Any extra precautions for visitors due to swine flu?

fiveofpeep · May 11, 2009

NICU visitors can only be gparents and mom and dad

Everyone gets a flyer when they sign in as visitor

dawnebeth · May 12, 2009

Our hospital just relaxed the mini triage they were doing on all people entering the hospital now that the Swine flu seems to be controlled.

Dawn

lamazeteacher · May 12, 2009

Our hospital just relaxed the mini triage they were doing on all people entering the hospital now that the Swine flu seems to be controlled.
Dawn

Who said the swine flu is controlled?

Anne Schuchat, Interim Deputy Director for Science and Public Health program at CDC, in her daily press briefing on May 12, 2009 said that:

".............as of today, there are about 3,600 probable and confirmed cases in 46 states and the District of Columbia. We have 3,002 confirmed cases in 44 states and D.C., with the most recent onset May 5th. As you know, there have been three reported fatalities confirmed to be due to the H1N1 virus. We have 116 hospitalizations that are being investigated at this point. Most of those have been confirmed to be due to the H1N1 virus. Our median age remains low at 15 years with a range, though, of 1 month of age up to 86 years. Almost two-thirds of our confirmed cases are under 18. Around the world, the case counts are continuing to increase. There's a total of 5,251 confirmed cases according to the World Health Organization, and those are occurring in 30 countries with Canada being and the United Kingdom having the largest number of confirmed cases after the U.S. and Mexico.......

"..........pregnant women are at higher risk of complications of influenza, whether it's the seasonal influenza or pandemics of the past. We are also seeing some severe complications among pregnant women in this year's novel H1N1 virus problem, and I really want to make you aware of that, because I think it's something that can have important clinical benefit. We have about 20 cases under investigation right now where the H1N1 virus has been found in association with pregnancy. We're continuing to understand the illness in these patients, and a few of the patients have had severe complications. As I think many of you know there was one fatality in a pregnant woman. Influenza can cause worse complications in pregnancy than in people who are not pregnant. Important complications include pneumonia and dehydration as well as complications for the newborn, like premature labor. We think it's very important when doctors are caring for pregnant women who they suspect may have influenza, that they issue prompt treatment with antiviral medicines. Sometimes, physicians are reluctant to treat pregnant women with medicines, and sometimes pregnant women are reluctant to take medicines because, of course, they are sometimes risky during pregnancy. The experts who have looked into this situation really strongly say that the benefits of using antiviral drugs to treat influenza in a pregnant woman outweigh the theoretical concerns about the drugs. We think that either of the two medicines that this virus is susceptible to it be used for this condition. So, while we don't have lots and lots of experience yet with this H1N1 virus in pregnancy, it's important to know, to look back on what we do know about seasonal influenza and pregnancy for this novel H1N1 virus, we really want to get the word out about the likely benefits of prompt antiviral treatment in pregnancy when you're suspecting influenza. We are going to be issuing an MMWR report with some clinical and some data about the pregnancy cases that we've been investigating.....

This is from yesterday's briefing:

They tell us for sure that this virus is circulating throughout the United States and it is likely that it's found in every state even though we don't have confirmations in every single state so far. The numbers tell us that more people have become ill and more are likely to become ill, but we continue to see that most people who are becoming ill with this virus tend to recover in a way that's similar to what we see with seasonal flu; some fatalities, some hospitalizations, but the vast majority recovering from their illness. Another note of caution is that many states did not report over the weekend and so we expect there to be a big jump in cases tomorrow. That doesn't mean

indigo girl · May 12, 2009

Considerations for Pregnant Women who are More likely to be Exposed to Novel H1N1 Flu (Swine Flu) at work; Information for Women in Education, Child Care, and Health Care.

Yes, the implications for pregnant women are enormous, and everyone should be aware of this. I posted this link already somewhere about 2 weeks ago, but it is worth looking at again because of what is occurring now with this new H1N1 virus. I am very much concerned about this.

http://www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm

Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
Endotracheal intubation
Aerosolized or nebulized medication administration
Diagnostic sputum induction
Bronchoscopy
Airway suctioning
Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
High-frequency oscillatory ventilation
Guidance on pre-exposure and post-exposure chemoprophylaxis with antiviral agents, including for pregnant women can be found at Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts.

indigo girl · May 13, 2009

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/may1209pregnancy-br.html

Here is the CIDRAP article on this. I love CIDRAP because they are so thorougly informative, and professional.

The first of three case reports in today's MMWR Dispatch appears to describe the Texas woman who was recorded as the nation's second novel H1N1 flu death. The 33-year-old woman was 35 weeks pregnant and had a 1-day history of myalgia, dry cough, and low-grade fever when she was seen on Apr 15 by her obstetrician. She had a history of psoriasis and mild asthma, but was not taking medication for the conditions.
Four days later she went to the emergency department with worsening shortness of breath, fever, and cough. During the visit the woman had severe respiratory distress. Chest radiographs showed bilateral nodular infiltrates, and the woman was intubated and placed on mechanical ventilation. Her doctors performed a cesarean delivery, and the healthy baby girl was later discharged home.
On Apr 21 the woman experienced acute respiratory distress syndrome. One week later, she began receiving oseltamivir (Tamiflu) and broad-spectrum antibiotics, but she died on May 4.
During the woman's hospitalization San Antonio health officials detected an untypable influenza A strain in the woman's nasopharyngeal specimen and sent it to the CDC, which on Apr 30 confirmed the novel H1N1 virus.

My first thought while reading this is, why did they wait until a week after she experienced acute respiratory distress syndrome before they started Tamiflu? Wow, I have to say that I am really surprised about this. I am also surprised that her biggest pre-exisiting condition is mild asthma.

The other two cases reported in the WMMR had better outcomes. Of interest was that one of the cases had a physician that was also pregnant, and started herself on Tamiflu.

lamazeteacher · May 13, 2009

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/may1209pregnancy-br.html
Here is the CIDRAP article on this. I love CIDRAP because they are so thorougly informative, and professional.
My first thought while reading this is, why did they wait until a week after she experienced acute respiratory distress syndrome before they started Tamiflu? Wow, I have to say that I am really surprised about this. I am also surprised that her biggest pre-exisiting condition is mild asthma.
The other two cases reported in the WMMR had better outcomes. Of interest was that one of the cases had a physician that was also pregnant, and started herself on Tamiflu.

In mid-April, I think Tamiflu was being stockpiled, but not distributed yet. Test kits hadn't been widely distributed and they didn't recognize pregnancy as the high risk factor it is. Tamiflu may not have been immediately available, and it is most effective the first 48 hours of becoming symptomatic, and some women don't want to take something during pregnancy without being assured that no terratogenic effects would result. Obviously they dropped the ball there, by not being assertive.

I think that she had scorriatic rheumatoid arthritis, an autoimmune disease that would predispose her to infection, as well as asthma which would exacerbate lung complications. Did we ever find out if her baby developed s/s of flu?

indigo girl · May 13, 2009

I have heard of Judy Trunell having RA as well, but find that it odd that the MMWR does not mention this, so I have to wonder what the truth is. I am very saddened by her death. She was a lovely women as you can see by her high school photos.

I am very worried about our pregnant colleagues as well. My hospital has yet to mention any of the recent CDC recommendations for pregnant women to the staff.

http://www.nydailynews.com/news/us_world/2009/05/06/2009-05-06_us_swine_flu_victim_judy_trunnell_33_in_hospital_2_weeks_before_death_delivered_.html

Baby was reported as healthy. Historically speaking, flu has always been a risk factor in pregnancy. This has certainly been the case with H5N1, bird flu. No pregnant women have survived that I can recall.

indigo girl · May 13, 2009

Just found more info about this unfortunate woman. I am certain that this is the same case, but find it very odd that the MMWR did not mention RA as a pre-existing condition. That is a very big omission.

http://content.nejm.org/cgi/content/full/NEJMoa0903810

Of the 399 patients with confirmed S-OIV infection for whom hospitalization status was known, 36 (9%) required hospitalization. The age of hospitalized patients ranged from 19 months to 51 years. Of the 22 hospitalized patients for whom data were available, 4 (18%) were children under the age of 5 years, and 1 patient (4%) was pregnant. Nine patients (41%) had chronic medical conditions: a 41-year-old woman with autoimmune disease treated with multiple immunosuppressive agents; a 35-year-old man with Down's syndrome and a history of congenital heart disease; a 33-year-old woman with asthma, rheumatoid arthritis, and psoriasis who was 35 weeks pregnant; a 22-month-old child with a history of neonatal myasthenia gravis, a ventriculoseptal defect, swallowing dysfunction, and chronic hypoxia; and five patients with asthma alone. Seven patients (32%) reported having traveled to Mexico within 7 days before the onset of illness. Eleven patients (50%) had radiologically confirmed pneumonia, including one patient who had pneumomediastinum, one patient who had necrotizing pneumonia, and one patient who had an empyema that was surgically drained, with no growth from culture of empyema fluid. Eight patients (36%) required admission to an intensive care unit, and four patients (18%) had respiratory failure requiring mechanical ventilation. Fourteen patients (74%) were treated with oseltamivir after admission to the hospital. As of May 5, 18 of the 22 patients (82%) had recovered from the acute illness; 2 patients-a previously healthy 23-month-old child and a previously healthy 30-year-old woman-remained critically ill with respiratory failure, and the 22-month-old child with neonatal myasthenia gravis and the 33-year-old woman who was pregnant when she became ill died.

indigo girl · May 13, 2009

Swine flu: case reports of 3 pregnant women

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_case_reports_in_3_pr.php

The Reveres commentary on the pregnant cases presenting with S-OIV is interesting. They explain why pregnancy is a risk factor. The thinking on the use of Tamiflu and Relenza in pregnancy is useful.

Patient A is the woman who died. Again, there is no mention of RA as one of her pre-exising conditions. The baby, borne via C-section was healthy.

On April 19, an emergency cesarean delivery was performed, resulting in a female infant with Apgar scores of 4 at 1 minute after birth and of 6 at 5 minutes after birth; the infant is healthy and has been discharged home.
Flu can be a nasty illness, nasty enough to kill you. Pregnant women are at more risk than others because their physiology is altered. They are carrying a foreign body (the fetus) so their immune response is not the same, and their cardiovascular and respiratory physiology are also different. CDC is reporting about 20 swine flu cases in pregnant women, and late yesterday they gave a more detailed description of three cases, one of which ended fatally:
Patient C's obstetrician was also pregant (13 weeks) and she was started on oseltamivir immediately. So far the swine flu virus is sensitive to the neuriminidase inhibitor antivirals, oseltamivir (Tamiflu) and zanamivir (Relenza), but oseltamivir is recommended for pregnant women because it is absorbed systemically. The oseltamivir tablet is not the active form of the drug but a "pro-drug" designed to be absorbed in the gastrointestinal tract. Once in the blood it is converted to the active form by enzymes in the liver. Zanamivir is already in the active form but cannot be absorbed. It is administered with an inhaler, so only affects virus in the respiratory tract. CDC believes it is preferable to get the drug to other organs, including the placenta.
Do we know that oseltamivir is safe for the fetus? No good safety studies have been done, but what evidence exists does not suggest risk to the fetus. Given the risk of influenza, CDC believes the risk-benefit balance nets out in favor of 5 days of oseltamivir use in pregnant women as early in their illness as possible.

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.