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COMMUNICABLE DISEASE MANUAL POLICIES / PROCEDURES
INFLUENZA SEASONAL &
NOVEL INFLUENZA
OBJECTIVE:
Control and management of Influenza.
DESCRIPTION:
Influenza is an illness affecting the respiratory tract. Infections can result in
severe complications. The incubation period for influenza is usually two (2)
days, but can vary from one (1) to four (4) days after exposure. Symptoms
include fever (often high), fatigue, headache, muscle pain, cough, runny nose,
chills and sore throat. The illness can last several days. Influenza is spread via
respiratory droplet infection.
Systemic symptoms and temperature usually last from two (2) to three (3) days,
rarely more than five (5) days. They may be decreased by such medications as
aspirin or acetaminophen. Aspirin should not be used for infants, children,
or teenagers, because they may be at risk for contracting Reye’s Syndrome
following an influenza infection. Recovery is usually rapid, but some may have
lingering depression and asthenia (lack of strength or energy) for several weeks.
The most frequent complication of influenza is pneumonia, most commonly
secondary bacterial pneumonia (e.g. Streptococcus pneumoniae,
Haemophilus influenzae, or staphylococcus aureus). Primary Influenza viral
pneumonia is an uncommon complication with a high fatality rate. Reye’s
Syndrome is a complication that occurs almost exclusively in children taking
aspirin, primarily in association with Influenza B (or varicella zoster), and
presents with severe vomiting and confusion which may progress to coma, due
to swelling of the brain.
Other complications include myocarditis (inflammation of the heart), and
worsening of chronic bronchitis and other chronic pulmonary diseases.
Death is reported in 0.5-1 per 1000 cases. The majority of deaths occur in
persons > 65 years of age.
The risk for complications and hospitalizations from influenza are higher among
persons 65 and older, young children, and persons of any age with certain
medical conditions.
Influenza A causes moderate to severe illness, and affects all age groups. The
virus infects humans and other animals, such as pigs and birds. Influenza B
generally causes milder disease than type A, and primarily affects children. It
affects only humans. Influenza C is rarely reported as a cause of human illness,
probably because most cases are subclinical. It has not been associated with
epidemic disease.
EQUIPMENT:
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Michigan Disease Surveillance System (MDSS) User Manual (disease specific
forms [Influenza-Seasonal and Novel Influenza] will be found in MDSS. The
CDC Influenza-Associated Pediatric Deaths Case Report Form and MDCH policy
is located in the Addendum section at the end of this policy. FAX “Notification
of Serious Communicable Disease” to Michigan Department of Community
Health (MDCH) if confirmed or suspected Novel Influenza case or Pediatric
death.
Also
MDCH
Web
site
at
www.michigan.gov/mdch,
www.michigan.gov/cdinfo and Centers for Disease Control (CDC) Web site
at www.cdc.gov/diseasesconditions/az/a.html.
POLICY:
Legal Responsibility: Michigan's communicable disease rules of Act No. 368 of
the Public Acts of 1978, as amended, being 333.5111 of the Michigan Compiled
Laws. Follow-up time is within 24 hours of receiving referral. If suspected or
confirmed Novel influenza or outbreak, notify MDCH by fax and CD Supervisor
who will notify Medical Director, Health Officer and HD Emergency Manager. In
absence of CD Supervisor, follow above established chain of command.
PROCEDURE:
A.
Case Investigation

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Influenza (Seasonal)
1.
For reporting seasonal influenza (replacing the individual
Flu-Like Disease form).
2.
Referrals received per phone call, laboratory results, or
automatically through MDSS.
3.
Document all case investigation proceedings.
4.
Contact MD and/or client to start process of completing
disease specific form in MDSS within 24 hours of receipt
of referral unless instructed to do differently by MDCH or
CDC.
5.
Purpose is to identify those influenza cases that are
unusual in their timing, scope or severity (see description
at top of form). This form is used in reporting of: a.) all
influenza cases during May-September; b.) facility
outbreak cases; c.) unusual or severe cases; d.) all
influenza cases October-April.
6.
Not to be used for Novel influenza strains (avian,
pandemic or new human strains). Please use the Novel
Influenza MDSS case form.
7.
PDF form with first page similar to other MDSS forms.
8.
All information fields should be filled out as
completely as possible (except for optional contact
information form on Page 4).
9.
While MDCH is most interested in those types of cases
listed at the top of the form, Local Health Departments
(LHD’s) may also utilize this form to track all of their
seasonal influenza cases from October-April, OR, add to
weekly aggregate flu-like disease counts in MDSS.
10.
As of December 14, 2006, the individual case report form
for Flu-Like Disease SHOULD NOT BE USED. Cases
with some sort of lab confirmation (culture, smear, rapid
test, etc.) should now be reported as INFLUENZA. If a lab
or health care provider enters a case into MDSS as FluLike Disease, the reportable condition will need to be
changed to INFLUENZA before completing the case
investigation.
11.
Reporting of typical Seasonal Influenza lab confirmed
cases from October-April required fields in MDSS are:
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12.
13.
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Part of an outbreak: Yes No Unknown
Investigation status: Active
Case status: Confirmed
Patient status: Inpatient/Outpatient
Patient status: Date of entry
Diagnosis date: Date of lab result
First name
Last name
NOTE: In the middle initial field, enter Influenza
type “A” or “B”.
Address, zip code, date of birth, sex, race/ethnicity
NOTE: Parent’s name is required if case is less
than 18 years of age. If parent’s first and last
name is unavailable, type “Unknown/Unknown”
or type the word “p-a-r-e-n-t/and the child’s last
name” in place of parent’s actual first/last
name.
Laboratory name
Town of laboratory
Doctor’s first and last name
Submitted by Date, Health Department, and Phone
Number of nurse.
Comments Section; No Further Follow-up Needed
as Individual Count only.
The status of the case investigation needs to be “Active”
once completed for the Administrator to know to change
status to “Complete”.
These cases are not tallied on the MDSS Aggregate Case
Report as this would be double counting, but are reported
on the Monthly Communicable Disease Report.
MDCH should be immediately notified of any possible
influenza-associated pediatric deaths in patients less
than 18 years of age. The CDC-specific form that must
be completed for these cases is located in the
Addendum at the end of this policy along with the
MDCH policy. Also, complete the Influenza form on
MDSS.
Please fax the “Notification of Serious
Communicable Disease” to MDCH and call at (517)335-8165.
Novel Influenza
B.
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1.
For reporting all human cases of avian influenza or a new
human influenza strain (replacing the use of the Unusual
Outbreak form for these cases).
2.
Referrals received per phone call, laboratory results, or
automatically through MDSS.
3.
Document all case investigation proceedings.
4.
Contact MD and/or client to start process of completing
disease specific form in MDSS within 24 hours of receipt
of referral, unless instructed to do differently by MDCH or
CDC.
5.
This form will be used to report initial cases in the event of
an influenza pandemic; after a certain number of cases,
MDCH will inform you to switch to aggregate counts.
6.
All data fields should be completely filled out,
including the contact form. This information will be
critical to an investigation.
7.
Any suspected and/or confirmed cases of any type of
Novel influenza virus should be reported immediately to
the MDCH Communicable Disease Division at (517)-3358165, or after-hours at (517)-335-9030.
Also, FAX
“Notification of Serious Communicable Disease” form
to MDCH at (517)-335-8263.
See “Pandemic Flu”,
Policy/Procedure
#7402
and
“Avian
Influenza”,
Policy/Procedure #7406.
8.
MDCH should be immediately notified of any possible
influenza-associated pediatric deaths in patients less
than 18 years old. The CDC-specific form that must be
completed for these cases is located in the Addendum
at the end of this policy along with the MDCH policy.
Also, complete the Novel Influenza form on MDSS.
Please fax the “Notification of Serious Communicable
Disease” to MDCH and call at (517)-335-8165.
Lab Diagnosis
1.
MDCH is very interested in cases that are off-season, i.e. MaySeptember, as well as the first cases from each region or
jurisdiction in the fall. Please try to report these cases and
obtain clinical samples to be sent to the MDCH lab for viral
culture confirmation.
2.
Many healthcare providers are now using rapid influenza tests,
which can test for Influenza A and/or B antibodies. However,
these tests have a low positive predictive value when influenza is
not circulating in the community. This means that there are many
false positives in the summer and early fall, yet many clinicians
appear to be basing their diagnoses on these tests. If you come
across a case that has tested positive via a rapid test, and
influenza is not being reported in your community, please consider
immediately contacting the referrer to pursue culture confirmation.
Samples from rapid tests are often immediately discarded, so time
is of the essence.
C.
3.
Encourage healthcare providers and clinical labs in your
jurisdiction to refrigerate and/or freeze samples after their testing
is completed (see #4 below for more details).
4.
Samples being sent to the MDCH lab for viral culture must be
refrigerated and shipped on cold packs within 48 hours of
collection. Over weekends and holidays, samples can be shipped
after 48 hours of collection if they have been stored in a -70ºF
freezer and shipped on dry ice. If shipping on dry ice, the
package is considered dangerous goods, and there will be
additional shipping requirements.
5.
Be prepared to order influenza test kits from the MDCH lab at the
first indication of an outbreak.
6.
Please contact the MDCH Communicable Disease Division at
(517)-335-8165 if you have any questions regarding reporting or
case investigations. For information regarding influenza test kits,
shipping or laboratory testing, please contact the MDCH
laboratory at (517)-335-8063.
Control Measures
Part I
1.
2.
Educate the public and health care personnel in basic personal
hygiene, especially transmission via unprotected coughs and
sneezes, and from hand to mucous membrane.
The Flu Fact Sheet on Prevention of Flu and What to Do If You
Become Sick are located in the Addendum section at the end of
this policy.
Part II
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1.
Vaccinate with Influenza Vaccine: There are two (2) types –
inactivated (killed) vaccine given by injection and (live) Flu-Mist
which is sprayed into the nostrils. Influenza season usually peaks
in February, but it can peak any time from November through
May, so getting a shot anytime from October through January can
be beneficial.
2.
Population needing flu vaccine:
a.
People 65 years of age and older.
b.
Residents of long term care facilities.
c.
People with long term health problems of heart disease,
lung disease, kidney disease, asthma, diabetes, anemia,
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
3.
D.
E.
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blood disorders, muscle or nerve disorders (seizure
disorders or cerebral palsy).
People with weakened immune system, i.e. HIV/AIDS,
long term treatment with steroids or cancer treatment with
x-ray or drugs.
People 6 months to 18 years of age on long term aspirin
treatment.
Women who will be pregnant during flu season.
All children 6-59 months of age.
Household contacts and out of home caretakers of
children.
Healthcare workers
People providing essential community service.
People living in dormitories or crowded conditions.
People 50 years of age or older.
Anyone wanting to reduce their chance of getting influenza
age 6 months and older.
Most people need one flu shot each year. Children younger than
nine (9) years of age getting influenza vaccine for the first time
should get two (2) doses, given at least one (1) month apart.
References
1.
Michigan Communicable Disease Rules
2.
Current Red Book
3.
Current Control of Communicable Disease Manual
Addendums
1.
Algorithm for LHD reporting of Influenza – 10/07 MDCH
2.
3.
Influenza outbreaks – suggested information to collect – 10/07
MDCH
Routine Influenza Algorithm – MDCH Clinical Labs
4.
Novel/Avian Influenza Algorithm – MDCH Clinical Labs
5.
Case Detection and Clinical Management during the
Interpandemic and Pandemic Alert Periods.
6.
MDSS Policy: Influenza-Associated Pediatric Mortality.
7.
02-01-08 – Request by CDC for Bacterial Isolates from InfluenzaAssociated Pediatric Deaths with Staphylococcus aureus coinfection with Health Alert Network (HAN) Alert 01-20-08.
8.
Guidance for Medical Examiners and Pathologists regarding
Influenza-Related pediatric mortality.
9.
CDC: Influenza-Associated Pediatric Deaths Case Report Form
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10.
MDCH Influenza Outbreak Guidelines for Long-Term Care
Facilities – 10/2007
11.
“Key Facts About The Flu” Fact Sheets