H1N1 Flu (Swine Flu)

Information For Health Care Providers

Click here for Information for Your Patients

Click here for Indiana University H1N1 Web pages

Click here for News

From the Indiana State Department of Health

Health care providers with concerns, comments, questions call ISDH Hotline at 1-877-499-0017 for assistance.

Health Care Providers with questions e-mail HealthCommissioner@isdh.IN.gov

ISDH Websites for Medical Providers

H1N1 Influenza A for Medical Providers
this page includes:

• Weekly Indiana Influenza Activity Report
• Questions from Clinicians & Answers from the ISDH (includes topics such as Medicare coverage, H1N1 vaccination kits, coding), issued weekly starting October 9th
• Centers for Disease Control (CDC) Clinical and Public Health Guidance
• Centers for Disease Control (CDC) Resources for Clinicians
• Laboratory Information including ISDH submission guidelines as of July 10, 2009 For Epidemiology and Surveillance contact Shawn Richards, ISDH Influenza Coordinator; 317-233-7740; srichard@isdh.in.gov. For Laboratory issues contact David Dotson, Director, Emergency Preparedness and Response; 317-921-5545, ddotson@isdh.in.gov
• Centers for Disease Control (CDC) Resources for Laboratories

H1N1 Flu Vaccine in Indiana

Google Maps Flu Shot Locator

ISDH has set up a hotline for the public to call about the H1N1 Flu and Vaccine: 1-877-826-0011 or TTY 1-888-561-0044 from 8:30a.m. to 4:45p.m., Monday-Friday. Indiana’s 93 local health departments will be determining how the H1N1 flu vaccine will be distributed in their communities, links to the departments may be found here.

State health officials recommend everyone over 6 months of age get the seasonal flu vaccine, note this is different and is not the H1N1 flu vaccine. The American Lung Association website has a flu clinic locator for clinics giving the seasonal flu vaccine.

Other Websites For Health Care Providers

• EBSCO Publishing and Medical and Nursing editors of Dynamed, Nursing Reference Center, and Patient Education Reference Center have made key information available at the Influenza Evidence-based Information Portal
• 2009 H1N1 Influenza Information: A physician resource from the American Medical Association, free registration required to access some of the tools.
• Pandemic H1N1 2009 from the World Health Organization

For Your Patients

From the American Medical Association

Seasonal Influenza vs. 2009 H1N1 Influenza
Explains the differences between “seasonal flu” and the H1N1 flu (Swine flu).

Indiana State Department of Health

The ISDH has set up a number for the general public at 1-877-826-0011. This number is answered from 8:15 am to 4:45 pm, Monday thru Friday.

ISDH website: 2009 H1N1 Influenza A

Marion County Health Department

Marion County Flu Helpline has health educators available to respond to questions in English or Spanish, Monday thru Friday, from 8a.m. until 5p.m. 317-221-3366

Centers for Disease Control (CDC)

What to do if You Get Sick: 2009 H1N1 and Seasonal Flu

Resources for Parents and Caregivers

People at High Risk for Developing Flu-Related Complications

• Children younger than 5, but especially children younger than 2 years old
• People 65 Years and Older
• Pregnant Women
• People with HIV Infections
• H1N1 and Diabetes
• People with Cardiovascular Disease
• People with Asthma
• People with Arthritis
• People with neurological or neurodevelopmental conditions, blood disorders, kidney disorders, liver disorders or metabolic disorders
• People younger than 19 years of age who are receiving long-term aspirin therapy

2009 H1N1 and Travel

Resources for the Deaf and Hard of Hearing

Indiana University H1N1 Web Pages

• Indiana University -All Campuses
• IUPUI Indiana University-Purdue University at Indianapolis Health Services
• Indiana University, Bloomington Health Center
• Indiana University, Fort Wayne Health and Wellness
• Indiana University-Purdue University at Columbus H1N1 FAQ
• Clarian Hospitals click on Flu News
• Indiana University East (Richmond) H1N1 Preparedness
• Indiana University, Kokomo Emergency Preparedness
• Indiana University Northwest (Gary), Environmental Health & Safety
  Avian Influenza
  H1N1 Influenza
• Indiana University, South Bend EmergencyPreparedness
• Indiana University Southeast (New Albany) Emergency Preparedness

News

• November 13, 2009 CDC Weekly FluView Updates (national and international)
• October 23, 2009 FDA Authorizes Emergency Use of Intravenous Antiviral Peramivir for 2009 H1N1 Influenza for Certain Patients, Settings

Indiana State Department of Health RSS

Centers for Disease Control RSS

IHAN - Indiana State Department of Health - Advisory - 654 - Updated Pediatric Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu

 Note on Tamiflu Oral Suspension Syringe

The second issue that pharmacists and physicians may face is the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.  An oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations of Tamilfu is provided in the packaging for the manufacturer’s product rather than graduations in milliliters (mL) or teaspoons (tsp).  This can lead to patient or caregiver confusion and dosing errors.  When dispensing commercially manufactured Tamiflu,  oral suspension, pharmacists should ensure the units of measure on the dosing instructions match the dosing device provided.   If prescription instructions specify administration using mL or tsp, then the device included in the Tamiflu product package should be removed and replaced with an appropriate measuring device, such as an oral syringe if the prescribed dose is in milliliters (mL).

When dispensing Tamiflu oral suspension for children younger than 1 year of age, the oral dosing dispenser that is included in the product package should always be removed. Pharmacists and health care providers should provide an oral syringe that is capable of accurately measuring the prescribed milliliter (mL) dose, and counsel the caregiver how to administer the prescribed dose. Oseltamivir is authorized for emergency use in children younger than 1 year of age under an Emergency Use Authorization (EUA) issued by FDA. For the EUA, see http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf.

For More Information:
2009-2010 Influenza Season: Information for Pharmacists: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm

Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/recommendations.htm

Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season:  http://www.cdc.gov/h1n1flu/antiviral.htm

Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm

Antiviral Drugs: Summary of Side Effects: http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm

For the FDA page on antiviral influenza drugs:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm

For the FDA-approved package insert with instructions for the emergency compounding of an oral suspension from Tamiflu 75mg capsules see http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf

For the FDA public health alert regarding Tamiflu (oseltamivir) for Oral Suspension: Potential Medication Errors see http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183714.htm.

For additional information, you can also call CDC’s toll-free hotline, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.

Indiana Health Alert Network

This is an Official
Indiana Health Alert Network Advisory Message

Distributed via the Indiana Health Alert Network
7/13/2009 7:17:51 PM
IHAN-641-2009-7-13

Urgency Type: Advisory
Message Status: Actual
Message Type: Original

Clinicians Advised to Halt Use of Propofol from Tainted Lots

This is an official
CDC Health Advisory

Distributed via Health Alert Network
July 13, 2009, 19:00 ET (7:00 PM ET)
CDCHAN-00296-09-07-13-ADV-N

Clinicians Advised to Halt Use of Propofol from Tainted Lots

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have been investigating recent cases of febrile reactions among patients undergoing endoscopy in the United States.

This investigation has revealed that all of the case-patients received the anesthetic propofol from 100 ml vials manufactured by Teva Pharmaceuticals.

Testing done by the FDA has found that two lots of this product that were in use in facilities reporting febrile reactions were positive for elevated levels of endotoxin.

The lots are 31305429B and 31305430B.

Teva Pharmaceuticals is initiating a voluntary recall for these lots, and clinicians are advised to immediately stop using these lots of Teva Pharmaceuticals propofol.

CDC, FDA and Teva Pharmaceuticals are continuing to investigate this issue.

To date, all case-patients have recovered.

As additional information about the recall becomes available, an updated Health Alert Notice will be provided.

For Physicians

As of 9PM EDT, Wednesday, February 4, 2009, 575 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 43 states. The number of ill persons identified in Indiana (9).

Multistate Outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter–Containing Products — United States, 2008–2009
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0129a1.htm

Salmonella Strains Tables for Outbreak Related to Peanut Butter and Peanut Containing Products
http://www.cdc.gov/salmonella/typhimurium/strains_table.html

Centers for Disease Control and Prevention in collaboration with the American Medical Association et. al. Diagnosis and Management of Foodborne Ilnesses, 2004
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm

Indiana State Department of Health Case Investigation Form
http://www.in.gov/isdh/files/49693_Salmonellosis.pdf

“Practice Guidelines for the Management of Infectious Diarrhea”
Clinical Infectious Diseases 2001; 32:331-50
http://www.journals.uchicago.edu/doi/pdf/10.1086/318514?cookieSet=1

PDA Version of the Practice Guidelines
http://www.idsociety.org/Content.aspx?id=5910

CDC Outbreak Page (includes information for the public):

Investigation Information for Outbreak of Salmonella Typhimurium Infections, 2008-2009
http://www.cdc.gov/salmonella/typhimurium/

To determine whether a product has been recalled, consumers can search the
list of recalled products at the Food and Drug Administration (FDA) website or
telephone the company that distributed the product at the phone number on the
package.

Consumers without internet access can telephone 1-800-CDC-INFO
(1-800-232-4636), 24 hours a day, 7 days a week, for product recall information
from the FDA website and for other information on salmonellosis.

FDA’s Salmonella Widget (below)
http://www.fda.gov/oc/opacom/hottopics/salmonellatyph/widget.html

For Physicians & Health Professionals

From the U.S. Centers for Disease Control and Prevention
Interim Antiviral Guidance for 2008-09, issued on December 19, 2008
http://www.cdc.gov/flu/professionals/antivirals/index.htm

Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection issued on January 30, 2008
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00268

Seasonal Flu and Staph Infections
http://www.cdc.gov/flu/professionals/flustaph.htm

2008–09 INFLUENZA PREVENTION & CONTROL RECOMMENDATIONS
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
http://www.cdc.gov/flu/professionals/acip/index.htm

FluView: Weekly Influenza Surveillance Report
http://www.cdc.gov/flu/weekly/

More at: CDC Seasonal Influenza Information for Health Professionals
http://www.cdc.gov/flu/professionals/index.htm

Indiana State Department of Health Forms
Influenza Lab Submission - State Form 35212
http://www.in.gov/icpr/webfile/formsdiv/35212.pdf

Influenza-Associated Deaths Case Investigation - State Form 52576 (2-06)
http://www.in.gov/isdh/files/52576_InfluenzaAssocDeath.pdf

For the Public

From the U.S. Centers for Disease Control and Prevention
Preventing Seasonal Flu:  CDC Says “Take 3” Steps To Fight The Flu
http://www.cdc.gov/flu/protect/preventing.htm

Seasonal Flu: What To Do If You Get Sick: Symptoms, Treatment, Taking Care of Yourself
http://www.cdc.gov/flu/whattodo.htm

Seasonal Flu Information for Parents
http://www.cdc.gov/flu/parents/

Seasonal Flu: What You Should Know About…
http://www.cdc.gov/flu/whatyoushouldknow.htm

From the National Library of Medicine
MEDLINEPlus Flu
http://www.nlm.nih.gov/medlineplus/flu.html

Shigella infection (shigellosis) is an intestinal disease caused by a family of bacteria known as shigella. The main sign of shigella infection is diarrhea, which often is bloody.

For Physicians

Shigellosis: Clinical Differentials, Workup, Treatment, Medication, Followup (eMedicine)
http://www.emedicine.com/med/topic2112.htm

Shigellosis Case Investigation - State Form #49694 (R2/1-05) (Indiana State Department of Health )

http://www.in.gov/isdh/files/49694_Shigellosis.pdf (180kb, 5 pages)

Diagnosis and management of foodborne illnesses: A primer for physicians and other health care professionals, 2nd Edition February 2004
http://www.ama-assn.org/ama/pub/category/3629.html (fulltext pdf files)

For The Public
Factsheet, Preventing the Spread in Childcare Settings, Flyers in English and Spanish (Marion County Health Department)
http://www.mchd.com/shigella_prevention.htm

Shigella: Information for Parents (FamilyDoctor.org, American Academy of Family Physicians)
http://www.kidshealth.org/PageManager.jsp?dn=familydoctor&lic=44&cat_id=20028&article_set=23014&ps=104

Shigellosis (CDC)
http://www.cdc.gov/nczved/dfbmd/disease_listing/shigellosis_gi.html

For Physicians
Centers for Disease Control and Prevention in collaboration with the American Medical Association et. al. Diagnosis and Management of Foodborne Ilnesses, 2004
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm

Centers for Disease Control and Prevention, Investigation of Outbreak of Infections Caused by Salmonella Saintpaul
http://www.cdc.gov/salmonella/saintpaul/

Indiana State Department of Health Case Investigation Form
http://www.in.gov/isdh/files/49693_Salmonellosis.pdf

Centers for Disease Control and Prevention, Reporting a Foodborne Illness-Healthcare Professionals
http://www.cdc.gov/foodborneoutbreaks/reporting_professionals.htm

eMedicine Salmonella Infection
http://www.emedicine.com/PED/topic2033.htm

For Patients
Centers for Disease Control and Prevention, Advice to Consumers
http://www.cdc.gov/salmonella/saintpaul/#advice

MEDLINEPlus, Salmonella Infections
http://www.nlm.nih.gov/medlineplus/salmonellainfections.html

For Physicians

CDC Factsheet West Nile Virus (WNV) Infection:  Information for Clinicians
http://www.cdc.gov/ncidod/dvbid/westnile/resources/fact_sheet_clinician.htm

CDC Statistics, Surveillance and Control (includes guidelines and case definition)
http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm

Indiana State Department of Health, Mosquito-borne Encephalitis Case Investigation Form (PDF file, 138KB)
http://www.in.gov/isdh/files/51382.pdf

Indiana State Department of Health, West Nile Virus Information of Health Professionals
http://www.in.gov/isdh/23594.htm

eMedicine West Nile Virus
http://www.emedicine.com/pmr/TOPIC236.HTM

eMedicine West Nile Encephalitis
http://www.emedicine.com/med/topic3160.htm

For Patients

MEDLINEPlus, National Library of Medicine, West Nile Virus
http://www.nlm.nih.gov/medlineplus/westnilevirus.html

Links for Physicians
http://www.bt.cdc.gov/disasters/hurricanes/pdf/dguidelines.pdf
Guidelines for the Management of Acute Diarrhea

http://www.atsdr.cdc.gov/publications/100233-RelocationStress.pdf
Helping Families Deal With the Stress of Relocation After a Disaster

http://www.aafp.org/afp/20070315/841.html
Disaster-Related Physical and Mental Health: A Role for the Family Physician

Links for the Public
http://www.bt.cdc.gov/disasters/floods/cleanupwater.asp
After a Hurricane or Flood: Cleanup of Flood Water

http://www.bt.cdc.gov/disasters/foodwater/facts.asp
Keep Food and Water Safe After a Disaster or Power Outage

http://www.bt.cdc.gov/disasters/wellsdisinfect.asp
Disinfecting Wells Following an Emergency

http://www.bt.cdc.gov/disasters/floods/after.asp
After a Flood

http://www.epa.gov/safewater/privatewells/whatdo.html
Private Drinking Water Wells: What to Do After a Flood

http://www.bt.cdc.gov/disasters/mold/protect.asp
Protect Yourself from Mold

http://www.bt.cdc.gov/disasters/floods/sanitation.asp
Sanitation and Hygiene

http://www.bt.cdc.gov/disasters/handhygienefacts.asp
Clean Hands Save Lives: Emergency Situations

http://www.bt.cdc.gov/disasters/animalhazards/facts.asp
Protect Yourself from Animal- and Insect-Related Hazards After a Disaster

http://www.bt.cdc.gov/disasters/electrical.asp
How to Protect Yourself and Others from Electrical Hazards Following a Natural Disaster

http://www.bt.cdc.gov/disasters/cofacts.asp
Preventing Carbon Monoxide Poisoning After an Emergency

Links For Physicians

Click Here for Links for the Public
Click Here for the Marion County Health Department Syphilis Links

Treatment
Treatment Guidelines for Sexually Transmitted Diseases (Center for Disease Control)
http://www.cdc.gov/std/treatment/

Syphilis (eMedicine)
http://www.emedicine.com/med/topic2224.htm (Adult)
http://www.medicine.com/ped/topic2193.htm (Pediatrics)

Confidential Report of Communicable Disease Form (Indiana State Department of Health)
http://www.in.gov/isdh/programs/hivstd/forms/Forms.htm

Where to Fax STD Morbidity Reports (Indiana State Department of Health)
http://www.in.gov/isdh/programs/hivstd/std/STD%20DIS%20map-fax%20numbers.pdf

Special Populations
Press Release 3/12/08: New Data Reveal 7th Consecutive Syphilis Increase in the U.S. and Opportunities to Improve STD Screening and Prevention for Gay and Bisexual Men (Centers for Disease Control and Prevention)
http:/www.cdc.gov/stdconference/2008/media/release-12march2008.htm

Syphilis and HIV from the HIV InSite Knowledge Base
(University of California San Francisco and San Francisco General Hospital)
http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-05-01-04 (last updated June 2006)

Syphilis from the Clinical Manual for Management of the HIV-Infected Adult (AIDS Training and Education Centers)
http://www.aidsetc.org/aidsetc?page=cm-531_syphilisSee Section 6: Disease-Specific Treatment

For the Public
Syphilis (MedlinePlus, National Library of Medicine)
http://www.nlm.nih.gov/medlineplus/syphillis.html

INHealthConnect (Database of health services in Indiana)
http://apps.nlm.nih.gov/medlineplus/local/indiana/list_location.cfm?areaid=13&service_type=topic&invokedby=services&service_id=400&ntopic_id=3017

Syphilis CDC Fact Sheet (Centers for Disease Control and Prevention)
http://www.cdc.gov/std/syphillis/STDFact-Syphilis.htm”

Syphilis and MSM (Men Who have Sex with Men) CDC Fact Sheet (Centers for Disease Control and Prevention)
http://www.cdc.gov/std/syphilis/STDFact-MSM&Syphilis.htm