Influenza Exposure Medical Response Guidance for the University of Wisconsin-Madison

Transcription

1 Influenza Exposure Medical Response Guidance for the University of Wisconsin-Madison Instructions: Information in this guidance is meant to inform both laboratory staff and health professionals about the risks and treatment in the event of an infectious agent exposure. In using this guidance, please consider that multiple routes of exposure may occur in a lab and that organism strains will sometimes be genetically modified to incorporate traits such as antimicrobial resistance. Research protocols and other available guidance such as Health Canada material safety data sheets will be provided as supporting information when available. It should be assumed that when exposures do occur, that the healthcare provider will be provided information about the specific strain involved, route of exposure, inoculum concentration, and victim vaccination and serological status, when available. This document was developed by UW Occupational Health in consultation with the UW Department of Infectious Disease. The information provided below is intended to provide guidance for treating physicians. Treatment and evaluation plans should be individualized to the patient based on the patient s symptoms, exposure risk, and underlying health status. If there are any questions about this document, please contact Jim Morrison, UW Occupational Health Officer at or jmorrison@fpm.wisc.edu or University Health Services, Occupational Medicine at Signs and Symptoms of Infection- Describe signs and symptoms associated with the agent. Watch for development of : Fever ( or else feeling feverish with chills) Sore throat Cough Runny or stuffy nose Muscle or body aches Headache Fatigue These symptoms herald the onset of infection Incubation period- time to onset of illness from time of exposure to virus is 1-4 days ( average 2 days) Infectivity- Describe infective dose, relevant exposure routes (considering laboratory use), incubation period and potential severity of infection. The infective dose for influenza is estimated to be particles. Infection is acquired largely via droplet transmission (inhalation of the virus from particles in the air). Other modes of suspected transmission include: a. direct skin to skin contact; or else b. indirect contact touching a surface with influenza virus and then touching mucosal surfaces- such as eyes, mouth or nostrils.

2 Incubation period- time to onset of illness from time of exposure to virus is 1-4 days( average 2 days) Lab personnel should be vaccinated and hence (depending on the strain) may have some degree of protection. Most persons who develop symptoms have uncomplicated influenza and improve over 2-5 days People at risk for developing severe infection include : Children younger than 5 years Adults older than 65 years Pregnant individuals Native American Indians and Alaskan Natives Morbidly Obese individuals People with underlying medical conditions such as Asthma, chronic lung disease, neurological disease, disorders such as diabetes, other immunosuppressive states. ( for a complete list visit www. cdc.gov/flu ) Description of First Aid - Provide an overview of first aid treatment of exposures considering that multiple routes of exposure could occur (needle stick, aerosol, eye, skin and ingestion). Exposure to skin: wash with chlorhexidine soap ( or else regular soap if chlorhexidine soap unavailable) for 15mins Exposure to eyes- wash at eyewash station for 15mins Exposure to oral surfaces- rinse / wash mouth for 15mins Urgency of Medical Care- Describe how soon medical attention should be sought, i.e. is an ER visit necessary, visit to University Health, or simply schedule a visit with a personal physician. The urgency of seeking medical attention depends on the health status of the affected individual and the type of exposure. Inhalation of large volume of likely contaminated material requires medical attention sooner than say a splash in the eye that was washed immediately. A person with asthma or else a chronic lung disorder or else a pregnant individual will require medical attention sooner than an otherwise young and healthy person. -Medical attention should be sought typically within 24 hours. -During weekday working hours - contact the University Health Services. -During weekday after hours and exposures on Sunday, contact the University Health Services the next morning. If afterhours on Friday or else on Saturday contact the UWHC Infectious Disease Physician/Fellow on call. If at any time, the exposed individual or else the lab supervisor is unsure, contact the UWHC Infectious Disease Physician/Fellow on call.

3 Description of Medical Response- Provide an overview for clinical treatment of exposures to the agent considering that multiple routes of exposure could occur (needle-stick, aerosol, eye, skin and ingestion) and that strains of agents will vary and sometimes include antimicrobial resistance. It is important to establish from the PI- the strain of Influenza and the resistance profile- whether the strain is susceptible to Oseltamivir or not. The key decision is whether to observe for development of symptoms of Influenza and start treatment if symptoms develop as against initiate prophylaxis upon exposure. The strain of Influenza, the route and degree of exposure and the underlying health of the exposed lab personnel determine the nature of the medical response. Indications for Antiviral Prophylaxis: Exposure to Avian Influenza H5N1 and 1918 Influenza warrants prophylaxis upon exposure irrespective of route and underlying health conditions. For other strains of Influenza (including H3N2, Pandemic H1N1, Avian Influenza H5N1, Swine Influenza, 1918 Spanish influenza, Influenza B and other influenza species): Individuals at risk for severe infection (as listed earlier) generally warrant prophylaxis upon exposure as against otherwise healthy individuals in whom we can opt to wait and watch for development of symptoms and then treat if needed. Individuals exposed to large amounts of Influenza virus via inhalation should be considered candidates for initiation of prophylaxis as against low risk exposures such as exposure to skin or mucosal surfaces. If a decision is made to initiate prophylaxis, choice of prophylaxis depends on the strain of Influenza virus. Prophylaxis: a)seasonal H1N1virus: Zanamavir 10mg once daily for 10 days (In asthmatics or persons with underlying lung disease, Zanamavir should be used with caution. If on bronchodilators, these should be taken prior to the Zanamavir. Short acting bronchodilators (such as albuterol) should be available at hand for such patients in case they develop difficulty in breathing or bronchoconstriction after use of Zanamavir). Zanamavir is generally available at the labs on campus with the PI. Individuals engaged in influenza research should have a prescription of Zanamivir prior to any potential exposure. Oseltamivir should not be used as seasonal H1N1 is mostly resistant to this Comment [VOS1]: We would be concerned that this could be interpreted that it is appropriate for PI s to provide prescription medications to their employees.

4 agent. b)other Influenza Viruses (including H3N2, Pandemic H1N1, Avian Influenza H5N1, Swine Influenza, 1918 Spanish influenza, Influenza B and other influenza species): Oseltamivir 75mg once daily for 10 days. Amantidine and Rimanditine are not generally recommended. Treatment: a)seasonal H1N1 virus Zanamavir 10 mg twice daily for 5 days (Caution for Asthmatics/ underlying lung disease as detailed above). b) Other Influenza viruses (including H3N2, Pandemic H1N1, Avian Influenza H5N1, Swine Influenza, 1918 Spanish influenza, Influenza B and other Influenza viruses) Oseltamivir 75 twice daily for 5 days. Amantidine, Rimantidine are generally not used. Description of Medical Surveillance- Describe the advisability of medical surveillance strategies (in particular baseline and annual serology) for those working with the agent. If doing so would likely improve the identification, diagnosis or treatment of exposures, please indicate so. Individuals engaged in influenza research should undergo occupational medicine consultation and receive a prescription for Zanamivir for use in the event of exposure prior to beginning such work. Prescriptions should be updated annually. There is no role for routine medical testing such as annual testing. Testing for influenza is indicated when symptoms develop (especially if there is a question regarding the infecting strain). Generally nasopharyngeal swabs are processed for PCR to identify Influenza infection. Treatment however may be initiated before waiting for results of the test based on the clinicians assessment Comment [VOS2]: As above, this should be prescribed in advance to the individual worker. Considerations for Infection Control-Describe any special precautions required to prevent the further spread of infection. Include precautions for the healthcare, workplace, and home setting. Comment [VOS3]: Any thoughts here? Formatted: Indent: Left: 0" Reporting-Describe any state public health or federal regulatory reporting requirements. Include the timing and mechanism for reporting. Public Health: Exposure or potential exposure to any non-endemic strains, Avian Influenza H5N1 and 1918 Influenza, is reportable IMMEDIATELY to Public Health Madison Dane County or emergency pager In addition to the immediate report, complete and mail an Acute and Communicable Diseases Case Report (DPH 4151) within 24 hours. Public health intervention is expected as indicated. See s. HFS (3) (a). Other: Comment [VOS4]: This is our suggestion, but would welcome review.

5 Completed By: Dr Prakash Balasubramanian Department: Infectious Disease, UWHC Phone: Date: 4/24/10