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Clinician guidance on flu

AMA Top Doc Provides Sage Guidance on Flu to Physicians

(This column appears in evoice, the AMA's e-newsletter for physicians.)

A National Response to an International Outbreak
by Nancy Nielsen, M.D.
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President, American Medical Association

It's been only two weeks since I wrote a column about the importance of focusing on public health. Now we are confronted with a real-life opportunity to test our partnership with our public health colleagues.

I'm talking, of course, about the swine flu outbreak in Mexico, the United States and abroad. While right now the appropriate stance is "alert" rather than "alarm," let's examine the role of practicing physicians, and our AMA, in this circumstance of a new influenza virus that seems more virulent in young adults and against which we don't have immunity.

Each of us needs to be vigilant when seeing patients with acute respiratory symptoms. Although the clinical illness caused by this swine flu virus has been mild in the U.S., it has not been mild in Mexico, as you know from news reports. In case you are confronted with a patient with possible influenza (recognizing that the "usual" seasonal influenza season is over), here are some important considerations.

Take a travel history from anyone with significant acute respiratory illness. Take appropriate precautions yourself, wearing an N95 respirator or a surgical mask/gown/gloves. Do a nasopharyngeal swab, put it in viral transport media and send to the appropriate clinical lab at your hospital. Dispose of gown, gloves and goggles in a biohazard bag. Pay strict attention to hand washing with soap/water or hand sanitizer.

Note that public health budgets are stretched, so don't do swabs for viral isolation on folks who seem to have the common cold!

The lab will do a real-time RT-PCR assay for influenza A. If the sample is A but is H1 and H3 negative, this will be considered "probably" H1N1 swine influenza and will be handled by a reference laboratory with biosafety precautions.

This is a new H1N1 swine influenza virus that has been identified. People who received flu vaccine this year are not protected. Antivirals zanamivir or oseltamivir are effective against this virus, but should not be used prophylactically except in very narrow, specific instances (see the Centers for Disease Control and Prevention Web site for details of treatment).

Each of us has an important role to play: educator, vigilant clinician and responsible public health partner. There is no need for alarm, just be cautious and remember to take the travel history. Stay tuned, as the situation is evolving daily. And if you're on your way to Mexico for a vacation, check out the State Department Web site before you go.
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