HEALTH

CDC updates proposed treatment course for swine flu

BY Michael Johnsen

ATLANTA The Centers for Disease Control and Prevention on Tuesday updated its proposed treatment course for any patient expected of having been exposed to the swine flu.

Either Tamiflu (oseltamivir) or Relenza (zanamivir) are recommended for up to 10 days after the last known exposure to a confirmed case of swine influenza A (H1N1) virus infection.

For pre-exposure protection, antivirals should be given during the potential exposure period and continued for 10 days after the last known exposure to a confirmed case of swine influenza A (H1N1) virus infection.

Antiviral used as a preventitive (pre-exposure or post-exposure) with either oseltamivir or zanamivir is recommended for the following individuals:

  • 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, probable or suspected case;
  • School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable or suspected case;
  • Travelers to Mexico 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);
  • Healthcare 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 influenza A (H1N1) virus infection during the case’s infectious period.

Pre-exposure antiviral used as a preventatitive with either oseltamivir or zanamivir can be considered for the following:

  • Any health care worker who is 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) who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute feverish respiratory illness;
  • Non-high risk persons who are travelers to Mexico, first responders or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

Children under one year of age are at high risk for complications from seasonal human influenza virus infections. The characteristics of human infections with swine H1N1 viruses are still being studied, and it is not known whether infants are at higher risk for complications associated with swine H1N1 infection compared to older children and adults. Limited safety data on the use of oseltamivir (or zanamivir) are available from children less than one year of age, and oseltamivir is not licensed for use in children less than 1 year of age. Available data come from use of oseltamivir for treatment of seasonal influenza. These data suggest that severe adverse events are rare, and the Infectious Diseases Society of America recently noted, with regard to use of oseltamivir in children young than one-year-old with seasonal influenza, that “…limited retrospective data on the safety and efficacy of oseltamivir in this young age group have not demonstrated age-specific drug-attributable toxicities to date.”

Because infants typically have high rates of morbidity and mortality from influenza, infants with swine influenza A (H1N1) influenza infections may benefit from treatment using oseltamivir.

Healthcare providers should be aware of the lack of data on safety and dosing when considering oseltamivir use in a seriously ill young infant with confirmed swine H1N1 influenza or who has been exposed to a confirmed swine H1N1 case, and carefully monitor infants for adverse events when oseltamivir is used.

Oseltamivir and zanamivir are “Pregnancy Category C” medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers’ package inserts should be consulted. However, no adverse effects have been reported among women who received oseltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir, Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because zanamivir is an inhaled medication and has less systemic absorption, some experts prefer zanamivir over oseltamivir for use in pregnant women when feasible.

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CDC issues swine flu advisory alert as additional cases are reported

BY Michael Johnsen

ATLANTA The Centers for Disease Control and Prevention issued a health advisory alert over the weekend concerning the recent outbreak of swine flu, which in addition to confirmed cases in southern California and Texas has been found in Kansas, New York and Ohio, and south of the U.S. border in Mexico.

As of Sunday at 9 a.m., the CDC confirmed 20 swine flu cases — seven in California, two in Kansas, eight in New York City, one in Ohio and two in Texas.

To date, confirmed swine flu cases in the United States have been relatively mild, causing one hospitalization. Swine flu cases in Mexico have been more severe, resulting in 59 deaths so far.

New York Governor David Paterson on Saturday directed the New York State Department of Health to activate its infectious disease, epidemiology, laboratory, disaster preparedness and health systems staff to coordinate efforts across the state, as eight cases of probable swine influenza were identified in New York City earlier in the day.

“I want to reassure all New Yorkers that we are taking appropriate measures to address these probable cases of swine flu,” Paterson said. “The New York State Department of Health is working closely with the CDC, the New York City Department of Health and Mental Hygiene, all local health departments across the State, hospitals, physicians, and other health care providers. [Earlier today], we shipped 1,500 treatment courses of Tamiflu to New York City. These will be used to treat any severely ill probable swine flu cases or household contacts of probable cases who have underlying chronic health conditions, placing them at extra risk.”

Complicating matters is the human influenza virus. While the 2008/2009 season has been winding down, for the week ending April 18 the CDC reported that New York is still measuring outbreaks of human influenza in more than two but less than half of the state’s regions. In California, human influenza is only prevalent in one region and Kansas has reported sporadic activity — small numbers of laboratory-confirmed influenza cases or a single laboratory-confirmed influenza outbreak has been reported, but there is no increase in cases of influenza-like illnesses.

It is not anticipated that the seasonal influenza vaccine distributed for the 2008/2009 flu season will provide protection against the swine flu H1N1 viruses, the CDC stated.

In addition to the CDC, the outbreak is also being tracked by the World Health Organization. WHO on Saturday suggested that the swine flu has the potential of becoming a global pandemic, though it is too early to tell. “WHO … is currently monitoring and assessing the evolution of the events in Mexico and in the United States related to the spread of swine influenza A/H1N1 virus,” the international health agency released in a statement Saturday. “The viruses so far characterized have been sensitive to [Tamiflu] oseltamivir, but resistant to both [older flu medicines] amantadine and rimantadine. … The rapid evolution of the events in Mexico and in the United States calls for a heightened degree of awareness and vigilance of both clinicians and public health professionals to ensure the early detection and management of possibly related events in countries other than Mexico and the United States.”

Persons with a temperature above 100 F accompanied with a severe cough or shortness of breath are being advised to stay home from work or school to avoid spreading the infection. In addition, frequent hand washing can lessen the spread of respiratory illness, the CDC noted.

As of April 25, CDC has confirmed 11 human cases of swine flu in the United States: seven in California, two in Texas and two in Kansas. CDC continues to investigate other suspected cases. Investigations are ongoing to determine the source of the infection and whether additional people have been infected with similar swine influenza viruses.

Illness onsets occurred between March 28 and April 14 for the majority of cases, affecting patients between the ages of 7 and 54.

The specific genetic makeup of the swine viruses has not been reported previously among swine or human influenza viruses in the U.S. or elsewhere, the CDC noted.Swine flu is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. These viruses do not normally infect humans, however, human infections with swine flu do occur.

Mexico has reported three separate events. In the Federal District of Mexico, surveillance began picking up cases of influenza-like illness beginning March 18. The number of cases has risen steadily through April and as of April 23 there are more than 854 cases of pneumonia from the capital. Of those, 59 have died. In San Luis Potosi, in central Mexico, 24 cases of influenza-like illnesses, with three deaths, have been reported. And from Mexicali, near the border with the United States, four cases of ILI, with no deaths, have been reported.

CDC has not recommended that people avoid travel to affected areas at this time.

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Study: UTIs more frequent in women with increased sexual activity, alcohol consumption

BY Michael Johnsen

LINTHICUM, Md. Increased sexual activity and alcohol consumption were associated with an increased risk of developing urinary tract infections, according to new research presented at the 104th Annual Scientific Meeting of the American Urological Association on Sunday.

From July 2001 through April 2005, researchers studied 181 women with their first UTI who presented to the student health care facility at the University of Florida. The control group consisted of 80 women attending the clinic without a UTI. A clinic nurse administered a survey that addressed lifestyle habits and dietary intake. Results showed that frequency and urgency were the most common symptom, and that UTIs were most commonly found in women who had increased sexual activity and recent alcohol consumption. The use of sanitary napkins during menstruation also increased the risk for a first-time UTI.

Co-existing chlamydia, gonorrhea and yeast infections did not contribute significantly to urinary symptoms.

“If you are experiencing urinary frequency and urgency, you should seek medical attention,” stated Anthony Smith, an AUA spokesman. “A woman experiencing her first UTI might not recognize these symptoms immediately. But, medical attention is necessary because UTIs can lead to kidney infection and even sepsis. So, it is important for women who notice these symptoms to seek medical attention.”

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