„Swine flu” (A/H1N1 type influenza)

„Swine flu” is a respiratory disease with fever caused by A/H1N1 influenza viruses. Previously only found in pigs, genetic changes have allowed this virus to be transmitted from human to human. “Swine flu” is therefore a new kind of human influenza.

Transmission
The disease is transmitted by droplet infection (e.g. through coughing or sneezing) and by hand contact.

Clinic
The clinical picture is similar to that of traditional influenza. Other symptoms include:

  • fever (≥ 38.5 °C)
  • cold symptoms
  • sore throat
  • fatigue, loss of appetite
  • and/or cough or shortness of breath.

Epidemiological criterion

  • Direct contact with people who are known to have contracted „swine flu”.

The current case definition may be found at www.rki.de/influenza/surveillance.

Sampling
While following personal protection measures (i.e. wearing an FFP2 standard protective mask along with goggles, gloves and protective gowns, ABAS Resolution 609) a swab should be taken from both the left nostril and the right nostril.

As far as possible, eSwabs (swabs with a liquid medium) or dry, sterile swabs should be used. Place the swab in a sterile tube, and then seal and send it to the laboratory.
If clinical suspicions persist, the diagnostics should be repeated a short time later.

Instructions for laboratory diagnostic confirmation of the diagnosis of infection with the new A/H1N1-V type influenza
When there are clinical suspicions of „swine flu”, the nasal swab should be tested for „swine flu” using PCR.

The sensitivity of the influenza (antigen) rapid test is below 50 %, and thus its use is not recommended for clarifying cases of new A/H1N1 type influenza. In the event of a negative result, further testing using PCR is required to confirm the suspected case of „swine flu”. In the event of a positive test result, the rapid test is still valuable because of its quick availability. If the rapid test is carried out in the practice, an additional nasal swab should be used (observe the manufacturer's instructions).

Therapy
Prescribing doctors should consider 5 days of treatment with antiviral medicines for all patients who have contracted influenza. This therapy can be continued when there are severe symptoms, even when seasonal influenza has been diagnosed (e.g. type B), and especially in patients at an increased risk. The neuraminidase inhibitors oseltamivir (Tamiflu®) and zanamivir (Relenza®) should be condered for treatment.
The therapy should begin as soon as possible after the diagnosis; the Robert Koch Institute recommends 5 hours.

Hygiene measures
In cases of suspected „swine flu”, the patient should kept away from the other patients, in a separate room wherever possible. When the patient is admitted to hospital, he/she should remain there until transported. The hospital receiving the patient is informed in advance concerning the patient’s confinement and suspected diagnosis/disease. If the patient’s state of health allows, he/she should be provided with mouth/nose protection or a breathing mask.

Personal protection measures

  • Personnel should be trained regarding hygiene measures (practice hygiene plan)
  • The wearing of protective gowns
  • Disposable gloves
  • Closely fitting mask (ideally, an FFP2 mask)

Disinfection and cleaning
Hand disinfection should be performed with a hand disinfectant effective against viruses (DGHM list) after each contact with hands, after contact with material containing the pathogen or contaminated objects or after taking off the gloves.
After leaving the patient’s room and practice, all surfaces with which the patient comes into contact should be disinfected using a disinfectant with a „limited virucidal effect” effectiveness range.

Reporting
In cases of suspected „swine flu” in humans, it is necessary to report patient names to the local health authority (in accordance with the German Infection Prevention Act (IFSG) extended sec. 6, dated 30/04/2009 on the basis of sec. 15). The special reporting form can be found on the website: www.rki.de/influenza. To be regarded as suspected cases are people whose symptoms match the clinical picture (see above), where there is epidemiological exposure and for whom there is no evidence of any other cause that fully explains the clinical picture. If the rapid test is positive for influenza A, this is to be noted on the laboratory report form (in accordance with sec. 7 and sec. 12 IFSG). In cases where there is positive evidence of influenza B, the case is to be reported as a seasonal disease.

Charge codes
For out-patients with statutory health insurance, please use the exception code 32006 (suspected reportable disease) and code 88200 for the medical services required in the course of treatment.
You can always find up-to-date information on the new flu on the website of the Robert Koch Institute.

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