable Disease control notification) Each specimen should be labeled with: date of collection, specimen type, and patient name. 1] Acceptable Specimens: At a minimum, collect a nasopharyngeal swab (nasopharyngeal wash or nasopharyngeal aspirate are also acceptable). Orophayrngeal (throat) swabs are acceptable, but may not have as high of a yield Place the swabs in a standard container with 2-3 ml of viral transport media (VTM). The same transport tube can be use for all swabs. DO NOT USE COTTON OR CALCIUM ALGINATE SWABS OR SWABS WITH A WOODEN SHAFT. Use of these swabs invalidates the specimen and may cause us to reject the sample. In the absence of VTM, sterile saline can be substituted, but every effort should be made to transport the specimen so that it reaches the Public Health Laboratory within 24 hours, If the patient is hospitalized with pneumonia, specimens from the lower respiratory tract (e.g., tracheal aspirate, bronchoalveolar lavage) should also be obtained. Refrigerate and transport within 24 hours. Specimen Storage and Shipment: The specimens should be kept refrigerated at 4ºC and sent on cold packs if they can be received by the laboratory within five days of the date collected. If samples cannot be received by the laboratory within five days, they should be frozen at -70 ºC or below and shipped on dry ice. Specimens should be shipped per usual protocol to your local public health laboratory at:

3 Ventura County Public Health Laboratory, 2240 E. Gonzales Rd, Suite 160, Oxnard, CA Phone # for questions: (805)

4 A Service of Ventura County Public Health Department Robert M. Levin M.D., Health Officer Hot Tips# 44-3 To ALL physicians at your location. Suspected Swine Influenza Virus Exposure Antiviral Prescription Referral Department of Public Health Now that Ventura County has reported cases of swine influenza virus (SIV), there is no longer a geographic/travel requirement for treatment. Patients should be treated based on clinical symptoms and signs. Reserve therapy for your sicker patients. Antiviral treatment is recommended for those patients with symptoms present less than 48 hours. No benefit from antiviral treatment has been demonstrated in patients with symptoms greater than 48 hours. Antiviral chemoprophylaxis is currently not recommended for healthy household or school contacts of suspected SIV cases. Healthy close contacts (face to face) of documented SIV cases should be swabbed and then treated for their infection if they become symptomatic. Prophylaxis should be reserved for those close household and school contacts with high risk chronic diseases, ie. Chronic lung disease, diabetes, heart disease, etc. Other individuals who may receive prophylaxis include 1) travelers to Mexico with high risk medical conditions, and 2) healthcare workers who were not wearing adequate personal protective equipment when exposed to confirmed cases of SIV. This form must be completed by your health care provider before you can obtain any medication from one of the pharmacies included or from the Public Health clinic in one of the following locations. It is advisable to contact the clinic to confirm clinic hours before coming in to be sure there have been no unexpected changes in clinic hours. The clinics are generally open from 8:30-4:45, Mon-Fri with lunch taken from 12-1PM. South Oxnard 2500 S. C Street, Suite D Oxnard, CA Ventura 3147 Loma Vista Road Ventura, CA Simi Valley 660 Los Angeles Avenue, Suite B-2 Simi Valley, CA Toll Fr North Oxnard 2240 E. Gonzales Road, Suite 140 Oxnard, CA Burt s Pharmacy 2333 Borchard Rd. Newbury Park Pharmacies where Antiviral Prescription can be obtained: The Medicine Shoppe 2241 Michael Drive Newbury Park Antiviral Prescription Patient Name: DOB Phone: Address: City: Zip: Rx: Physician Name (Print): Address: Physician Signature: City/Zip: CA License: Phone:

5 For additional sites to pick up antiviral prescriptions, see the list of VCMC Ambulatory Care Clinics in this hot tips. All will follow the same procedure in providing antiviral drugs without charge. Conejo Valley Family Medical Group 223 E. T.O. Bl., #102, Thousand Oaks Paulo Carvalho, MD, Director Ivonne Mendez, Manager (805) Fax: Fillmore Family Medical Group 828 Ventura Street, Fillmore Christine Johnston, MD, Director David Oviedo, Manager (805) Fax: Urgent Care: Fax: Magnolia Family Medical Clinic 2240 E. Gonzales Rd., #100, Oxnard Stan Patterson, MD, Director Debra Shay, Manager (805) Fax: MSC East: Fax: Urgent Care: Fax: Las Islas Family Medical Group 325 W. Channel Islands Bl., Oxnard Miguel Cervantes, MD, Director Irene Guerrero, Manager (805) Fax: Urgent Care: Fax: Santa Paula Medical Clinic 1334 E. Main Street, Santa Paula Connell Davis, MD, Director Socorro Rodriguez, Manager (805) Fax: West Ventura Medical Clinic 133 W. Santa Clara Street, Ventura Ramsey Ulrich, MD, Director Kristina Navarro, Manager (805) Fax: Urgent Care: Fax: