February 27, 2004

Information update about treating infectious illnesses

With the heightened awareness this winter of such illnesses as severe acute respiratory syndrome (SARS) and different strains of influenza, the MGH Infectious Diseases Division and the Infection Control Unit have been keeping clinicians apprised of any new developments in the spread of these illnesses.

According to David Hooper, MD (pictured at right), chief of the Infection Control Unit, although local flu activity has decreased, there continue to be large outbreaks of flu in poultry in the Far East — including Cambodia, Indonesia, Japan, Vietnam and Taiwan. The strain of influenza A causing these outbreaks, H5N1, is different from the strains found in the United States. There have been a small number of cases of H5N1 influenza transmitted from poultry to humans in the Far East, causing severe illness with high mortality, but with little or no transmission of H5N1 influenza from person to person.

There have been four probable or confirmed cases of SARS this season, all in Guangdong Province in southern China, where SARS first began last year. The Centers for Disease Control and Prevention (CDC) now recommend a greater index of suspicion for SARS in patients hospitalized with pneumonia who have a history of travel to that area.

For patients with influenza-like illness, MGH care providers should use droplet precautions status, and ask about the history of contact with domestic poultry or history of contact with a known or suspected human case of influenza A (H5N1) in an H5N1-affected country within 10 days of onset of symptoms. If a patient meets the SARS or H5N1 influenza case definitions, care providers should place the patient on strict isolation precautions status and consult the Infectious Diseases Division at (617) 726-3812. If an inpatient is put on a strict isolation precautions status because of suspected SARS or H5N1 influenza, caregivers should place the patient in a negative-pressure room with an anteroom if available. Caregivers also should wear an N95 respirator, gown, gloves and face shield for eye protection.

For more information to help identify cases, make a diagnosis and manage treatment, call the Infectious Diseases Division at (617) 726-3812 or page the Infectious Disease fellow on call. For more information about infection control and transmission issues, call the Infection Control Unit at (617) 726-2036. For more information and regular updates about these and related infectious disease issues, visit the Division of Infectious Diseases website at http://www.mgh.harvard.edu/depts/id/index.html.