Influenza Pandemic Update - 8/7/2009

8th July 2009

Pandemic Update

Dear Colleague,

The situation regarding the spread of Influenza A H1N1 infections in Malta is rapidly progressing. Until 22.00hrs on the 7th July we have confirmed a cumulative total of 49 cases with 25 of them originating in Gozo (16 from Gharb). It appears that during the feast activities in Gharb, according to tradition, people drink from a common recipient and this seems to have been the common source of infection for most of the cases confirmed. The index case has to date not been identified and the chances are that the case is no longer symptomatic rendering identification virtually impossible

Yesterday we also received new guidelines from WHO in respect of how best to tackle the disease at this stage of the pandemic. The spread of H1N1 has been extremely rapid and reached a level in six weeks which in other pandemics took 6 months. Because of the number of cases involved, WHO advises that efforts should not be concentrated on confirming all cases of infection but rather on mitigation to ensure that we treat and protect the most vulnerable groups. Moreover, in view of the mildness of the illness, it is recommending that mild cases should not be treated with antivirals.

On the basis of the above recommendations, and in view of the rapid rise in the number of community transmitted cases experienced over the past two days, it has been decided that we change our response strategy from one of containment to one of mitigation. This means that as from the 9th July the following protocol will come into Operation:

Swabbing for confirmation will only be carried out on symptomatic patients who:
are aged less than five years,
are pregnant,
suffer from one of the following chronic diseases:
 Chronic Respiratory Problems,
 Chronic Heart Disease
 Diabetes
 Immunosupression
 Chronic Renal Failure
have early signs of complications of Influenza

In line with WHO recommendations, treatment with antivirals will only be given to the above group of patients on laboratory confirmation of the illness.

ALL symptomatic patients, and not just the above, are to be quarantined for 7 days from onset of symptoms.

Prophylactic treatment will no longer be given.

Doctors should therefore only contact Public Health for swabbing if they are dealing with a patient falling within one of the above categories. The arrangements for swabbing, prescription of antivirals, and follow up by Public Health will remain as they are at present.

Doctors are requested not to send patients suspected to be suffering from Influenza to hospital for investigation of symptoms unless arrangements for such referrals are made with A&E personnel. The same procedure should apply when referring these patients for admission due to the development of complications.

You will appreciate that it is important for us to keep track of the extent to which the illness is affecting the population. The best way to achieve this is to develop a system of sentinel surveillance where selected GPs report to Public Health the total number of patients seen in a day and the number of influenza patients diagnosed. If you are interested in participating kindly contact Public Health on 7935 3322 or 79012679.

I thank you all for your hard work and cooperation.

Ray Busuttil
Director General
Public Health Regulatio

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