ZymeTx Inc. (fka ZMTX)

[Bull Trader]

Pennsylvania Department of Health Health Alert Network 2006
http://www.dsf.health.state.pa.us/health/cwp/view.asp?A=171&Q=246228&pp=12&n=1

HEALTH ADVISORY #0019
Influenza Activity in Pennsylvania

DATE: November 9, 2006
TO: Health Alert Network
FROM:Calvin B. Johnson, M.D., M.P.H. Secretary of Health
COUNTIES AFFECTED:Statewide


This transmission is a "Health Advisory," provides important information for a specific incident or situation; may not require immediate action.

HOSPITALS: PLEASE SHARE WITH ALL MEDICAL, PEDIATRIC, INFECTION CONTROL,
NURSING, AND LABORATORY STAFF IN YOUR HOSPITAL

FQHCs: PLEASE DISTRIBUTE AS APPROPRIATE

LOCAL HEALTH JURISDICTIONS: PLEASE DISTRIBUTE TO ALL PRIMARY CARE PHYSICIANS IN YOUR JURISDICTION AND AS APPROPRIATE

PROFESSIONAL ORGANIZATIONS: PLEASE DISTRIBUTE TO YOUR MEMBERSHIP

Positive influenza test identified:

The Pennsylvania Department of Health released the following statement on November 9, 2006 regarding influenza activity throughout the Commonwealth of Pennsylvania.



On November 9, 2006, a case of influenza B was confirmed by the Department of Health Bureau of Laboratories (BOL). This is the first influenza case in Pennsylvania confirmed by BOL in the 2006-07 influenza season. The specimen was collected on October 30, 2006 from a 20 month old resident of Philadelphia. Further subtyping of the influenza isolate is in progress.



Influenza vaccines:

This flu season, two influenza vaccines are available, an injected inactivated vaccine and a nasal-spray attenuated vaccine. Vaccine information statements (VIS) are available at http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf and http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf. Recommendations for use of the inactivated and attenuated vaccines differ; these recommendations can be found at http://www.cdc.gov/flu/professionals/vaccination/recommendations.htm.

Both the inactivated and live, attenuated vaccines prepared for the 2006--07 season will include A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens (for the A/Wisconsin/67/2005 [H3N2]-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus, and for the B/ Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus). These viruses will be used because they are representative of influenza viruses that are anticipated to circulate in the United States during the 2006--07 influenza season and have favorable growth properties in eggs. Because circulating influenza A (H1N2) viruses are reassortants of influenza A (H1N1) and A (H3N2) viruses, antibodies directed against influenza A (H1N1) and influenza (H3N2) vaccine strains should provide protection against the circulating influenza A (H1N2) viruses. Influenza viruses for both TIV and LAIV are initially grown in embryonated hens eggs, and, therefore, might contain limited amounts of residual egg protein. Therefore, persons with a history of severe hypersensitivity, such as anaphylaxis, to eggs should not receive influenza vaccine.



Influenza vaccine:

CDC, in coordination with its Advisory Committee for Immunization Practices (ACIP), has issued recommendations for influenza vaccination during the 2006–07 season. These recommendations can be found in Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP), (July 28, 2006 / 55(RR10);1-42) (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5510a1.htm).



For the 2006-2007 season, influenza vaccination is recommended for the following groups:

Persons at high risk for influenza-related complications and severe disease, including
---children aged 6--59 months,
---pregnant women,
---persons aged >50 years,
---persons of any age with certain chronic medical conditions; and
Persons who live with or care for persons at high risk, including
---household contacts who have frequent contact with persons at high risk and who can transmit influenza to those persons at high risk and
---health-care workers.


Additional Clinical management:

Consider also providing pneumococcal vaccine to those patients who may need them.

Communicate to your patients with influenza-like illness that any significant deterioration in their condition should prompt them to seek medical attention urgently;

Consider obtaining an influenza culture on any patient with influenza-like illness with unexpectedly severe signs or symptoms;

Since the vast majority of patients with influenza do not have respiratory samples taken for culture, it should be understood that influenza infections are much more common than the number of positive cultures indicate.

US Influenza Sentinel Provider Surveillance Network:

There are 65 Pennsylvania physicians/practices from across the state who have signed up to participate in the Influenza Sentinel Provider Surveillance Network program in the 2006-2007 season. The reporting period started October 1, 2006 and will continue until May 19, 2007. Influenza-like illness is defined by the CDC as a fever of 100 degrees F (37.8 C) AND cough or sore throat (in the absence of a known cause other than influenza).

Please consider joining the Influenza Sentinel Provider Network. Details regarding participation in the network can be obtained from:

Marjorie Ebenezer, MD, MPH

Influenza Sentinel Provider Surveillance Coordinator

PA Department of Health

Harrisburg, PA 17108

717-787-3350 (phone)

[e-mail]


--------------------------------------------------------------------------------

The text below is taken from Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (MMWR 2006 Jul 28;55(RR10):1-42).

--------------------------------------------------------------------------------

Influenza Diagnostic Table
Procedure
Influenza Types Detected
Acceptable Specimens
Time for Results
Rapid result available

Viral culture
A and B
NP swab2, throat swab, nasal wash, bronchial wash, nasal aspirate, sputum
3-10
days 3
No

Immunofluorescence DFA Antibody Staining
A and B
NP swab2, nasal wash, bronchial wash, nasal aspirate, sputum
2-4 hours
No

RT-PCR5
A and B
NP swab2, throat swab, nasal wash, bronchial wash, nasal aspirate, sputum
1-2 days
No

Serology
A and B
paired acute and convalescent serum samples6
>2 weeks
No

Enzyme Immuno Assay
(EIA)
A and B
NP swab2 , throat swab, nasal wash, bronchial wash
2 hours
No

Rapid Diagnostic Tests

Directigen Flu A7
(Becton-Dickinson)
A
NP wash and aspirate
<30 minutes
Yes

Directigen Flu A+B7,9
(Becton-Dickinson)
A and B
NP swab2,aspirate, wash; lower nasal swab; throat swab; bronchioalveolar lavage
<30 minutes
Yes

Directigen EZ Flu A+B7,9
(Becton-Dickinson)
A and B
NP swab2, aspirate, wash; lower nasal swab; throat swab; bronchioalveolar lavage
<30 minutes
Yes

FLU OIA4,7
(Biostar)
A and B
NP swab2 , throat swab, nasal aspirate, sputum
<30 minutes
Yes

FLU OIA A/B 7, 9
(Biostar)
A and B
NP swab2 , throat swab, nasal aspirate, sputum
<30 minutes
Yes

XPECT Flu A&B7,9
(Remel)
A and B
Nasal wash, NP swab2, throat swab
<30 minutes
Yes

NOW Influenza A8,9
(Binax)
A
Nasal wash/aspirate, NP swab2
<30 minutes
Yes

NOW Influenza B8,9
(Binax)
B
Nasal wash/aspirate, NP swab2
<30 minutes
Yes

NOW Influenza A&B8,9
(Binax)
A and B
Nasal wash/aspirate, NP swab2
<30 minutes
Yes

OSOM® Influenza A&B9
(Genzyme)
A and B
Nasal swab
< 30 minutes
Yes

QuickVue Influenza Test4,8
(Quidel)
A and B
NP swab2, nasal wash,
nasal aspirate
<30 minutes
Yes

QuickVue Influenza A+B Test8,9
(Quidel)
A and B
NP swab2, nasal wash,
nasal aspirate
<30 minutes
Yes

SAS Influenza A Test7,8,9
A
NP wash2, NP aspirate2
<30 minutes
Yes

SAS Influenza B Test7,8,9
B
NP wash2, NP aspirate2
<30 minutes
Yes

ZstatFlu4,8
(ZymeTx)
A and B
throat swab
<30 minutes
Yes

List may not include all test kits approved by the U.S. Food and Drug Administration
NP = nasopharyngeal
Shell vial culture, if available, may reduce time for results to 2 days
Does not distinguish between influenza A and B virus infections
RT-PCR = reverse transcriptase polymerase chain reaction
A fourfold or greater rise in antibody titer from the acute- (collected within the 1st week of illness) to the convalescent-phase (collected 2-4 weeks after the acute sample) sample is indicative of recent infection.
Moderately complex test – requires specific laboratory certification.
CLIA-waived test. Can be used in any office setting. Requires a certificate of waiver or higher laboratory certification
Distinguishes between influenza A and B virus infections
Disclaimer: Use of trade names or commercial sources is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention or the Department of Health and Human Services.


The following are CDC recommendations:

During outbreaks of respiratory illness when influenza is suspected, some samples should be tested by both rapid tests and by viral culture. The collection of some samples for viral culture is essential for determining the influenza subtypes and strains causing illness, and for surveillance of new strains that may need to be included in the next year's influenza vaccine. During outbreaks of influenza-like illness, viral culture also can help identify other causes of illness when influenza is not the cause.

Anti-viral agents:

Although a flu shot is the best way to prevent the flu, antiviral drugs are other tools that can be used to help prevent and treat influenza.