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Influenza Information For Healthcare Providers

Clinical Information

Symptoms

Influenza illness can include any or all of these symptoms: fever, muscle aches, headache, lack of energy, dry cough, sore throat, and possibly runny nose. The fever and body aches can last 3-5 days and the cough and lack of energy may last for 2 or more weeks. The Department of Health defines a fever as 100.4ºF/38ºC for people with influenza-like illness.

Influenza can be difficult to diagnose based on clinical symptoms alone, because the initial symptoms of influenza can be similar those caused by other infectious agents. Most patients with influenza will have mild illness and can be cared for at home, but some patients, such as infants younger than 6 months of age, people with high-risk medical conditions, and anyone with moderate to severe illness, should be seen by a healthcare provider.

Treatment

People with influenza who have high-risk conditions, who have moderate to severe illness, or who live in households with high-risk individuals should take antiviral medications to treat influenza or prevent influenza transmission.

In emergency situations where commercially manufactured Tamiflu for Oral Suspension is not available, pharmacists may compound a suspension (15mg/mL) from Tamiflu (oseltamivir phosphate) Capsules 75mg using either Cherry Syrup (Humco) or Ora-Sweet Sugar-Free. more

Laboratory Testing

Healthcare providers should send rapid diagnostic tests, PCR, or cultures that have been ordered to commercial or hospital laboratories. Do not send patient specimens to the State Lab.

The reliability of rapid diagnostic tests depends largely on the conditions under which they are used. Understanding some basic considerations can minimize misreading false-positive or false-negative results. Sensitivities are approximately 50-70% when compared with viral culture or reverse transcription polymerase chain reaction (RT-PCR), and specificities of rapid diagnostic tests for influenza are approximately 90-95%. False-positive (and true-negative) results are more likely to occur when disease prevalence in the community is low and are generally found at the beginning and at the end of the influenza season. Additionally, false-negative (and true-positive) results are more likely to occur when disease prevalence is high in the community.

To minimize false results, healthcare providers can take several important measures:

Use rapid diagnostic tests with high sensitivity and specificity.
Collect specimens as early as possible (within four to five days of the onset of symptoms in a patient).
Follow manufacturers’ instructions, including instructions on the proper handling of specimens.
Consider sending specimens for viral culture or PCR to confirm results of rapid tests. This is especially recommended when prevalence of influenza in the community is low and the rapid diagnostic test result is positive, or when the rapid diagnostic test result is negative but disease prevalence is high.
CDC’s additional information on testing.

Infection Control

Preventing transmission of influenza virus and other infectious agents within healthcare settings requires a multi-faceted approach. The spread of influenza virus can occur among patients, healthcare providers, and visitors. Healthcare providers can also acquire influenza from household or community contacts and, in turn, transmit the virus to patients. The core strategies for preventing the spread of influenza are:

Administer influenza vaccine to patients and to staff.
Manage all ill healthcare providers and staff.
Adhere to infection-control precautions for all patient care activities and aerosol-generating procedures.
Implement environmental and engineering infection control measures.
Implement respiratory hygiene and cough etiquette.

Some specific respiratory hygiene recommendations include:

When there is increased respiratory infection activity in the community, (increased school/work absenteeism, increase in office visits for respiratory illness) offer masks to anyone who is coughing.
When space permits, encourage anyone who is coughing to sit at least three feet away from others in waiting areas.
Advise healthcare staff to use droplet precautions (wear a surgical or procedure mask for close contact) in addition to standard precautions when examining a patient with symptoms of a respiratory infection, especially if fever is present. These precautions should be maintained for seven days after patient’s illness onset or for 24 hours after the resolution of the fever and respiratory symptoms (whichever is longer) while a patient is in a healthcare facility.
Healthcare staff should wear respiratory protection equivalent to a fitted N95 respirator during aerosol-generating procedures such as bronchoscopy, sputum induction, intubation and extubation, autopsies, and open suctioning of airways.

Epidemiology

Surveillance

The Department of Health’s primary method of surveillance is its statewide sentinel physician network. Sentinel physicians are recruited and appointed to report weekly the percentage of influenza-like illness seen during office visits. Sentinel physicians also provide three random swabs (early, mid, and late influenza season) for PCR testing. The Department of Health works directly with hospital laboratories and/or infection control practitioners to identify confirmed cases of influenza for active surveillance. The Department of Health’s surveillance reports and the CDC’s surveillance reports are published weekly.

Reporting Influenza

Healthcare providers should report any laboratory-confirmed influenza hospitalizations to the Department of Health, as well as any influenza-associated deaths. Healthcare providers should also report all influenza-like illness institutional clusters (two or more influenza cases within four to five days). Hospital laboratories must report all laboratory-confirmed influenza to the Department of Health and specify if a patient is an inpatient or an outpatient.

To report, call 401-222-2577 Monday through Friday from 8:30 a.m. to 4:30 p.m. After hours, call 401-276-8046 or fax information to 401-222-2488.

Any healthcare provider who would like to volunteer influenza information for the Rapid Flu Test Reporting Network should call 401-222-2577.

Vaccination

Healthcare providers who are interested in vaccinating patients against influenza must enroll in the Department of Health’s State-Supplied Vaccine program. Through this program healthcare providers can order influenza vaccine for both children and adults.