As many of you are seeing in your clinical settings, Virginians continue to experience influenza-like illness (ILI) this summer. As you can see on a following page, the state public health laboratory and private laboratories have confirmed cases of novel influenza A (H1N1) virus in all five health regions of Virginia and through surveillance testing we have identified that H1N1 currently accounts for over 95% of influenza illness. The virus continues to affect the young disproportionately, resulting in continued outbreaks in camps and daycare. The Virginia Department of Health (VDH) is working closely with the Department of Education on guidance for schools in the fall. High risk groups, the medically fragile, and pregnant women continue to be at risk for more severe disease. The Centers for Disease Control and Prevention (CDC) continues to monitor closely the situation in the Southern Hemisphere, where H1N1 appears to be the dominant influenza strain early in their flu season.
Since my last letter, VDH has undertaken two important actions for our H1N1 response. The Commissioner?s Infectious Disease Clinical Advisory Group, whose members are listed below, provides an essential consultation and communication channel between healthcare providers and VDH. These experts are working closely with my newly established Office of H1N1 Response and our Emergency Preparedness and Response team to be sure we meet your need for timely and actionable information as we approach the fall.
Every week we continue to learn more about this novel virus and anticipate that clinical guidelines may change. I will share with you any major changes through this venue but I also suggest you review the CDC guidelines at (www.cdc.gov/h1n1flu/guidance/) on a regular basis. These guidelines can help you determine if any of your patients with ILI symptoms should be screened for novel H1N1 flu by diagnostic testing, which is now available through private laboratories. Additionally, we continue to hear of significant use of Tamiflu outside of these guidelines. In an effort to minimize resistance, please consult these guidelines when determining appropriateness of antiviral use. Another available resource is Virginia?s 35 district health directors, all expert public health physicians. You can find contact information for your local health director at www.vdh.virginia.gov/lhd/. VDH?s toll-free number (866-531-3068) can also connect you with local health department contacts to provide your practice with additional guidance and answer your questions about H1N1 flu.
VDH continues surveillance activities through tracking of patient visits with influenza-like symptoms at representative medical facilities and limited testing of patients for H1N1. We no longer focus on case counts as they represent only a small fraction of actual cases.
VDH will continue to provide you with information on H1N1 flu, including information about community mitigation strategies such as school closure and vaccinations, throughout the late summer and fall. To help VDH reach you and your colleagues across the Commonwealth, please update your contact information by going online to the Virginia Department of Health Professions Web site at www.vahealthprovider.com/edit/.
Thank you for your continued partnership as we work through what promises to be a very busy influenza season and thank you in advance for your understanding the need for flexibility as we both learn more about this new virus and the pandemic.
Sincerely,
Karen Remley, M.D., MBA, FAAP
State Health Commissioner
Commonwealth of Virginia Clinician update-H1N1 July 8, 2009
State Health Commissioner Clinical Infectious Disease Workgroup
Frederick G. Hayden, M.D.
Stuart S. Richardson Professor of Clinical Virology
Professor of Medicine and Pathology
University of Virginia School of Medicine
Thomas M. Kerkering, MD
Chief of Infectious Diseases
Virginia Tech, Carilion School of Medicine
Carilion Clinic Infectious Disease
Edward C. Oldfield, III, MD
Chief of Division of Infectious Disease
Eastern Virginia Medical School
Donald Poretz, MD, FACP, IDSA
Chief of the Infectious Disease
INOVA Health System
Richard P Wenzel, MD, MSc
Chair of Internal Medicine
Virginia Commonwealth University School of Medicine
Michael B. Edmond, MD, MPH, MPA
Chair of the Division of Infectious Disease
Virginia Commonwealth University Health System
Ronald B. Turner, M.D.
Professor of Pediatrics
Associate Dean for Clinical Research
Department of Pediatrics
University of Virginia School of Medicine
James L. Pearson, DPh BCLD
Director , Division of Consolidated Laboratories, Department of General Services
Diane Helentjaris, MD
Acting Director, Office Epidemiology
Virginia Department of Health
Jim Burns, MD, MBA
Deputy Commissioner for Public Health
Virginia Department of Health
Mark Levine, MD, MPH
Deputy Commissioner for Emergency Preparedness and Response, Virginia Department of Health
Karen Remley, MD, MBA, FAAP
State Health Commissioner
Virginia Department of Health
