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Paradigm Shift Intervention Monitoring
Texas Issues Influenza Health Alert
influenza is now widespread
When there is clinical suspicion of influenza and antiviral treatment is indicated, antiviral treatment should be started as soon as possible, even if the result of the RIDT is negative, without waiting for results of additional influenza testing.
Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza.
In Texas, influenza-associated pediatric mortality is required to be reported within one work day. Clusters or outbreaks of any disease, including influenza, should be reported immediately. Reports of influenza-associated pediatric mortality and influenza or influenza-like illness outbreak should be made to your local health department or to 1-800-705-8868.
The above comments are from the bolded portions of a December 20, 2013 Influenza Health Alert from the Commissioner of the Texas Department of State Health Services. They were precipitated by widespread high levels of H1N1pdm09. The warning on false negatives by the rapid test was likely linked to the “mystery disease” at the Conroe Regional Medical Center, which involved 8 patients (including 4 who had died) between the ages of 41-68 with text book swine flu symptoms who progressed to severe pneumonia and death but had tested negative on the widely used rapid test.
Two of the patients subsequently tested positive on a third party PCR test and samples from the other six patients were sent to the CDC for re-testing. In addition, other patients, who had died last month were also H1N1pdm09 confirmed, suggesting that false negatives in H1N1pdm09 cases were common.
Moreover, the number of patients who had died, were in hospital ICUs, or had recently visited hospital emergency rooms, highlighted the need for the alert and recommendations to consider immediate anti-viral treatment for patients who present with flu-like symptoms, regardless of rapid tests results (and treatment should not be delayed while re-testing results are in progress).
The Texas Department of Health is to be commended for taking this aggressive action, and the recommendations should be issued nationwide by the CDC or HHS.