Swine Flu Update: April 30 @ 2:00 p.m. First Cases Confirmed

Good morning.  At a press conference yesterday, Governor Deval Patrick announced the first 2 confirmed cases of swine influenza in the Commonwealth.  Both school-aged children from Middlesex County are doing well, and are expected to make a complete recovery.  Neither child attended school during the course of their illness, nor were they ever hospitalized.  Please read the press release from the announcement here.

The CDC has confirmed 109 cases of swine flu 11 states in the U.S., including the death of a 22 month old from Texas -- the nation's first death associated with this swine flu outbreak.  We continue to work very closely with the CDC and our partners at the state and local level. 

While there is no vaccine for the current swine flu strain, there are still important steps that everyone can take to help prevent getting or spreading any type of influenza:

• Wash your hands often with soap and water, especially after you cough or sneeze.  Alcohol-based hand cleaners are also effective.
• Practice good "cough etiquette" by coughing or sneezing into a tissue, or into your elbow instead of into your hands.
• Try to avoid close contact with sick people.
• If you get sick, stay home from work or school and limit contact with others to avoid infecting them.

MASS 211 ACTIVATED TO HELP PROVIDE THE PUBLIC WITH INFORMATION:

Massachusetts residents can now call (2-1-1) for basic information about swine flu.

NEW MATERIALS ON DPH WEB SITE

We are adding new materials to our web site on a regular basis. To see all our fact sheets visit http://www.mass.gov/dph/swineflu.

INFORMATION ABOUT SWINE FLU AND PREVENTION STEPS TO HELP YOU STAY HEALTHY:

Swine flu is a respiratory infection caused by influenza type A virus that regularly cause outbreaks of influenza in pigs.  People do not normally get swine flu, but human infections can occur.  Human cases typically involve people who have had direct contact with pigs, but person-to-person transmission is suspected among recent confirmed cases.  

For more information on swine flu, visit the CDC's new web site at www.cdc.gov/swineflu.  We also have some very good information on how to care for someone at home who has the flu on our DPH web site.

DPH STATEMENT ON CASE ANNOUNCEMENTS:

Consistent with CDC guidelines, it is the policy of the Massachusetts Department of Public Health to comment only on confirmed cases of swine influenza.  There are several important reasons for not commenting on specific "suspect cases".  First, many of these cases will rule out for swine influenza, and commenting on them raises undue concern for families and communities.  During a time of enhanced alertness for cases, DPH and local public health authorities will get many reports from health care providers about cases of flu-like illness.  We will always follow up on reports consistent with CDC guidance and good public health practice; just because we are not commenting on unconfirmed cases, doesn't mean we're not working on those cases.  Second, there have been a number of media reports on suspect cases that have included information that could be used to identify a specific person's health information, which in turn could violate that person's health privacy.  Third, our goal throughout this outbreak is to provide the public with the most accurate and useful information.  

We will update this blog regularly with new information when it becomes available.  As with every public health investigation, the situation will likely change many times, and we will do our best to keep the residents of Massachusetts updated as the situation evolves.  Thanks in advance for your patience and please check back for updates.

Comments

[Melissa Edwards]

How long after the onset of the swine flu virus did the currently documented swine flu related deaths occur?

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Suzanne Crowther responds: After conducting a reveiw of CDC updates and reports, I was not able to find information as specific as you would like about the 3 deaths. I can tell you that all 3 had underlying medical conditions that made them more likely to experience complications from the flu.

There is information about the 1st two deaths in the latest addition of CDC's Morbidity and Morality Weekly Review (MMWR). It was publish last Friday, so the information about the 3rd death is not included.

Your best source for the type of detailed information about the mortality of the virus is: www.cdc.gov/mmrw.

[Mike McGuill]

Thanks for the great site. My son attends a Boston public school, and they have a policy that no alcohol-based hand sanitizers are allowed in classrooms (concerns about chapped hands). I thought that these sanitizers were a good supplement - not replacement for - thorough hand-washing. Your Swine Flu Advisory for Schools and Child Care Settings makes no mention of alcohol-based sanitizers. Why not, and if there's no good reason, would you please add them as an additional preventive measure in your next version of this advisory?

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Kristin Golden responds: As long as children have the ability to regularly wash their hands with soap and water throughout the day (and do so!) that is the ideal preventative measure. Alcohol-based sanitizers can be a good supplement when water is not nearby. Thanks for the suggestion; the language is included in our general fact sheet but not the school advisory and we will consider that as we continue updating. I'd also like to let you know about the Boston Public Health Commission which has additional information on its website: www.bphc.org.

[Julie Read]

I was wondering if a public service announcement could go out to ask people in Massachusetts to voluntarily call into a hotline whether they have traveled to Mexico in the past month or two. That would give some idea as to how many people could have been exposed versus the number of confirmed cases. Also, asking if they would be willing to keep their children home from school until after the incubation period, if they had traveled to Mexico.

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Thank you for your comments. The incubation time for flu (the time between when you are exposed and when you get sick) is relatively short (less than a week). People who traveled to Mexico several weeks or months ago are not a risk to the public. At this time, exclusion is not recommended for school or childcare participants who have recently traveled to an area where swine flu cases have been confirmed (such as Mexico), and who do not have an acute febrile respiratory illness.
Kristin Golden

[P.S.]

I am glad to hear that the children who tested positive for H1N1 influenza in MA are clinically doing well.

I currently live in western MA, but I have traveled to both New York City and Boston in the last 21 days. For the last 7 days, I had what I assumed were typically influenza symptoms (fever, cough, rhinorrhea, headache, myalgias, fatigue). I received the annual influenza vaccine last fall, although I do not know it's efficacy against either H1N1 or this year's seasonal influenza.

I have some questions for you:

1. Regarding the 2 children in Middlesex County, MA, with confirmed H1N1 infection, what were their risk factors for H1N1 exposure? Had they recently traveled to Mexico City, or were they exposed to people who were known to be positive in New York City?

2. Is there any data to support the use of Tamiflu or Relenza more than 72 hours after symptom onset?

3. How long after onset (and resolution) of symptoms can the H1N1 virus be detected by current RT-PCR or culture techniques? I am trying to decide if it worth getting tested for influenza via nasal swab or wash/aspirate.

Thanks,
P.S.

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Thank you for your questions. The 2 confirmed cases in Massachusetts had recently traveled to Mexico where it is believed they were exposed to the virus. The annual flu shot is not protective of this strain of the flue. If you are experiencing symptoms consistent with flu, you should contact your health care provider by phone and explain your personal situation so that he / she can advise you on whether you should be seen. Kristin Golden, DPH

[Maureen Campbell]

Our family traveled to Mexico also during school vacation (April 19-25). Is Airline information going to be given out that the family from Lowell was on so the public is aware that they were exposed to this virus in such close quarters such as an aircraft.

Maureen Campbell
Wakefield, Mass
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Hello Maureen: the best advice would be to monitor yourself and your family for any signs of flu. The symptoms for swine flu are pretty much the same as what you would see for seasonal flu. If you start seeing these symptoms, contact your health care provider for testing and treatment. It's a good idea to call ahead to your doctor's office, so they can make arrangements to make sure you get seen while not possibly exposing other patients, just in case.

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