399 East 72nd Street Suite 1A
Between First and York Avenues
New York, NY 10021
(212) 988-8822
(212) 988-8858 Fax

   Simon W Rosenberg, DMD

Prosthodontics and Cosmetic Dentistry
The Center for High Tech Dentistry
"Improving Smiles One Patient at a Time
Using High Tech with a Gentle Touch
"

Call for your initial exam or for a Free Consultation!
 

Site Menu                

 

April 25 2009 Update from NYC Dept of Health on Swine Flu

 

2009 New York City Department of Health and Mental Hygiene (NYC DOHMH) Health Alert #11: Swine Influenza Update

Please distribute to staff in the Departments of Critical Care, Emergency Medicine, Family Practice, Geriatrics, Internal Medicine, Infectious Disease, Infection Control, Pediatrics, Neonatal Units, Nurseries, Pulmonary Medicine and Laboratory Medicine

April 25 , 2009

PLEASE NOTE: This is a rapidly evolving situation. This alert provides interim guidance. Guidance is likely to change in the upcoming days and weeks as more information becomes available.

• Swine influenza is suspected as the cause of a large outbreak of influenza A at St. Francis Preparatory High School in Queens. Specimens obtained from students at the school have been confirmed as influenza A, and are unsubtypeable as either H1 or H3 at the NYC Public Health Laboratory. This meets the case definition for probable swine influenza (see CDC case definitions below).
o To date, all illnesses appear to have been mild and no cases have been hospitalized.
o Samples are being sent to CDC tonight to determine if this outbreak is due to swine influenza. Results will be available tomorrow (Sunday).
o At this time, we are recommending antiviral treatment with oseltamivir or zanamavir as follows for persons associated with the school:
§ Severe influenza-like illness (ILI) or other severe febrile respiratory illness in a student, teacher, staff, or in any close contacts (e.g., household) of someone who attends or works at the school.
§ For patients with mild illness, treatment is only recommended for people who also have underlying conditions that increase the risk for more severe illness due to influenza (listed below). Mild illness should be treated only if treatment can be started within 48 hours of symptom onset.
o At this time, prophylaxis is only being recommended for the following contacts of ill persons associated with the school:
§ Healthcare workers who provided care to ill patients, and who either were not using or had a breach in appropriate personal protection when caring for patients or obtaining specimens
§ Asymptomatic household and other close contacts of ill persons who are at higher risk for complications of influenza (listed below).
• Reporting and management of other NY C hospitalized patients with severe, unexplained febrile, respiratory illness:
o Immediately report all patients with severe, unexplained febrile respiratory illness to the Provider Access Line at 1-917-438-9766.
o Test patients with severe febrile respiratory illness for influenza A using a commercially available rapid test, PCR or immunofluorescence test (e.g., DFA or IFA).
o Personal protective measures should be taken by medical personnel caring for or obtaining specimens from patients being tested for influenza or who have suspected, probable or confirmed swine influenza. See http://www.cdc.gov/swineflu/guidelines_infection_control.htm.
o If hospitals are not able to conduct initial rapid influenza testing, please contact the DOHMH to arrange for testing for influenza A.
• Management of patients with mild influenza-like illness
o Patients with mild illness should be encouraged to stay home until 24-48 hours after resolution of symptoms.
§ Pat ients should be instructed to wash their hands frequently, cough into a tissue or sleeve (not into bare hands or onto another person), dispose of tissues in the trash, and stay home from school or work until 24-48 hours after illness is resolved.
o At this time, we are not recommending routine influenza testing and/or antiviral treatment for persons with mild influenza-like illness, unless they meet the usual criteria for empiric influenza treatment based on underlying illnesses that put them at higher risk for complications of any type of influenza.
• According to the CDC, vaccination for seasonal influenza is unlikely to be effective for prevention of swine influenza.
• Additional information on the outbreaks in the US and Mexico, including NYC, as well as further clinical guidance will be provided as it becomes available. For updated information on the national situation, see http://www.cdc.gov/swineflu/general_info.htm.

Dear Colleagues,

On April 23, a high school in Queens was noted to have an outbreak of mild febrile respiratory illness that was confirmed last night to be caused by influenza A. Specimens were sent to the NYC Public Health Laboratory and were untypeable for human H1 or H3 strains, meeting the CDC case definition for probable swine influenza. These specimens are being forwarded to CDC today for further testing to determine if these infections are due to swine influenza. Results should be available tomorrow. The high school has approximately 2,700 students, and as of yesterday, 200 children were reported to be ill, mostly with mild influenza-like symptoms (fever, cough, and/or sore throat). None of the cases were severe or required hospitalization.

In the United States, there are currently 6 California residents and 2 Texas residents who have been diagnosed with swine influenza A (H1N1) virus infection; all of these patients had mild illness (only one hospitalization) and all have recovered. Isolates from California and Texas have been found to be susceptible to the neuraminidase inhibitors (oseltamivir and zanamavir) but resistant to the adamantanes (amantadine and rimantadine). In addition, there has been an outbreak of respiratory illness in Mexico, which has been confirmed as at least partly due to swine influenza; clinical and epidemiologic details of this outbreak are still pending, but preliminary reports are of thousands of cases and approximately 70 deaths.

Surveillance for Swine Influenza in Hospitalized Cases Citywide:
The NYC Health Department is now prioritizing its surveillance efforts for swine influenza on identifying potential cases of febrile, respiratory illness in hospitalized patients, in order to rapidly identify and confirm potential cases with more severe illness. Therefore, DOHMH requests that providers seeing patients with acute febrile respiratory illness only test those patients who are either currently hospi talized or are being admitted to the hospital with unexplained febrile respiratory illness. These patients should be tested for influenza using either a commercial rapid test, or direct or indirect immunofluorescence. Patients who test positive for influenza A should be reported to DOHMH and have specimens referred to DOHMH for further testing to determine whether the influenza A can be subtyped. See contact information below. DOHMH will arrange for transportation of clinical specimens to the Public Health Laboratory. See attached instructions for collecting and submitting laboratory diagnostic specimens for swine influenza testing. Nasopharyngeal swabs are the preferred specimens for influenza testing in the current swine influenza context.

Management of Persons with Milder Influenza-like Illness
At this time, providers assessing patients with mild febrile respiratory illness in clinical settings, including emergency departments, should not test for influenza and should not administer antiviral medications for presumptive therapy, unless patients meet the usual criteria for empiric influenza treatment based on underlying illnesses (listed below) that put them at higher risk for complications of any type of influenza. These patients may be sent home with instructions to stay at home until 24-48 hours after their symptoms resolve and instructed on the importance of hand and respiratory hygiene. Instructions should be given to seek medical care with worsening of symptoms.

Infection Control
For current recommendations on infection control in medical care facilities, see http://www.cdc.gov/swineflu/guidelines_infection_control.htm.

Antiviral Treatment and Prophylaxis Guidelines
Swine influenza viruses identified in this outbreak to date have been susceptible to both oseltamivir and zanamivir. Antiviral therapy with one of these agents should be initiated empirically for patients currently hospitalized with sever e unexplained febrile respiratory illness, pending testing for swine influenza. See http://www.cdc.gov/swineflu/recommendations.htm for specific guidelines. This document also includes detailed guidance on antiviral prophylaxis.

The Health Department requests that providers also immediately report any clusters of influenza-like illness in medical facilities, congregate settings such as long-term care facilities, or schools.

To contact the Health Department, including to report suspected cases of swine influenza in hospitalized patients and arrange for specimen testing, please call the Provider Access Line at 1- 917-438-9766. This number is also available for questions or consultations by providers.

As always, we appreciate the cooperation of the medical community in New York City and will update you with further information when it becomes available.


Sincerely,

Scott A. Harper, MD, MPH, MSc
Medical Epidemiologist
Zoonotic, I nfluenza, & Vectorborne Diseases Unit
Bureau of Communicable Disease

Annie Fine, MD
Medical Director
Zoonotic, Influenza, & Vectorborne Diseases Unit
Bureau of Communicable Disease

Definitions of Respiratory Illness

1. Acute respiratory illness
Recent onset of at least two of the following:
1. rhinorrhea or nasal congestion
2. sore throat
3. cough
4. fever or feverishness
2. Influenza-like illness: fever >37.8°C (100°F) plus cough or sore throat
Case Definitions for Infection with Swine Influenza A (H1N1) Virus
1. A Confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:
1. real-time RT-PCR
2. viral culture
3. four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies
2. A Pr obable case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with an influenza test that is positive for influenza A, but H1 and H3 negative.
3. A Suspected case of swine influenza A (H1N1) virus infection is defined as:
1. A person with an acute respiratory illness who was a close contact to a confirmed case of swine influenza A (H1N1) virus infection while the case was ill OR
2. A person with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swine influenza A (H1N1) virus infection OR
3. A person with an acute respiratory illness who has traveled to an area where there are confirmed cases of swine influenza A (H1N1)


Conditions which increase the risk of severe influenza infection
• chronic pulmonary, cardiovascular, renal, hepatic, hematological, or metabolic disorders,
• immunosuppression,
• compromised respiratory function , including conditions which increase the risk for aspiration,
• long-term aspirin therapy
• pregnancy
• age > 65 years
• age < 2 years

    Office Hours   

Mon 8am-6pm
Tue 8am-6pm
Thur 8am-6pm
Wed 8am-5pm
Fri: 8am-3pm
Sat: Closed
Sun: Closed

LinkedIn Professional Connection Profiles
 
Link to me on Twitter
 

Click to Go to Secure Website to Complete New Patient Forms which will be sent to us by a secure, encripted method to preserve your confidentiality

 Home Page
 About Us
 Directions and Map
 My Staff
 My Curriculum Vitae
 Choosing a Dentist
 Technology in Our Office
 Fully Computerized Dental Office
 Patient Education
 Infection Control
 Videos of Our Patients
 What our Patient Say
 Survey Results 7-2006 - 10-2007
 Second Survey 10-2007 - 3-2008
 Testimonials From CitySearch.com
 Services We Offer
 CEREC - One-Visit All-Porcelain
 Why CEREC is Best Restoration
 Research on CEREC
 CEREC Videos
 Waterlase MD dental laser
 SNAP Dental Imaging Software
 Choosing Ortho Treatment
 Invisalign
 Six Month Smiles
 Problems Treated with 6 Month Smiles
 Six Month Smile Videos
 Six Month Smiles FAQ
 Implants
 T-Scan Occlusal Analysis
 X-Ray Examinations
 Computerized Digital Radiography
 Composite vs Amalgam Fillings
 Crowns
 Bridges
 Veneers
 Root Canal Endodontic Treatment
 Dentures
 How Dentures are Made
 Immediate Dentures
 Removable Partial Denture
 Denture Care
 Soft Denture Liners
 Oral Medicine
 OsteoNecrosis from Medications
 Diagnodent
 TMJ and TMD
 Pediatric Dentistry
 Maxillofacial prosthetics
 Cosmetic Dentistry
 Smile Analysis
 Smile Evaluation Form
 Snap Digital Imaging
 Bonding
 Zoom In-Office Whitening
 The Zoom Procedure
 Veneers or Laminates
 da Vinci Labs
 Laser Dentistry
 Biolase Waterlase Dentistry
 Laser Questions & Answers
 Videos of Laser Treatment
 Laser Root Canal on "The Doctors"
 Before and After Photos
 Periodontal Disease Prevention & Treatment
 Periodontal Disease (Gum Disease & Gingivitis)
 A Dental School Explanation of Periodontal Disease
 Periodontal Risk Factors
 The Stages Of Periodontal Disease
 The Role of X-Rays in Periodontal Disease Diagnosis
 Gum Disease Linked with Heart Disease
 Flossing and Brushing
 Fluoride Role in Decay, Periodontitis and Sensitivity
 Deep Scalling and Root Planing
 Occlusal (Bite) Adjustment
 The Latest News in Periodontalogy
 Technology We Use
 Patient Loyalty Program
 Insurance and Financing
 Articles
 I Hate My Smile What Can I Do
 Why You Need to Know How To Choose A Dentist
 Oral Complications of Cancer Therapies:
 Altered Dental Root Development in 17 Leukemia Patients
 Right in the Kisser: Entrepreneur.com Article
 Resources
 Web Sites
 Services
 Subscribe to My Newsletter
 2008 Newsletters
 January 5 2008 Newsletter
 June 6 2008 Newsletter
 July 4 2008 Newsletter
 July 8, 2008 Newsletter
 August 8, 2008 Newsletter
 August 24, 2008 Newsletter
 September 5 2008 Newsletter
 October 15 2008 Newsletter
 October 23 2008 Newletter
 November 11, 2008 Newsletter
 Thanksgiving Thoughts 2008
 December 5, 2008 Newsletter
 Previous Newsletters
 SmiileLink Newsletter by CAESY
 Dec 24, 2006 Newsletter
 January 14, 2007 Newsletter
 February 19th 2007 Newsletter
 March 24, 2007 Newsletter
 April 6, 2007 Newsletter
 May 6, 2007 Newsletter
 May 20, 2007 Newsletter
 June 5, 2007 Newsletter
 June 15, 2007 News Alert
 July 1 2007 Newsletter
 July 6 2007 Newsletter
 December 2, 2007 Newsletter
 December 12 2007 Newsletter
 Testimonials
 From Linked-In
 From YP.com
 Dentistry in the News
 The Doctor's Channel - Dentistry
 The Journal of Prosthetic Dentistry
 New York Times -- Health News
 Contact Us
 Privacy Policy and HIPAA
 Employment Application
 Swine Flu Info
 April 25 2009 NYC Update
 April 26 2009 NYC Update
 April 29 2009 NYC Update
 May 1 2009 NYC Update
 May 12 2009 NYC Update
 May 24 2009 NYC Update
 Making a Video
 SBH
 Site Map