MDP 84 GPO Box 9848 Canberra ACT 2601

Dear Colleague,

I am writing to update you on the H1N1 Influenza 09 situation within Australia. As you are

aware, in April a new strain of influenza was identified in North America. In response,

Australia activated the Australian Health Management Plan for Pandemic Influenza 2008

(AHMPPI 2008). We now have community acquired cases in Australia, and on 22 May

2009, moved to the CONTAIN phase of our response. The aim of this phase is to contain the

spread of the virus in our communities. The current border measures will remain in place. We

have also updated the case definition which will enhance our capacity to detect community

acquired cases and ask you to beware of travellers especially those from Japan and Panama,

as well as those from USA, Canada and Mexico as advised previously.

As we are entering winter with increased transmission of influenza, I am writing to share with

you the messages we are conveying. Influenza is potentially a serious illness. We are unlikely

to have a specific H1N1 Influenza 09 vaccine in sufficient quantities this winter, and the

seasonal trivalent influenza vaccine is not expected to provide any protection.

Overseas experience with this virus is that most cases have a mild illness, with those at risk of

poor outcomes and death being pregnant women, some children and young adults, those with

prior respiratory illness, asthma, diabetes and the grossly obese. I would urge you to consider

the possibility of influenza complications in your patients this season. All patients with acute

febrile respiratory infections should be tested for influenza.

At present the new H1N1 Influenza 09 strain is sensitive to the neuraminidase inhibitors

(Tamiflu and Relenza). Early treatment (within 48 hours of symptom onset), of cases is

important, particularly for those at high risk of a poor outcome.

I strongly encourage you to remind any unwell patients that they must: remain away from

work or school; practice good hand hygiene and cough and sneeze etiquette; to wear a mask

if within one metre of others; remain well hydrated and take antipyretics. Children less than

12 years who have influenza should not be given aspirin because of the risk of Reye’s

syndrome.

Both you and your staff should continue to maintain good infection control standards. If a

patient with a travel history to an affected area or history of contact with a confirmed case

presents with an influenza-like illness they should immediately be given a surgical mask and

moved into a separate room. Remain at least one metre from them, and use personal

protective equipment (PPE) if you must be closer than a meter. With all other patients who

have acute respiratory illness (but no travel history) it is advisable to wear a mask when

taking a nose and throat swab. If you have specific concerns about a particular patient I

would encourage you to speak to your local public health unit or Infectious Diseases

Physician.

To assist you further in management of suspected cases in your practice, I am attaching a

summary sheet of information which you may find useful as a quick guide. We will place

this summary sheet on the health professionals’ page of the commonwealth health

I am attaching information on these other commonwealth, state and territory and international

resources as well.

I will continue to keep you advised as the situation evolves.

Kind regards

MD MMed MBBS FRACP FRCPA

24 May 2009

person with an acute respiratory illness with onset:

09 (human swine influenza) virus infection or a suspected case with an influenza A positive

test result OR

be updated regularly).

If the patient is positive on a test for influenza A, and H1N1 influenza 09 cannot be excluded yet, they

confirmed H1N1 Influenza 09 (human swine influenza) virus infection by one or more of the following

tests:

required.

The situation is particularly urgent if the patient is a child attending school or resides

in an institution such as a residential care facility because of the risk of transmission

in these settings.

All persons meeting the definition for a suspected case must be notified to the local Public Health

Unit.

The Public Health Unit will provide further advice such as the need for isolation of the case,

tracing and subsequent management of contacts, laboratory testing arrangements, antiviral

usage, and infection control measures. The information provided below is a brief outline of the

important aspects of managing potential cases in your rooms.

Some basic principles include:

waiting room.

surgical mask when others are present.

control precautions such as hand-washing and wear appropriate personal protective

equipment.

Further information will be provided by your local Public Health Unit.

Influenza 09

Personal protective equipment must be worn.

Suspected cases should be tested for respiratory viruses using nose and throat swabs provided

the specimen can be collected safely in a controlled clinical setting. Swabs from suspected cases

should be sent directly to the State/Territory reference laboratory for urgent testing for respiratory

viruses.

Blood, rather than swabs, should be collected for future serologic testing for suspect cases where

presentation is more than 7 days after onset, and may also be collected at the same time as

swabs are collected in other cases, depending on circumstances.

Specimen collection and transport arrangements should be discussed with your local Public

Health Unit.

Antiviral treatment should be given to ‘Suspected’, ‘Suspected Influenza A-positive’ and

‘Confirmed’ cases within 48 hours of illness onset. Antiviral treatment may be commenced more

than 48 hours after onset in rare circumstances where clinically indicated. Public Health Unit staff

will assist with identification of cases for treatment, appropriate medication and dosage regimes

and where to access antivirals.

Following the initial assessment, ‘Suspected’, ‘Suspected Influenza A-positive’ and ‘Confirmed’

cases who do not need hospitalisation must be isolated at home until the diagnosis is excluded or

the infectious period is over. Your local Public Health Unit will contact the patient regularly and

provide them with further information, such as infection control advice. They will also arrange for

tracing of the patient’s contacts and their subsequent management.

and young adults, those with prior respiratory illness, asthma, diabetes and the grossly

need for hospitalisation?

resolution of fever, whichever is longer)

infectious droplets produced while talking, coughing and sneezing; transmission may also occur

through direct and indirect (fomite) contact.

only)

and

and

and

and

and

and

Supplementary Information regarding the following issues is available at

http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/healthprof#clini

cal

sound high risk? Who will do testing? If GPs are very busy in practice they do not necessarily

have the time to do many home visits. What is recommended?

infected patient from others in the waiting room?

brought them into close physical proximity (sitting within one metre for at least 15 minutes) with

the case, but not people who share general office space

case is a child in the same class for 4 hours or more

people who share the classroom, where the case is a child in multiple classes in a day (such as in

a typical secondary school setting)

having been in close physical contact (hugging, kissing, sitting within one metre for at least 15

minutes).

1. passengers seated in the same row, and within two (2) rows in front of and behind the

case;

2. any passengers identified by the case who moved from elsewhere in the aircraft to spend

more than 15 minutes near a case;

3. airline staff (unless they did not service the section of the plane in which a case was

For Protocols for follow-up of exposed staff, see:

“Questions and answers”

Masks and other Personal Protection Equipment (PPE) are available through normal suppliers. They

are also part of the National Medical Stockpile (NMS). These will be made available on the advice of

the Australian Health Protection Committee (AHPC), based on the risk of exposure and availability of

supply. Supplies in both the NMS and in jurisdictions are limited.

Supplies of both oseltamivir and zanamivir are available through community pharmacies. Neither drug

is on the PBS. Initially, advice should be sought from local Public Health Units on the indications and

availability of prophylaxis at a local level. The Department of Health and Ageing is regularly liaising

with drug manufacturers and suppliers to ensure regular supply of these medications.

At this stage, protection of families of health care workers (HCW) is dependent on a risk assessment.

If a HCW has been exposed to H1N1 influenza 09 (and therefore regarded as a contact), depending

on the risk, they may be placed on an antiviral medication, which would confer protection against both

contracting the illness and infecting others. They may also be advised to quarantine themselves at

home. Apart from this, no other protection would be deemed necessary. General “social distancing”

measures are recommended, such as maintaining a minimum of 1 metre distance away from others

(including other members of a household), regular hand hygiene, avoiding touching the face, and

sleeping in a room of their own. PPE would not be indicated for a HCW who is regarded as a contact

or family members.