BCRT: British Columbia Respiratory Therapy

October 12, 2009 — H1N1 critical illness mostly affects young patients and is often fatal, according to the results of a Canadian and Mexican study and an editorial published online October 12 in the Journal of the American Medical Association(JAMA).

“Of 215 patients with critical illness, 162 had confirmed, 6 had probable, and 47 had suspected community-acquired 2009 influenza A (H1N1) infection. Mean age was 32.3 ± 21.4 years in the 168 patients with confirmed or probable 2009 influenza A (H1N1); 113 patients (67.3%) were women and girls, 50 patients (29.8%) were children, and 43 patients (25.6%) were aboriginal Canadians…”

H1N1 Critical Illness Mostly Affects Young Patients and Is Often Fatal

Google.org has an interesting site devoted to following flu trends. You can chart by “National” or by “Province.

Google Flu Trends uses aggregated Google search data to estimate current flu activity around the world in near real-time.

Check out the site below:

Learn more about the research behind Google Flu Trends:
Read the article published by Nature, Detecting influenza epidemics using search engine query data.

For Fraser Health:

A.  Context

Identification and investigation of hospitalized cases of influenza is needed to assess the effect of

Swine-origin influenza A/H1N1 virus (S-OIV) in BC.  The BC College of Physicians also sent an email on

July 2, 2009 to all physicians from the Provincial Health Officer that included this request to test for

influenza.  S-OIV continues to circulate in BC and in recent weeks, provinces have noted increasing

numbers of hospitalization due to S-OIV

B.  Guidelines for testing

• TEST all patients admitted overnight (or longer) to hospital with a history of recent acute

respiratory illness (i.e., history of fever and new or worse cough/breathing difficulty, with or

without other flu-like symptoms such as sore throat, rhinorrhea, sneezing, myalgia, arthralgia,

headache, fatigue, etc.);

• Test as soon as possible on admission to increase likelihood of virus detection;

• Test even if the etiology appears to be bacterial;

• Specimen collection for influenza testing may include a nasopharyngeal (NP) swab or

bronchoalveolar lavage (BAL). If patient presents with a rapidly progressive acute respiratory

illness that is negative by NP swab for influenza A/H1N1, additional testing should be performed

on tracheal or other pulmonary samples, if clinicians suspect influenza pneumonia diagnosis.

NP samples should be collected on viral swabs (ideally, COPAN flocked swabs);

• Specimens should be submitted to BCCDC Public Health Microbiology & Reference Laboratory,

with “hospitalized” written in large letters on the requisition;

• The requisition form, along with detailed instructions, can be found online at

(click on “Forms & Requisitions” on the left-hand panel,

then choose “H1N1 Flu Virus: Virus Culture Form”);

• Start antivirals according to clinical judgment without waiting for test results.  Antivirals

are most effective when administered within 48 hours of illness onset.

C.  Reporting of Cases

Lab-confirmed S-OIV cases who are admitted to hospital must be reported to the Public Health

Unit in the area where the patient lives. Public health staff will follow-up with detailed investigation of

hospitalized, lab-confirmed S-OIV cases.

A.  Context

Identification and investigation of hospitalized cases of influenza is needed to assess the effect of

Swine-origin influenza A/H1N1 virus (S-OIV) in BC.  The BC College of Physicians also sent an email on

July 2, 2009 to all physicians from the Provincial Health Officer that included this request to test for

influenza.  S-OIV continues to circulate in BC and in recent weeks, provinces have noted increasing

numbers of hospitalization due to S-OIV

B.  Guidelines for testing

• TEST all patients admitted overnight (or longer) to hospital with a history of recent acute

respiratory illness (i.e., history of fever and new or worse cough/breathing difficulty, with or

without other flu-like symptoms such as sore throat, rhinorrhea, sneezing, myalgia, arthralgia,

headache, fatigue, etc.);

• Test as soon as possible on admission to increase likelihood of virus detection;

• Test even if the etiology appears to be bacterial;

• Specimen collection for influenza testing may include a nasopharyngeal (NP) swab or

bronchoalveolar lavage (BAL). If patient presents with a rapidly progressive acute respiratory

illness that is negative by NP swab for influenza A/H1N1, additional testing should be performed

on tracheal or other pulmonary samples, if clinicians suspect influenza pneumonia diagnosis.

NP samples should be collected on viral swabs (ideally, COPAN flocked swabs);

• Specimens should be submitted to BCCDC Public Health Microbiology & Reference Laboratory,

with “hospitalized” written in large letters on the requisition;

• The requisition form, along with detailed instructions, can be found online at

http://www.phsa.ca/bccdcpublichealthlab (click on “Forms & Requisitions” on the left-hand panel,

then choose “H1N1 Flu Virus: Virus Culture Form”);

• Start antivirals according to clinical judgment without waiting for test results.  Antivirals

are most effective when administered within 48 hours of illness onset.

C.  Reporting of Cases

Lab-confirmed S-OIV cases who are admitted to hospital must be reported to the Public Health

Unit in the area where the patient lives. Public health staff will follow-up with detailed investigation of

hospitalized, lab-confirmed S-OIV cases.

Abbotsford HU

Tel:  604-864-3400 Agassiz HU

Tel:  604-793-7160 Burnaby HU

Tel:  604-918-7605 Chilliwack HU

Tel:  604-702-4900 Cloverdale HU, Surrey

Tel:  604-575-5100 Guildford HU, Surrey

Tel:  604-587-4750

Hope HU

Tel:  604-860-7630 Langley HU

Tel:  604-539-2900 Maple Ridge HU

Tel:  604-476-7000 Mission HU

Tel:  604-814-5500 New Westminster HU

Tel:  604-777-6740 Newport HU, Port Moody

Tel:  604-949-7200

Newton HU, Surrey

Tel:  604-592-2000 North Delta HU

Tel:  604-507

-5400 North Surrey HU

Tel:  604-587-7900 Port Coquitlam HU

Tel:  604-777-8700 South Delta HU

Tel:  604-952-3550 White Rock HU

Tel:  604-542-4000

After Hours Public Health Emergency Pager:  604-527-4806.  Ask for the Medical Health Officer On-Call

Research Scientists Discover How Flu Damages Lung Tissue: “A protein in influenza virus that helps it multiply also damages lung epithelial cells, causing fluid buildup in the lungs, according to new research from the University of Alabama at Birmingham (UAB) and Southern Research Institute . Publishing online this week in the journal of the Federation of American Societies for Experimental Biology, the researchers say the findings give new insight into how flu attacks the lungs and provides targets for new treatments.”

(Via Respiratory / Asthma News From Medical News Today.)