H1N1 Flu (swine flu)
Recommendations for Health Care Providers
Swine flu appears to present with symptoms similar to seasonal influenza. Cases may
range from a mild respiratory illness to fulminant disease. Just as with seasonal
influenza there is likely risk of secondary bacterial infections or exacerbations
of chronic comorbidities.
At the current time, the CDC is recommending droplet, contact and respiratory precautions
for patients suspected of harboring swine flu. Early triage and cohorting of respiratory
illness in the emergency room setting would theoretically decrease transmission rates.
Hospitalized patients should ideally be placed in a single bed room with negative
pressure flow and high rate air exchange if available. If single rooms are unavailable
, cohorting proven cases appears reasonable. It is currently recommended that healthcare
providers to these patients should wear fitted N-95 masks, gowns and gloves when interacting
closely with these patients. In seasonal influenza, the rate of viral shedding decreases
significantly after 5 days, although children may shed the virus for more than a week.
As always, frequent hand washing with soap and water or an alcohol based hand hygiene
system is the cornerstone of nosocomial infection prevention.
Swine origin H1N1 is predominantly susceptible to oseltamivir and zanamivir, although
rare reports of resistance have been reported. The virus appears to be resistant to
the adamatanes (amatadine and rimantadine). Treatment with oseltamivir or Zanamivir
within the first 48 hours of illness may decrease the duration and severity of symptoms,
and theoretically would decrease the risk of subsequent disease transmission.
As with all influenza, the risk of secondary bacterial infection is high. Clinicians
should watch for signs of sudden exacerbation of illness, bimodal disease course,
or unexpectedly severe disease as these may be signs of secondary bacterial infection.
Given increasing rates of community acquired MRSA colonization and infection over
the past decade, MRSA coverage in individuals suspected of secondary bacterial infection
should be considered.
Recent CDC Treatment Guidelines
Technical Resources for Professionals