1) The Miami-Dade County Health Department (MDCHD) reminds providers of the importance of OBTAINING A TRAVEL HISTORY from all patients being hospitalized for pneumonia, Acute Respiratory Distress Syndrome (ARDS) or other unexplained severe respiratory disease. This will allow the rapid identification and reporting of suspect cases of Influenza (H5N1) upon admission to health care facilities;
2) MDCHD continues to request immediate reporting of patients who have traveled during the 10 days preceding symptom onset to a country with confirmed avian and/or human Influenza A (H5N1) activity AND who meet the following clinical criteria:
- Severe respiratory disease, including unexplained pneumonia or ARDS
- Milder illness, defined as fever and respiratory symptoms (e.g., cough or shortness of breath), among patients who, while traveling in a country with Influenza A (H5N1) activity, ALSO report contact with either a) live birds (e.g., at a live poultry market or farm), or b) a confirmed human case;
3) The Centers for Disease Control and Prevention (CDC) recommends that health care workers practice airborne and contact precautions (including eye protection) for all patients with suspected Influenza A (H5N1) until 14 days after the onset of illness or until an alternative diagnosis is established.
Please distribute to staff in the Departments of Critical Care, Emergency Medicine, Family Practice, Internal Medicine, Infectious Disease, Pediatrics, Pulmonary Medicine and Laboratory Medicine.
Categories of urgency levels for MDCHD Broadcast Notification System:
Health Alert: conveys the highest level of importance; warrants immediate action or attention
Health Advisory: provides important information for a specific incident or situation; may not require immediate action
Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action
Surveillance for Influenza A (H5N1) in Miami-Dade:
To rapidly detect the importation of influenza A (H5N1) into Miami-Dade County, MDCHD requests that providers remain vigilant for respiratory disease among travelers returning from Asia, and report immediately all patients who have:
- A history of travel within the 10 days before illness onset to a country with confirmed or suspected influenza A (H5N1) in either birds or humans (currently includes Cambodia, mainland China, Indonesia, Japan, Laos, South Korea, Thailand, or Vietnam) and EITHER:
- Severe respiratory illness requiring hospitalization, with radiographic evidence of pneumonia or ARDS, OR
- Milder illness, defined as fever > 38°C AND respiratory symptoms (e.g., cough or shortness of breath) AND either a) contact with live birds (e.g., at a live poultry market or farm) or b) a confirmed human case of H5N1, while traveling in an affected country
All hospitalized patients meeting the above clinical and epidemiologic criteria should be placed under airborne and contact precautions. Once avian influenza has been ruled out, these patients may be placed under droplet precautions; or if the cause of illness is determined to be noncontagious, no further infection control precautions are needed.
Report suspect cases immediately to the MDCHD at (305) 470 5660; this service is available 24 hours a day, weekdays, weekends, and holidays.
To ensure that individuals meeting the above criteria are rapidly identified, it is recommended that acute care facilities institute routine screening for travel history among all patients with suspected pneumonia or severe respiratory infections at the time of triage or on initial medical evaluation.
Please note that the list of countries with H5N1 activity may change. We recommend monitoring the following web sites for the most up-to-date information on current avian influenza activity worldwide:
Please notify MDCHD immediately so we can assist you with clinical management and laboratory testing.
For up-to-date information, visit http://www.cdc.gov/flu/avian/index.htm,
or http://www.who.int/csr/disease/avian_influenza/en/
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