Advisory targets severe infections in travelers

The Centers for Disease Control and Prevention has advised state public health departments to be aware of the possibility of incoming cases of avian influenza A (H5N1) linked to Hong Kong. It has been left to individual states to then distribute the advisory to hospitals. The version sent out by the New York health department in Albany on Jan. 16, 1998, is summarized below.

The normal influenza season is just beginning in Hong Kong and there is concern that genetic reassortment between human influenza strains and the H5N1 strain could occur, resulting in a strain that is readily transmitted person to person. City, state, and federal health officials have begun efforts to prepare for this possibility. Early identification of imported cases of influenza A (H5N1) is critical to public health surveillance and control. To assist us in this effort, we request that hospitals develop a plan to implement the following: Obtain viral cultures (throat or nasopharyngeal swab) from all patients who meet all of the criteria below.

• Age: at least one year old but no older than 60.

• Initial presentation of an influenza-like illness (temperature greater than 100 degrees F and symptoms of cough or sore throat).

• Hospitalization with unexplained viral or interstitial pneumonia or Adult Respiratory Distress Syndrome (ARDS).

• Symptom onset within 10 days of having been in Hong Kong or southern China. because laboratory capacity for viral culture testing is limited, we are NOT recommending that viral testing be performed routinely for patients without a recent travel history to Hong Kong or southern China except in the case of outbreaks in a health care facility or institution.

Specimen Collection and Transport: Cotton or Dacron swabs with a plastic or wire shaft should be used to collect specimens, which are immediately placed in viral transport media. All specimens should be kept refrigerated (but not frozen) after collection and during transport to the laboratory. If your laboratory/hospital does not offer viral culture testing, please contact the state health department. If the culture is positive for influenza A, we will assist in arranging for transport to a laboratory with the capacity for influenza subtyping.