January 15 Update on Influenza in San Diego County
January 15, 2014
By the California Health Alert Network (CAHAN)
Influenza is well established in the San Diego region with increasing numbers of cases reported. Seven deaths are among the 1,391 cases detected this season through the week ending January 11. Consistent with national and state reports, the predominant influenza virus identified here so far this season is influenza A (H1N1)pdm09. Compared to last flu season, a significantly greater proportion of flu detections are in adults ages 20 to 64, expected with the H1N1 strain. More details on influenza in the region are available in the weekly San Diego Influenza Watch, available by clicking here. On January 3, the California Department of Public Health (CDPH) issued an alert addressing recent reports of critically ill children and young and middle aged adults with complications associated with influenza. The alert included detailed information about high risk persons, treatment, testing, infection control, and reporting. Clinicians are urged to click here to review the full update.
Oseltamivir (Tamiflu) Shortage
On January 6, the Food and Drug Administration (FDA) announced a temporary shortage of oseltamivir oral suspension due to demand increases and manufacturing delays. The shortage is expected to last until through January. The oral suspension is intended for small children and others who cannot swallow capsules.
Although there have been local reports of difficulty obtaining oseltamivir capsules, these remain available at all three doses (30, 45, and 75 milligrams). Children over 1 year old can be dosed correctly with 30- or 45-mg capsules. For those unable to swallow pills, a capsule can be opened and mixed with chocolate syrup or some other liquid as directed by a health professional. Pharmacists can use 75-mg capsules to make a liquid form of the drug using directions for compounding oral suspension found on the manufacturer’s website and the FDA webpage. Physicians should advise their patients that individual pharmacies may only carry a limited supply of antiviral drugs and that they may need to contact more than one pharmacy to fill their prescriptions. Patients may need to consult with their physician or pharmacist for additional antiviral options if the exact prescribed formulation cannot be located. If providers become aware of persistent unavailability of oseltamivir capsules, please contact the Epidemiology program at 619-692-8499.
H5N1 Avian Influenza
Canadian officials announced that an Alberta resident who traveled to Beijing in December died of H5N1 avian influenza, marking the first human H5N1 case reported in North America. A ProMed report on January 12 provides historical, clinical and laboratory details of the case. Canadian health officials have emphasized the unique and isolated nature of this fatality. The World Health Organization has confirmed 648 human cases between 2003 and 2013 with no evidence of sustained human-to-human transmission. CDC has an updated information page on H5N1, and a health advisory was released today with interim guidance on the management of H5N1. Travel and animal contact histories are critical components of an evaluation of suspected influenza cases. Clinicians with suspected cases of novel or avian influenza should immediately contact the Epidemiology Program at (619) 692-8499.
Thank you for your continued participation.
CAHAN San Diego
County of San Diego, Health & Human Services Agency
Epidemiology and Immunization Services Branch
Phone: (619) 692-8499 • Fax: (858) 715-6458
Urgent Phone for pm / weekends / holidays: (858) 565-5255
Email: cahan@sdcounty.ca.gov
Secure Website: http://cahan.ca.gov
Public-Access Website: http://www.cahansandiego.com
CAHAN San Diego Alerts are intended for the use of public health, medical and laboratory professionals in San Diego County. This alert has been approved for reproduction and distribution to interested professionals. An online CAHAN San Diego application is available at http://www.cahansandiego.com for appropriate and interested individuals.