Tuesday, April 28, 2009

Swine Flu Question of the Day

Actually, there are many, but one that is being batted around here is: Who should be tested? All those with acute febrile respiratory illness, or only those who also have an “epi link” (residence in or travel to an area with confirmed cases, or contact with a suspected/confirmed case)?

The opening paragraph of the CDC website for clinicians states,

“Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.”
That sounds pretty general. If we tested everyone with that presentation, we’d quickly overwhelm our public health labs (since they are currently the only labs capable and recommended to handle these samples). Or, as our state public health department is recommending, should we only test those who meet the CDC criteria for a suspected case, as outlined here:

A suspected case of swine influenza A (H1N1) virus infection is defined as a person with acute febrile respiratory illness with onset
  • within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or
  • within 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, or
  • resides in a community where there are one or more confirmed swine influenza cases.
Once a case is confirmed in your locale, of course this question becomes moot. But for those in states that haven’t yet seen confirmed cases, it looms fairly large.

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