Subject: NM Dept of Health General Notification on H1N1 Influenza -- Update No. 4
From: "Shaun H. Cooper"
Date: Thu, 30 Apr 2009 09:04:11 -0600

!!! NM Dept of Health General Notification
Message !!! Message ID 938 Sent 4/29/2009 7:02:09 PM Mountain Time

THIS A NEW MEXICO HEALTH UPDATE -- H1N1 Influenza Update No. 4

This information is being sent to infection
control practitioners, hospitals, physicians,
primary and urgent care contacts and facilities,
occupational medicine clinics, long-term care
facilities, student health clinics, schools,
first responders, emergency managers, IHS
contacts and facilities, CHRs, environmental and
public health contacts, veterinarians,
agricultural contacts, elected/appointed officials.


SUPERINTENDENTS:  You are reminded to forward
this notification to the school nurses in your region/district. ===

reminded to forward this notification to the
district/volunteer departments/services in your county. ===

===TO EMS CAREGIVERS:  Assess and appropriately
transport all patients.  If the patient is
reporting a recent exposure or travel history
(described below) and exhibiting signs and
symptoms consistent with influenza, communicate
this information to the healthcare personnel at
the receiving facility.  EMS providers are not
expected to obtain specimens. ===


CDC has confrimed more H1N1 influenza cases, and the Word Health Organization

Detailed Message:

The Centers for Disease Control and Prevention
(CDC) confirmed that there are 90 cases of swine
influenza in the United States. There are 51
cases in New York, 16 in Texas, 14 in California,
2 in Massachusetts, 2 in Kansas, 1 in Indiana, 1
in Michigan, 1 in Arizona, 1 in Nevada, and 1 in Ohio.

The World Health Organization raised the
worldwide pandemic alert level to Phase 5 which
is characterized by human-to-human spread of the
virus into at least two countries in one 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.


-     HOSPITALIZED PATIENTS: Until otherwise
notified, we ask that specimens be collected (see
below) from patients who have acute febrile
respiratory illness (defined as influenza-like
illness [ILI] in New Mexico) and are hospitalized
in New Mexico with suspect or confirmed influenza.

(ILI): Fever greater or equal to 37.8C (100F),
oral or equivalent, AND a cough and/or sore
throat in absence of a known cause other than influenza

that influenza sentinel surveillance providers in
New Mexico collect specimens from outpatients who
meet the definition for influenza-like illness above.

patient meets the definition for influenza-like illness with illness onset:

o               within 7 days of close contact
with a person who is a confirmed case of swine
influenza A (H1N1) virus infection, or

o               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

o               resides in a community where
there are one or more confirmed swine influenza cases:

we ask that you collect a nasopharyngeal swab for
viral culture and call the Epidemiology and
Response Division epidemiologist on-call at 505-827-0006.

Persons with acute febrile respiratory illness
should stay home from work or school to avoid
spreading infections (including influenza and
other respiratory illnesses) to others in their
communities. In addition, frequent hand washing
can lessen the spread of respiratory illness. If
your condition worsens or you have questions
about your illness, please contact your health care provider.

SPECIMEN COLLECTION: Please collect up to 2 (one
for your in-house rapid testing and one for the
state lab culture) nasopharyngeal swab from each
patient with ILI, placing the swab in a standard
container with 2-3 ml of viral transport media.
If the patient is hospitalized with pneumonia,
specimens from the lower respiratory tract (e.g.,
tracheal aspirate, bronchoalveolar lavage) should
also be obtained. Specimens should be collected
within the first 24-72 hours of onset of symptoms
and no later than 5 days after onset of symptoms.

Specimens should be shipped to:  Scientific
Laboratory Division, 700 Camino De Salud NE
Albuquerque, NM 871 6 (505) 841-2500.

SPECIMEN STORAGE: The specimens should be kept
refrigerated at 4C and sent on cold packs if
they can be received by the Scientific Lab
Division (State PH lab) within 72 hours of the
collection date.  If samples will not be received
by the laboratory within 72 hours of collection,
they must be frozen at -70 C or below and shipped on dry ice.


A. Interim Guidelines for Prioritization of Uses
of the New Mexico Stockpile of Antiviral Medications (April 29, 2009)

New Mexico has not confirmed any cases of swine
influenza.  However, given the rapidly changing
picture of this outbreak and the occurrence of
swine influenza in multiple other states in the
U.S. and other countries, the New Mexico
Department of Health has developed the following
guidelines for use of antiviral medication in the
state stockpile.  Since the demand for antiviral
medications for treating influenza may be greater
than the available supply at some point in the
future, it is prudent that our state stockpile
and the pending release of the federal Strategic
National Stockpile (SNS) be used in a manner that
will conserve available supply.

    1.  The majority of state stockpiled
antiviral medications will be used for treatment of swine influenza cases.

    2.  The highest priority for use of
antiviral medications in the state stockpile will
be for treatment of hospitalized swine influenza
cases, and cases at higher risk for influenza
complications, within 48 hours of onset of illness.

    3.  Antiviral medications may not be needed
for treatment of mild swine influenza cases that
are not at higher risk for complications of influenza.

    4.  A smaller amount of state stockpiled
antiviral medications will be available for
post-exposure chemoprophylaxis using interim CDC
guidelines for groups recommended for prophylaxis
following exposure to a swine influenza case.
Antiviral chemoprophylaxis with either
oseltamivir or zanamivir is recommended
(depending on the availability of
pharmaceuticals) for the following individuals:

         o     Household close contacts who are
at high-risk for complications of influenza
(e.g., persons with certain chronic medical
conditions, persons 65 or older, children younger
than 5 years old, and pregnant women) of a confirmed or probable case.

         o     Health care workers or public
health workers who were not using appropriate
personal protective equipment during close
contact with an ill confirmed, probable, or
suspect case of swine-origin influenza A (H1N1)
virus infection during the case's infectious period.

         o     Dosing recommendations are given
in several tables on the CDC website at:

    5.  At this time antiviral medications from
the state stockpile will not be used for pre-exposure chemoprophylaxis.

    6.  The NM DOH will determine swine
influenza case and close contact classifications.
Medical providers are urged to call the
Epidemiology and Response Division (505-827-0006)
immediately to assist in the diagnosis and
confirmation of swine influenza in patients that
providers believe may have been exposed to swine
influenza and are exhibiting signs and symptoms consistent with influenza.

B. Interim Guidelines for Mask and Respirator Use
among the General Public in New Mexico (April 29, 2009)

    1.  Facemasks and respirators are not
recommended for the well general public at this time.

    2.  Ill persons may be instructed to wear a
facemask by their health care provider.

C. Interim Guidelines for Infection Control Providers

    1.   New Mexico guidelines for infection
control providers can be found on the NMDOH Swine
Influenza Resources website under "Information
for Providers" at:

The guidelines include a Hand Hygiene Etiquette
Poster, Swine Flu Infection Control
Recommendations, and Urgent Care and Emergency
Room Swine Flu Infection Control Recommendations.


Guidance is available from CDC at including:

    o          Interim Guidance for Swine
influenza A (H1N1): Taking Care of a Sick Person in Your Home

    o          Interim Guidance on Antiviral
Recommendations for Patients with Confirmed or
Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts

    o          Interim CDC Guidance for
Nonpharmaceutical Community Mitigation in
Response to Human Infections with Swine Influenza (H1N1) Virus

    o          Interim Recommendations for
Facemask and Respirator Use in Certain Community
Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected

    o          Interim Guidance on Specimen
Collection and Processing for Patients with
Suspected Swine Influenza A (H1N1) Virus Infection

    o          Swine Influenza A (H1N1) Virus
Biosafety Guidelines for Laboratory Workers

    o          Interim Guidance for Infection
Control for Care of Patients with Confirmed or
Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting

    o          Interim Guidance on Case
Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases

    o          Interim Guidance to Assist
Airline Flight Deck and Cabin Crew in Identifying
Passengers Who May Have Swine Influenza

    o          Interim Guidance-Pregnant Women
and Swine Influenza: Considerations for Clinicians

Morbidity and Mortality Weekly Reports Dispatch
(April 24) provides detailed information about
the initial cases at

For more information about swine flu:

Additional information is also available by
calling 1-800-CDC-INFO (1-800-232-4636)

Health alerts are messages from the New Mexico
Department of Health that contain important
information for responding to a health
emergency.  Health alerts are sent to health care
providers, emergency responders, first
responders, and other affiliated professionals.

There are four types of messages that come from the Health Alert Network (HAN):

ALERT:  Conveys the highest level of importance;
warrants immediate action or attention.

ADVISORY:  Provides important information for a
specific incident or situation; may not require immediate action.

UPDATE:  Provides updated information regarding
an incident or situation; unlikely to require immediate action.

TEST:  Tests the alerting system technologies,
the ability to reach the intended recipients, or
provides simulated alerts for exercise purposes.

If you have questions about the Health Alert
Network, please contact the HAN at

Shaun Cooper, Ph.D
Chief Information Officer and
Associate Vice President
ICT/NMSU, MSC 3AT, Box 30001, Las Cruces, NM 88003
(575) 646-6030 work, (575) 646-4560 fax