Novel influenza a testing guidance revised june 30

June 30, 2009

Updated Testing Guidance For 2009 Novel H1N1 Influenza A In Florida.
Richard S. Hopkins, MD, MSPH, Acting State Epidemiologist
Max Salfinger, MD, PhD, Chief, Bureau of Laboratories
Florida Department of Health

This document supersedes the testing portions of an earlier Florida DOH document: “Enhanced Influenza
Surveillance and Testing for Hospitals and Clinicians for Swine-Origin Influenza A (H1N1)” Version 5,
dated May 7, 2009. That document will be revised soon to include these changes.
What’s new: Starting July 13, the Bureau of Laboratories will only test for the novel
2009 H1N1 virus specimens from:

Patients with life-threatening illnesses,
Patients from county health departments investigating suspected influenza
outbreaks, and
Patients from the Florida network of sentinel surveillance practices.
Thank you for helping us implement this refined testing guidance.

As of today, there have been at least 1200 persons reported in Florida with lab-confirmed novel
2009 influenza A H1N1 infection. Ninety percent of positive influenza tests in the state public
health laboratory in recent weeks have been positive for this new virus, rather than the seasonal
influenza viruses that were circulating last winter and spring.
A specific virologic diagnosis of infection with the new virus is not currently needed for
clinical or public health purposes for most people with influenza-like illness
. Almost all
people with influenza are infected with the new virus, which is susceptible to both oseltamivir
and zanamivir (Tamiflu and Relenza). Decisions regarding infection control and personal
protective equipment for patients with illness suggesting influenza do not require and should not
wait for specific novel H1N1 virologic diagnosis.
RT-PCR testing to detect the novel H1N1 virus is now also available through at least one
commercial laboratory (Quest), and others may soon offer the service.
It remains important for public health purposes to know the specific virologic diagnosis on
people who have life-threatening illness with influenza – for example, those admitted to an ICU.
For this purpose, the Bureau of Laboratories will continue to offer RT-PCR diagnostic testing to
assure that no barriers are placed in the way of such diagnoses.
We will phase out use of the state’s public health laboratories for purposes other than sentinel
surveillance, testing of patients with life-threatening illness, and outbreak investigation as of July
13, 2009.
Testing recommendations: The following people should be tested for novel H1N1 infection
through the Florida Bureau of Laboratories:
People admitted to hospital with life-threatening illness suggesting influenza People who appear to be part of outbreaks of influenza, especially in certain group settings – please see below for further information. A sample of people presenting with influenza-like illness at specific practices participating in the Sentinel Practice Influenza Surveillance System. Others should not be tested through the Florida Bureau of Laboratories.
Call your county health department (CHD) to report people hospitalized with strongly
suspected or confirmed life-threatening H1N1 infection, to report possible influenza outbreaks,
and to get advice on testing and management of cases and contacts. The CHD will advise on
whether or not specific tests are needed on patients who appear to be part of an outbreak.
An influenza-like illness outbreak is defined as three or more people who are connected
through a group setting (see below for further details), are ill with symptoms suggesting
influenza, and are not part of a household cluster.
You can tell if a person is part of such an outbreak by asking the person if they have recently
had face to face or close social contact with other people with similar symptoms who share a
similar social environment such as a school, workplace, summer camp, or church.
Some settings of concern for outbreaks:
For adults: • Healthcare setting, either inpatient or ambulatory (patient or staff) • Children’s camp or recreation program • Jail, detention, or correctional facility (as inmate or worker) • Adult congregate living facility (resident or worker) Not every apparent case in an outbreak needs to be tested – two or three confirmed positive results are enough.


June 2009 5-29-09.pmd

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