by Mary Helen Yarborough
Public Relations
The threat of an emerging influenza outbreak has prompted MUSC officials to activate its pandemic response plan.
 
With clinical and administrative emergency response teams in constant contact with regional, state and federal health agencies, MUSC is preparing for an anticipated series of “outbreak waves” of the H1N1 type-A influenza strain. Coordinating with the S.C. Department of Health and Environmental Control (DHEC), MUSC’s medical center measures call for increased surveillance, testing, anti-viral response and containment. If necessary, surge capacity measures would prompt the opening of triage centers located away from populated areas, expanded use of existing ambulatory and specialty health centers and access restriction to limit exposure to other patients and hospital workers.
 
State and local health officials are  closely monitoring cases. To better manage state epidemiological lab service availability, physicians are advised to assess patients’ likelihood of having contracted the swine flu.
 
If a person fits the criteria for likely exposure, state officials are asking clinicians to contact the local state epidemiologist for guidance and conduct nasal swabs for testing at DHEC labs in Columbia.
 
To protect the supply of anti-virals (Tamiflu and Relenza), clinicians are advised to prescribe through a commercial pharmacy either Tamiflu or Relenza, to which the swine flu responds. Stockpiled anti-virals will be distributed once the commercial supply has been exhausted.
 
The novel type-A influenza virus has components of swine, avian and human flu. While no cases have been confirmed in this area, the H1N1 strain has demonstrated rapid human-to-human infection.
 
MUSC microbiologist Michael Schmidt, Ph.D., said that models indicate that every confirmed case could be expected to affect 63 people within two weeks. Statewide, officials estimated that as many as 560,000 people could be infected during a pandemic; and at least 5,000 people could die from conditions, such as pneumonia, resulting from the flu.
 
This flu has never been seen before and is expected to mutate in the future, Schmidt said. Cassandra Salgado, M.D., a leading infectious control expert, said that as the virus mutates, its symptoms could become more severe.

Keeping it clean
The medical center instituted additional measures to limit possible exposure to contaminated surfaces. Epidemiologists believe that the virus can survive for up to two hours on an infected surface.
 
Facilities, housekeeping  and administrative staff are urged to  focus on sanitizing common surfaces, such as door knobs, counters, elevator buttons or exposed work areas.
 
Individuals should maintain personal hygiene, i.e. washing hands with warm soap and water; use hand hygiene gel, and avoid touching their faces with their fingers or hands before washing.

Tips for prevention

• Use elbows or arms to open doors when possible.

• Press the elevator button with a knuckle, back of the hand or elbow.

• Carry and often use sanitizing hand hygiene gel.

• Use a paper towel to shut off the water, turn out lights or flush a toilet in a public bathroom.

• For 20 seconds, wash hands with soap and warm water.

• Avoid close contact with sick people. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. (Get no closer than 6 feet from an infected person)

• If exposed or sick, isolate or quarantine yourself and/or family members.

• Limit travel.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after use.

• Avoid touching your eyes, nose or mouth. Germs spread that way.

• If you get sick, stay home from work or school and limit contact with others to keep from infecting them.
  

Symptoms
For those who live where swine influenza cases have been identified or have recently traveled to Mexico and become ill with influenza-like symptoms, this could indicate infection from the swine flu. Symptoms include fever, body aches, runny nose, sore throat, nausea or vomiting or diarrhea. The incubation period of the infection is about two days and an infected person can be infectious to others for at least seven days.
 
The DHEC Bureau of Laboratories can currently offer the following tests:

• Polymerase chain reaction (PCR) testing  can rapidly (within eight hours) characterize a viral isolate as belonging the human H1, H3, H5 or H7 groups. However, the new novel swine flu virus, although it is an “H1” virus, cannot be so characterized using reagents currently available. Thus, the swine flu virus subject to DHEC's PCR test would be reported as an “Influenza A non-subtypable virus” (report which, in of itself, may provide circumstantial evidence that the isolate is the “swine flu”). These non-sub typable isolates would then be sent to CDC’s reference laboratory in Atlanta, currently the only laboratory in the United States able to confirm and otherwise characterize swine flu isolates.

• Viral culture: Cultures can be performed on the same specimens submitted for PCR testing. Cultures can provide information not only about the sub-type itself, but also provide the substrate needed for anti-viral drug susceptibility testing and for further sophisticated genetic sequencing and characterization as may also be done at CDC.
  

When available rapid flu tests (RFT) performed at the site of patient contact can provide valuable information regarding patients who might have swine flu.
 
For more information call 953-0095; or visit http://www.scdhec.gov or http://www.cdc.gov.

Friday, May 1, 2009