Swine Flu

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Swine Flu
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Epidemic

• An excess over the expected incidence of disease
  within a geographical area during a specified
  time period

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Flu Terms Defined

• H1N1 Influenza (H1N1flu) is a respiratory disease
  of pigs caused by type A influenza viruses that
  causes regular outbreaks in pigs. People do not
  normally get swine flu, but human infections can
  and do happen.
• Bird flu is commonly used to refer to Avian flu
  (see below). Bird flu viruses infect birds,
  including chickens, other poultry and wild birds
  such as ducks.
• Avian flu (AI) is caused by influenza viruses
  that occur naturally among wild birds. Low
  pathogenic AI is common in birds and causes few
  problems. Highly pathogenic H5N1 is deadly to
  domestic fowl, can be transmitted from birds to
  humans, and is deadly to humans. There is
  virtually no human immunity and human vaccine
  availability is very limited.
• Pandemic flu is virulent human flu that causes a
  global outbreak, or pandemic, of serious illness.
  Because there is little natural immunity, the
  disease can spread easily from person to person.
  Currently, there is no pandemic flu.
• Seasonal (or common) flu is a respiratory illness
  that can be transmitted person to person. Most
  people have some immunity, and a vaccine is
  available.

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WHAT IS SWINE FLU ?

• a respiratory disease of pigs caused by
• type A influenza viruses (H1N1 subtype)
  Influenza A Virus
• H1N1 and H3N2 are the yearly winter human
  influenza A viruses
• H1N1 Subtype
• HHemagglutinin 1-16
• First name of a flu virus is the H
• NNeuraminidase 1-9
• Last name of a flu virus is the N
• It causes regular outbreaks in pigs.
• People do not normally get swine flu, but
• human infections can and do happen
• Swine flu viruses have been reported to
• spread from person-to-person, but in the
• past, this transmission was limited and
• not sustained beyond three people

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What is new about the Swine Influenza?

• The world Health Organization has confirmed that
  at least some of the human cases are
  never-before-seen version of H1N1 strain of
  Influenza Type A.
• H1N1 is the same strain which causes seasonal
  outbreaks of flu in humans on regular basis. But
  latest version of H1N1 is different it contains
  genetic material that is typically found in
  strains of the virus that affect humans, birds
  and swine.
• Flu viruses have the ability to swap genetic
  components with other, and it seems likely that
  the new version of H1N1 resulted from a mixing of
  different versions of the virus, which may
  usually affect different species, in the same
  animal host.
• Pigs provide an excellent melting pot for these
  viruses to mix and match with each others.

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Novel H1N1 Flu

•  
• What is H1N1 (swine flu)?H1N1 (referred to as
  swine flu early on) is a new influenza virus
  causing illness in people. This new virus was
  first detected in people in the United States in
  April 2009. Other countries, including Mexico and
  Canada, have reported people sick with this new
  virus. This virus is spreading from
  person-to-person, probably in much the same way
  that regular seasonal influenza viruses spread.
• Why is this new H1N1 virus sometimes called
  swine flu?This virus was originally referred
  to as swine flu because laboratory testing
  showed that many of the genes in this new virus
  were very similar to influenza viruses that
  normally occur in pigs in North America. But
  further study has shown that this new virus is
  very different from what normally circulates in
  North American pigs. It has two genes from flu
  viruses that normally circulate in pigs in Europe
  and Asia and avian genes and human genes.
  Scientists call this a quadruple reassortant
  virus.

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  Epidemic and Pandemic Alert and Response (EPR)

• In nature, influenza viruses circulate
  continuously among animals, especially birds.
  Even though such viruses might theoretically
  develop into pandemic viruses, in Phase 1 no
  viruses circulating among animals have been
  reported to cause infections in humans.
• In Phase 2 an animal influenza virus circulating
  among domesticated or wild animals is known to
  have caused infection in humans, and is therefore
  considered a potential pandemic threat.
• In Phase 3, an animal or human-animal influenza
  reassortant virus has caused sporadic cases or
  small clusters of disease in people, but has not
  resulted in human-to-human transmission
  sufficient to sustain community-level outbreaks.
  Limited human-to-human transmission may occur
  under some circumstances, for example, when there
  is close contact between an infected person and
  an unprotected caregiver. However, limited
  transmission under such restricted circumstances
  does not indicate that the virus has gained the
  level of transmissibility among humans necessary
  to cause a pandemic.
• Phase 4 is characterized by verified
  human-to-human transmission of an animal or
  human-animal influenza reassortant virus able to
  cause community-level outbreaks. The ability to
  cause sustained disease outbreaks in a community
  marks a significant upwards shift in the risk for
  a pandemic. Any country that suspects or has
  verified such an event should urgently consult
  with WHO so that the situation can be jointly
  assessed and a decision made by the affected
  country if implementation of a rapid pandemic
  containment operation is warranted. Phase 4
  indicates a significant increase in risk of a
  pandemic but does not necessarily mean that a
  pandemic is a forgone conclusion

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• Phase 5 is characterized by human-to-human spread
  of the virus into at least two countries in one
  WHO region. While most countries will not be
  affected at this stage, the declaration of Phase
  5 is a strong signal that a pandemic is imminent
  and that the time to finalize the organization,
  communication, and implementation of the planned
  mitigation measures is short.
• Phase 6, the pandemic phase, is characterized by
  community level outbreaks in at least one other
  country in a different WHO region in addition to
  the criteria defined in Phase 5. Designation of
  this phase will indicate that a global pandemic
  is under way.
• During the post-peak period, pandemic disease
  levels in most countries with adequate
  surveillance will have dropped below peak
  observed levels. The post-peak period signifies
  that pandemic activity appears to be decreasing
  however, it is uncertain if additional waves will
  occur and countries will need to be prepared for
  a second wave.
• Previous pandemics have been characterized by
  waves of activity spread over months. Once the
  level of disease activity drops, a critical
  communications task will be to balance this
  information with the possibility of another wave.
  Pandemic waves can be separated by months and an
  immediate at-ease signal may be premature.
• In the post-pandemic period, influenza disease
  activity will have returned to levels normally
  seen for seasonal influenza. It is expected that
  the pandemic virus will behave as a seasonal
  influenza A virus. At this stage, it is important
  to maintain surveillance and update pandemic
  preparedness and response plans accordingly. An
  intensive phase of recovery and evaluation may be
  required.

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• Is this new H1N1 virus contagious?CDC has
  determined that this new H1N1 virus is contagious
  and is spreading from human to human. However, at
  this time, it is not known how easily the virus
  spreads between people.

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HOW DOES SWINE FLU SPREAD ?

• Spread of this swine influenza A (H1N1) virus is
  thought to be happening in the same way that
  seasonal flu spreads.
• Flu viruses are spread mainly from person to
  person through coughing or sneezing of people
  with influenza.
• Sometimes people may become infected by
• touching something with flu viruses on it and
• then touching their mouth or nose.

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IS IT SAFE IF I EAT PORK ?

• Swine influenza viruses are not spread by food.
  You cannot get swine influenza from eating pork
  or pork products.
• Eating properly handled and cooked pork products
  is safe.

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Is there a risk from drinking water?

• Tap water that has been treated by conventional
  disinfection processes does not likely pose a
  risk for transmission of influenza viruses.
• Current drinking water treatment regulations
  provide a high degree of protection from viruses.
  No research has been completed on the
  susceptibility of the novel H1N1 flu virus to
  conventional drinking water treatment processes.
  However, recent studies have demonstrated that
  free chlorine levels typically used in drinking
  water treatment are adequate to inactivate highly
  pathogenic H5N1 avian influenza.
• It is likely that other influenza viruses such as
  novel H1N1 would also be similarly inactivated by
  chlorination.
• To date, there have been no documented human
  cases of influenza caused by exposure to
  influenza-contaminated drinking water.

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Contamination Cleaning

•  
• How long can influenza virus remain viable on
  objects (such as books and doorknobs)?Studies
  have shown that influenza virus can survive on
  environmental surfaces and can infect a person
  for up to 2-8 hours after being deposited on the
  surface.
• What kills influenza virus?Influenza virus is
  destroyed by heat (167-212F 75-100C). In
  addition, several chemical germicides, including
  chlorine, hydrogen peroxide, detergents (soap),
  iodophors (iodine-based antiseptics), and
  alcohols are effective against human influenza
  viruses if used in proper concentration for a
  sufficient length of time. For example, wipes or
  gels with alcohol in them can be used to clean
  hands. The gels should be rubbed into hands until
  they are dry.

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How should linens, eating utensils and dishes of
persons infected with influenza virus be handled?

• Linens, eating utensils, and dishes belonging to
  those who are sick do not need to be cleaned
  separately, but importantly these items should
  not be shared without washing thoroughly first.
• Linens (such as bed sheets and towels) should be
  washed by using household laundry soap and
  tumbled dry on a hot setting.
• Individuals should avoid hugging laundry
  prior to washing it to prevent contaminating
  themselves.
• Individuals should wash their hands with
  soap and water or alcohol-based hand rub
  immediately after handling dirty laundry.
• Eating utensils should be washed either in a
  dishwasher or by hand with water and soap.

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• High-risk groups A person who is at high-risk
  for complications of novel influenza (H1N1) virus
  infection is defined as the same for seasonal
  influenza at this time. As more epidemiologic and
  clinical data become available, these risk groups
  might be revised.
• Children younger than 5 years old. The risk for
  severe complications from seasonal influenza is
  highest among children younger than 2 years old.
• Adults 65 years of age and older.
• Persons with the following conditions
• Chronic pulmonary (including asthma),
  cardiovascular (except hypertension), renal,
  hepatic, hematological (including sickle cell
  disease), neurologic, neuromuscular, or metabolic
  disorders (including diabetes mellitus)
• Immunosuppression, including that caused by
  medications or by HIV
• Pregnant women
• Persons younger than 19 years of age who are
  receiving long-term aspirin therapy
• Residents of nursing homes and other chronic-care
  facilities.

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Special Considerations for Children

• Aspirin or aspirin-containing products (e.g.
  bismuth subsalicylate Pepto Bismol) should not
  be administered to any confirmed or suspected ill
  case of novel influenza H1N1 virus infection aged
  18 years old and younger due to the risk of Reye
  syndrome. For relief of fever, other anti-pyretic
  medications such as acetaminophen or non-
  steroidal anti-inflammatory drugs are
  recommended.
• Children younger than 4 years of age should not
  be given over-the-counter cold medications
  without first speaking with a healthcare provider

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SIGNS AND SYMPTOMS

• The symptoms of swine flu in people are similar
  to the
• symptoms of seasonal flu in humans and may
  include
• Fever (greater than 100F or 37.8C)
• Sore throat
• Cough
• Stuffy nose
• Chills
• Headache and body aches
• Fatigue
• Some people have reported diarrhea and
• vomiting associated with swine flu.

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What are its symptoms?

• According to the Centers for Disease Control and
  Prevention (CDC), in humans the symptoms of swine
  flu appear to be similar to those produced by
  standard, seasonal flu.
• These include fever, cough, sore throats, body
  aches, headache, chills and fatigue.
• The 2009 outbreak has shown an increased
  percentage of patients reporting diarrhea and
  vomiting.

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• In children emergency warning signs that need
  urgent medical attention
• include
• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want
  to be held
• Flu-like symptoms improve but then return with
  fever and worse cough
• Fever with a rash
• In adults, emergency warning signs that need
  urgent medical attention
• include
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

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SIGNS AND SYMPTOMS

• Like seasonal flu, swine flu may cause
• a worsening of underlying chronic medical
  conditions.

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• What Is the Range of Illness Severity Seen
  With Swine Flu?
• Many cases of swine flu may be mild or even
  asymptomatic.
• In the past, cases were identified by chance as
  part of regular seasonal influenza surveillance.
• Most of the recent cases seen in the United
  States thus far have been mild as well. However,
  in Mexico, many patients' illnesses have been
  much more severe, have presented in young adults,
  and have included pneumonia, respiratory failure,
  and acute respiratory distress syndrome.
• Illness-related fatalities have been recorded in
  Mexico. At this time, it is not clear why such
  differences in illness severity have been seen.
• Early in epidemics it is difficult to gauge
  severity because the overall denominator of
  people infected is unknown.

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HOW CAN SOMEONE WITH THE FLU INFECTSOMEONE ELSE ?

• Infected people may be able to infect others
  beginning 1 day before symptoms develop and up to
  7 or more days after
• N.B Children, especially younger children, might
  be contagious for longer periods.
• becoming sick. That means that you may be able to
  pass on the flu to someone else before you know
  you are sick, as well as while you are sick.

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WHAT SHOULD I DO TO KEEP FROM GETTING THE FLU ?

• First and most important wash your hands.
• Try to stay in good general health. Get plenty
  of sleep, be physically active, manage your
  stress, drink plenty of fluids, and eat
  nutritious food.
• Try not touch surfaces that may be
  contaminated with the flu virus.
• Avoid close contact with people who are
  sick.
• SAFETY PRECAUTIONS-
• Avoid live animal markets, poultry and pig farms
  in affected
• countries
• Always maintain high levels of personal hygiene,
  especially before
• and after food preparation and in-out of
  toilets. Regular wash your
• hands
• Cook pork thoroughly
• Do not consume half-done pork
• Clean hard surfaces (kitchen worktops, door
  handles) frequently using a normal cleaning
  product.
• While in an affected region, seek immediate
  medical attention if
• you develop influenza-like symptoms. (High
  Fever, body pain, coughing and red nose)

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Do I need a face mask?

• Although wearing a mask is unlikely to be
  effective in preventing the infection it may
  limit further spread of the virus.

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What is a facemask?

• Facemasks are loose-fitting, disposable masks
  that cover the nose and mouth. These include
  products labeled as surgical, dental, medical
  procedure, isolation, and laser masks.
• Facemasks help stop droplets from being spread by
  the person wearing them. They also keep splashes
  or sprays from reaching the mouth and nose of the
  person wearing the facemask. They are not
  designed to protect you against breathing in very
  small particles. Facemasks should be used once
  and then thrown away in the trash.

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TRAVEL HEALTH

• WHO does not recommend any travel restrictions to
  areas outbreaks, including countries, which have
  reported, associated cases of human infection.
• WHO does not, at present recommend the routine
  screening of travelers coming from affected
  areas.

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WHAT CAN I DO TO PROTECT MYSELF FROM GETTINGSICK
?

• There is no vaccine available right now to
  protect against swine
• flu.
• There are everyday actions that can help prevent
  the spread
• of germs that cause respiratory illnesses
  like influenza.
• Take these everyday steps to protect your
  health
• Cover your nose and mouth with a tissue when you
  cough or
• sneeze.Throw the tissue in the trash after
  you use it
• Wash your hands often with soap and water,
  especially after
• you cough or sneeze. Alcohol-based hand
  cleaners are also
• effective
• Avoid touching your eyes, nose or mouth. Germs
  spread this
• way
• Try to avoid close contact with sick people

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WHAT IS THE BEST WAY TO KEEP FROM SPREADING
THEVIRUS THROUGH COUGHING OR SNEEZING ?

• If you are sick, limit your contact with other
  people as much as possible. Do not go to work ,
  stay at home or in your hotel room .
• Cover your mouth and nose with a mask when
• coughing or sneezing. It may prevent those
• around you from getting sick.
• Put your used tissue in the waste basket.
• Cover your cough or sneeze if you do not have
  a mask. Then, clean your hands, and do so every
  time you cough or sneeze.

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IS THERE A HUMAN VACCINE TO PROTECT FROM
SWINEINFLUENZA ?

• There are no vaccines that contain the current
  swine influenza
• virus causing illness in humans.
• It is not known whether current human
  seasonal influenza vaccines can provide any
  protection.
• Influenza viruses change very quickly. It is
  important to develop a
• vaccine against the currently circulating
  virus strain for it to
• provide maximum protection to the vaccinated
  people. This is
• why WHO needs access to as many viruses as
  possible in order
• to select the most appropriate candidate
  vaccine virus.

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Treatment is Available for Those Who Are
Seriously III

• It is expected that most people will recover
  without needing medical care.
• If you have severe illness or you are at high
  risk for flu complications, contact your health
  care provider or seek medical care. Your health
  care provider will determine whether flu testing
  or treatment is needed.
• Be aware that if the flu becomes wide spread,
  there will be little need to continue testing
  people, so your health care provider may decide
  not to test for the flu virus.
• Antiviral drugs can be given to treat those who
  become severely ill with influenza. These
  antiviral drugs are prescription medicines
  (pills, liquid or an inhaler) with activity
  against influenza viruses, including H1N1 flu
  virus. These medications must be prescribed by a
  health care professional.

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• There are two influenza antiviral medications
  that are recommended for use against H1N1 flu.
  The drugs that are used for treating H1N1 flu are
  called oseltamivir (trade name Tamiflu ) and
  zanamivir (Relenza ).
• As the H1N1 flu spreads, these antiviral drugs
  may become in short supply.
• Therefore, the drugs will be given first to those
  people who have been hospitalized or are at high
  risk of complications.
• The drugs work best if given within 2 days of
  becoming ill, but may be given later if illness
  is severe or for those at a high risk for
  complications.

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• Antiviral drugs are prescription medicines
  (pills, liquid or an inhaler) that fight against
  the flu by keeping flu viruses from reproducing
  in your body.
• If you get sick, antiviral drugs can make your
  illness milder and make you feel better faster.
• They may also prevent serious flu complications.
  During the current outbreak, the priority use for
  influenza antiviral drugs during is to treat
  severe influenza illness.

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CDC Recommendation

• CDC recommends the use of oseltamivir or
  zanamivir for the treatment and/or prevention of
  infection with swine influenza viruses.
• Oseltamivir (brand name Tamiflu ) is approved to
  both treat and prevent influenza A and B virus
  infection in people one year of age and older.
• Zanamivir (brand name Relenza ) is approved to
  treat influenza A and B virus infection in people
  7 years and older and to prevent influenza A and
  B virus infection in people 5 years and older.
• Recommendations for using antiviral drugs for
  treatment or prevention of swine influenza will
  change as we learn more about this new virus.
• Clinicians should consider treating any person
  with confirmed or suspected swine influenza with
  an antiviral drug.

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MINIMISING THE RISK OF AN EPIDEMIC

• Culling killing large numbers of infected and
  potentially infected animals
• Quarantine putting infected farms in quarantine
• Vaccination??
• operations to minimize the risk of being infected
  by both swine flu and human flu simultaneously

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Pandemic Preparedness Plans

• Most countries have plans
• Most plans focus on health sector
• Plans should focus on continuity of
  government,utilities,Humanitarian
  relief,financial services
• Importance of cross border planning
• Ideal plans
• -All of government involved
• -Link of plans of private Entities and
  voluntary sector
• -Engage Military
• -Involve Civil Defence
• -Priority to Public Information

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• Pandemic Preparedness Plans
• -Action items indicated
• -Responsible Bodies Identified
• -Emphesis on Communicating information to
  public
• Plan must be revised regularly

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How can I prepare for a pandemic?

•  
• Confirm a network of flu-friends, such as
  friends and relatives, to help you if you fall
  ill. Keep all important emergency telephone
  numbers in a safe place.
• Have a stock of food and other supplies available
  at home that will last for two weeks. Current
  recommendations for stockpiling measures are
• 2-week supply of water per each family member
• 2-week supply of non-perishable food for each
  family member
• Adequate supply of on going medication
• Soap / cleansing agents
• Torches and batteries
• Portable radio
• Manual can opener
• Bin bags
• Sanitary items (toilet tissue, diapers, etc.)

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Response Investigation

• What is CDC doing in response to the
  outbreak?CDC has implemented its emergency
  response.
• The agencys goals are
• to reduce transmission and illness severity,
• and provide information to help health care
  providers, public health officials and the public
  address the challenges posed by the new virus.
• CDC continues to issue new interim guidance for
  clinicians and public health professionals.
• In addition, CDCs Division of the Strategic
  National Stockpile (SNS) continues to send
  antiviral drugs, personal protective equipment,
  and respiratory protection devices to all 50
  states and U.S. territories to help them respond
  to the outbreak.

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What epidemiological investigations are taking
place in response to the recent outbreak?

• CDC works very closely with state and local
  officials in areas where human cases of new H1N1
  flu infections have been identified. In
  California and Texas, where EpiAid teams have
  been deployed, many epidemiological activities
  are taking place or planned including

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• Active surveillance in the counties where
  infections in humans have been identified
• Studies of health care workers who were exposed
  to patients infected with the virus to see if
  they became infected
• Studies of households and other contacts of
  people who were confirmed to have been infected
  to see if they became infected
• Study of a public high school where three
  confirmed human cases of H1N1 flu occurred to see
  if anyone became infected and how much contact
  they had with a confirmed case and
• Study to see how long a person with the virus
  infection sheds the virus.

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• Who is in charge of medicine in the Strategic
  National Stockpile (SNS) once it is deployed?
• Local health officials have full control of SNS
  medicine once supplies are deployed to a city,
  state, or territory. Federal, state, and local
  community planners are working together to ensure
  that SNS medicines will be delivered to the
  affected area as soon as possible.
• Many cities, states, and territories have already
  received SNS supplies. After CDC sends medicine
  to a state or city, control and distribution of
  the supply is at the discretion of that state or
  local health department.
• Most states and cities also have their own
  medicines that they can access to treat infected
  persons.

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•  
• Information provided by states and local health
  authorities should be consulted to determine
  whether public health authorities are advising
  that patients who test positive on a rapid
  influenza antigen test need additional testing.
• In areas with many new confirmed cases of novel
  H1N1 flu infection and where community spread of
  H1N1 is occurring, patients who test positive on
  a rapid influenza diagnostic test can be treated
  empirically with antiviral medications if
  clinically indicated without further testing..

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• In areas with no or few confirmed cases of novel
  H1N1 flu, a nasopharyngeal swab/aspirate or nasal
  aspirate should be collected and sent to the
  state public health laboratory for RT-PCR to
  determine if the patient has H1N1 infection,
  seasonal influenza A virus infection, or a
  false-positive test result.

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How Should Swine Flu Be Diagnosed?

• Preferred specimens. If swine flu is suspected,
  clinicians should obtain a respiratory specimen
  for analysis.
• In an ideal situation, the best method is via
  nasal pharyngeal aspirate or nasal wash aspirate
  into viral culture media however, some experts
  are recommending the use of Dacron nasal swabs to
  decrease aerosolization of the virus.
• If these specimens cannot be collected, a
  combined nasal swab with an oropharyngeal swab is
  also acceptable and will be feasible in most
  settings. (Ideally, swab specimens should be
  collected using swabs with a synthetic tip and an
  aluminum or plastic shaft.
• Swabs with cotton tips and wooden shafts are not
  recommended. Specimens collected with swabs made
  of calcium alginate are not acceptable.)

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• The specimen should be placed in a 4C
  refrigerator (not a freezer) or immediately
  placed on ice or cold packs for transport to the
  laboratory.
• Once collected, make contact with the state or
  local health department to facilitate transport
  and timely diagnosis at a state public health
  laboratory.
• Recommended tests. The CDC currently recommends
  "real-time RT-PCR for influenza A, B, H1, H3
  conducted at a State Health Department
  Laboratory.
• Currently, swine influenza A (H1N1) virus will
  test positive for influenza A and negative for H1
  and H3 by real-time RT-PCR.
• If reactivity of real-time RT-PCR for influenza
  A is strong (e.g., Ct 30) it is more suggestive
  of a novel influenza A virus.
• " Confirmation as swine influenza A (H1N1) virus
  is now performed at the CDC but may be available
  in state public health laboratories soon.

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Increased Testing

• CDC has developed a PCR diagnostic test kit to
  detect this novel H1N1 virus and has now
• distributed test kits to all states in the
  U.S. and the District of Columbia and Puerto
  Rico. The test kits are being shipped
  internationally as well. This will allow states
  and other countries to test for this new virus.
  This increase in testing will likely result in an
  increase in the number of confirmed cases of
  illness reported. This, combined with ongoing
  monitoring through Flu View should provide a
  fuller picture of the burden of disease in the
  United States over time

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• Rapid influenza testing. Rapid testing for swine
  flu
• Rapid tests can distinguish between influenza A
  and B viruses.
• A patient with a positive rapid test for
  influenza A may meet criteria for a probable case
  of swine flu,
• but again, a negative rapid test could be a false
  negative and should not be assumed a final
  diagnostic test for swine influenza infection.

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• Reliability and Interpretation of Rapid
  Influenza Test Results
• The reliability of rapid influenza diagnostic
  tests depends largely on the conditions under
  which they are used, and are entirely based on
  the experience with seasonal influenza.
• For detection of seasonal influenza virus
  infection, sensitivities of rapid diagnostic
  tests are approximately 50-70 when compared with
  viral culture or RT-PCR, and specificities of
  rapid diagnostic tests for influenza are
  approximately 90-95. Sensitivity and specificity
  of these tests for detection of the novel H1N1
  flu virus are unknown.

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• False-positive (and true-negative) results are
  more likely to occur when influenza is uncommon
  in the community, which is generally at the
  beginning and end of an outbreak.
• False-negative (and true-positive) results are
  more likely to occur when influenza is common in
  the community, which is typically at the height
  of an outbreak.
• Test sensitivity may vary depending on when in
  the course of illness the specimen is collected.
  Respiratory specimens for testing should be
  collected in the first 4-5 days of illness when
  viral shedding is greatest.

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• How to interpret a positive test result
• A patient testing positive for influenza B by
  rapid diagnostic test likely has been infected
  with seasonal influenza B virus that is
  continuing to circulate or is a false-positive
  result. Such a patient is unlikely to have novel
  H1N1 virus infection.
• There are several possibilities when a patient
  tests positive for influenza A by rapid antigen
  test
• The patient might have novel H1N1 virus infection
  
• The patient might have seasonal influenza A virus
  infection or
• The patient might have a false positive test
  result.

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• How to interpret a negative result Novel H1N1
  flu virus infection cannot be excluded when a
  patient tests negative for influenza A by rapid
  antigen test.
• If the patient has an epidemiologic link to a
  confirmed case (i.e. had close contact with a
  confirmed case), or has either traveled to or
  resides in a community where there are one or
  more confirmed novel H1N1 cases, further testing
  and treatment should be based upon clinical
  suspicion, severity of illness, and risk for
  complications.
• If there is no epidemiologic link and the patient
  has mild illness, further testing and treatment
  are not recommended.

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• Other tests. Immunofluorescence (DFA or IFA)
  tests can distinguish between influenza A and B
  viruses.
• A patient who is positive for influenza A by
  immunofluorescence may meet criteria for a
  probable case of swine influenza.
• However, a negative immunofluorescence could be
  a false negative and should not be assumed a
  final diagnostic test for swine influenza
  infection.
• Isolation of swine influenza A (H1N1) virus by
  viral culture is also diagnostic of infection but
  may not yield timely results for clinical
  management. A negative viral culture does not
  exclude infection with swine influenza A (H1N1)
  virus.

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• Surveillance of healthcare personnel
• (A) In communities where swine influenza A
  (H1N1) virus transmission is occurring
• healthcare personnel should be monitored
  daily for signs and symptoms of febrile
  respiratory illness. 
• Healthcare personnel who develop these symptoms
  should be instructed not to report to work should
  be excluded from work for 7 days or until
  symptoms have resolved, whichever is longer.
• or if at work, should cease patient care
  activities and notify their supervisor and
  infection control personnel.

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• (B) In communities without swine influenza A
  (H1N1) virus transmission
• healthcare personnel working in areas of a
  facility where there are patients being assessed
  or isolated for swine influenza infection should
  be monitored daily for signs and symptoms of
  febrile respiratory infection. 
• This would include healthcare personnel exposed
  to patients in an outpatient setting or the
  emergency department. 
• Healthcare personnel who develop these symptoms
  should be instructed not to report to work should
  be excluded from work for 7 days or until
  symptoms have resolved, whichever is longer.
• or if at work, should cease patient care
  activities and notify their supervisor and
  infection control personnel.
• Healthcare personnel who do not have a febrile
  respiratory illness may continue to work. 
• Asymptomatic healthcare personnel who have had an
  unprotected exposure to swine influenza A (H1N1)
  also may continue to work if they are started on
  antiviral prophylaxis. 

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• Interim Infection Control Recommendations
• If the patient is presenting in a community where
  swine influenza A (H1N1) transmission is
  occurring , these infection control
  recommendations should apply to all patients with
  febrile respiratory illness (defined as fever
  greater than 37.8 Celsius plus one or more of
  the following rhinorrhea or nasal congestion
  sore throat cough).
• If the patient is presenting in a community
  without swine influenza A (H1N1) transmission,
  these infection control recommendations should
  apply to those patients with febrile respiratory
  illness AND

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• close contact with a person who is a confirmed,
  probable, or suspected case of swine influenza A
  (H1N1) virus infection, within the past 7 days OR
  
• travel to a community either within the United
  States or internationally where there are one or
  more confirmed swine influenza A (H1N1) cases
  within 7 days
• As the situation evolves, the ability to use
  epidemiologic links to identify potentially
  infectious patients may be lost and these
  recommendations may need to be applied to all
  patients with febrile respiratory illness.  This
  situation will be monitored, and these guidelines
  will be updated as needed.

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• Infection Control of Ill Persons in a Healthcare
  Setting
• Screening of patients presenting to medical
  facilities
• Patient placement and transport
• Any patients who are confirmed, probable or
  suspected cases and present for care at a
  healthcare facility should be placed directly
  into individual rooms with the door kept closed.
•  
• Healthcare personnel interacting with the
  patients should follow the infection control
  guidance in this document. 
• For the purposes of this guidance, healthcare
  personnel are defined as persons, including
  employees, students, contractors, attending
  clinicians, and volunteers, whose activities
  involve contact with patients in a healthcare or
  laboratory setting.

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• Procedures that are likely to generate aerosols
  (e.g., bronchoscopy, elective intubation,
  suctioning, administering nebulized medications),
  should be done in a location with negative
  pressure air handling whenever feasible. 
• An airborne infection isolation room (AIIR) with
  negative pressure air handling with 6 to 12 air
  changes per hour can be used.
•  
• Air can be exhausted directly outside or be
  recirculated after filtration by a high
  efficiency particulate air (HEPA) filter.
• Facilities should monitor and document the proper
  negative-pressure function of AIIRs, including
  those in operating rooms, intensive care units,
  emergency departments, and procedure rooms.

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• Procedures for transport of patients in isolation
  precautions should be followed.
• Facilities should also ensure that plans are in
  place to communicate information about suspected
  cases that are transferred to other departments
  in the facility (e.g., radiology, laboratory) and
  other facilities.
• The ill person should wear a surgical mask to
  contain secretions when outside of the patient
  room, and should be encouraged to perform hand
  hygiene frequently and follow respiratory hygiene
  / cough etiquette practices.
• Limitation of healthcare personnel entering the
  isolation room
• Healthcare personnel entering the room of a
  patient in isolation should be limited to those
  performing direct patient care.
• Isolation precautions

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• Standard and Contact precautions plus eye
  protection should be used for all patient care
  activities for patients being evaluated or in
  isolation for swine influenza A (H1N1) (i.e.,
  including all healthcare personnel who enter the
  patients room).
• Maintain adherence to hand hygiene by washing
  with soap and water or using alcohol-based hand
  sanitizer immediately after removing gloves and
  other equipment and after any contact with
  respiratory secretions.
•  Nonsterile gloves and gowns along with eye
  protection should be donned upon room entry.

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• Respiratory protection All healthcare personnel
  who enter the rooms of patients in isolation for
  swine influenza should wear a fit-tested
  disposable N95 respirator or equivalent (e.g.,
  powered air purifying respirator).
• Respiratory protection should be donned upon room
  entry.
• Note that this recommendation differs from
  current infection control guidance for seasonal
  influenza, which recommends that healthcare
  personnel wear surgical masks for patient care. 
• The rationale for the use of respiratory
  protection is that a more conservative approach
  is needed until more is known about the specific
  transmission characteristics of this new virus. 

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• Management of visitors
• Limit visitors to patients in isolation for swine
  influenza A virus (H1N1) infection to persons who
  are necessary for the patient's emotional
  well-being and care. 
• Visitors who have been in contact with the
  patient before and during hospitalization are a
  possible source of swine influenza A virus
  (H1N1).
• Therefore, schedule and control visits to allow
  for appropriate screening for acute respiratory
  illness before entering the hospital and
  appropriate instruction on use of personal
  protective equipment and other precautions (e.g.,
  hand hygiene, limiting surfaces touched) while in
  the patient's room. 
• Visitors should be instructed to limit their
  movement within the facility.
• Visitors may be offered a gown, gloves, eye
  protection, and respiratory protection (i.e., N95
  respirator) and should be instructed by
  healthcare personnel on their use before entering
  the patients room.