H1N1 - Latest Guidelines Resources

Provides up to date links to a variety of good resources. Includes information for pregnant women and parents; information for clinicians and health officials, general H1N1 and seasonal flu information.

This guideline represents a tweaking of the CDC/Emory evaluation algorithm to be pregnancy specific. It is an excellent summary of current thinking.

SUMMARY: This document has been developed to provide guidance for prevention and management of novel H1N1 flu infection in inpatient and out-patient obstetric settings. Severe illnesses among pregnant woman and infants have been reported in this outbreak, although the epidemiology and spectrum of illness among pregnant woman and infants are not fully understood at this time and are under investigation. Prevention of infection with novel influenza A (H1N1) virus in pregnant women and infants is the highest priority message in this guidance. Healthy pregnant women should have access to prenatal care and labor and delivery services in settings where they can be separated from persons who are ill or potentially ill with novel H1N1 flu infection. In addition, a cautious approach to the management of neonates with ill mothers is recommended which includes isolation and close observation. Recommendations are interim, based on current knowledge of the novel H1N1 flu outbreak in the United States, and may be revised as more information becomes available.
COMMENT: It is widely anticipated that this document will be revised shortly, particularly the sections on isolation.

REVISIONS FROM EARLIER GUIDANCE INCLUDE: criteria for identification of suspected influenza patients; recommended time away from work for healthcare personnel; changes to isolation precautions based on tasks and anticipated exposures; expansion of information on the hierarchy of controls which ranks preventive interventions in the following order of preference: elimination of exposures, engineering controls, administrative controls, and personal protective equipment; and changes to guidance on use of respiratory protection.

UPDATES INCLUDE: 1. Clarify treatment and chemoprophylaxis considerations for persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines. 2. Include women up to 2 weeks postpartum at higher risk for complications from 2009 H1N1 influenza. 3. Provide additional oseltamivir dosing instructions for children younger than 1 year of age. 4. Review adverse events and contraindications associated with oseltamivir and zanamivir.

SUMMARY: This is an algorithm developed by the Emory School of Medicine and used widely on the East Coast. ACOG has adopted it with minor modifications for use in telephone triage for OB's offices. Teo key elements for OB's are: 1) be sure the patient knows to call back and seek care if she worsens or does not improve, and 2) there needs to be a clear plan and site for evaluation other than the OB's office.

Slide set (55 slides) discussing the latest CDC guidelines with some background. Largely replaces the earlier CDC COCA slides.