{"id":10123,"date":"2025-03-01T14:02:49","date_gmt":"2025-03-01T19:02:49","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan166\/"},"modified":"2025-03-02T00:47:52","modified_gmt":"2025-03-02T05:47:52","slug":"dhan166","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan166\/","title":{"rendered":"php\/alerts\/dhan166 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan166.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->166 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->December 23, 2008 2:01 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n              <\/div>\n\n            <\/div>\n\n          <\/div>\n\n        <\/div><br>\n\n      <\/div>\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n  \n\n<h2 class=\"center\">Health\n\n<!--[type=EDIT name=\"DHANType\"]-->\n\n\n\n   Advisory<!--[END]-->\n\n<br>\n\n<!--[type=EDIT name=\"DHAN Heading\"]-->\n\n\n\nCDC ISSUES INTERIM RECOMMENDATIONS FOR THE USE OF INFLUENZA ANTIVIRAL MEDICATIONS IN THE STTING OF\n\n\n  OSELTAMIVIR RESISTANCE AMONG CIRCULATING INFLUENZA A (H1N1) VIRUS, 2008-09 INFLUENZA SEASON<!--[END]-->\n\n<\/h2>\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n<h3 class=\"text-center\">\n\n\n  Posted: December 21, 2008\n\n\n<\/h3>\n\n\n<p>\n\n\n  Although influenza activity is low in the United States to date, preliminary data from a limited number of states indicate that the\n\n\n  prevalence of influenza A (H1N1) virus strains resistant to the antiviral medication oseltamivir is high. Therefore, CDC is issuing\n\n\n  interim recommendations for antiviral treatment and chemoprophylaxis of influenza during the 2008-09 influenza season. When influenza A\n\n\n  (H1N1) virus infection or exposure is suspected, zanamivir or a combination of oseltamivir and rimantadine are more appropriate options\n\n\n  than oseltamivir alone. Local influenza surveillance data and laboratory testing can help with physician decision-making regarding the\n\n\n  choice of antiviral agents for their patients. The 2008-09 influenza vaccine is expected to be effective in preventing or reducing the\n\n\n  severity of illness with currently circulating influenza viruses, including oseltamivir-resistant influenza A (H1N1) virus strains. Since\n\n\n  influenza activity remains low and is expected to increase in the weeks and months to come, CDC recommends that influenza vaccination\n\n\n  efforts continue.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Background\n\n\n<\/h4>\n\n\n<p>\n\n\n  Influenza A viruses, including two subtypes (H1N1) and (H3N2), and influenza B viruses, currently circulate worldwide, but the prevalence\n\n\n  of each can vary among communities and within a single community over the course of an influenza season. In the United States, four\n\n\n  prescription antiviral medications (oseltamivir, zanamivir, amantadine and rimantadine) are approved for treatment and chemoprophylaxis\n\n\n  of influenza. Since January 2006, the neuraminidase inhibitors (oseltamivir, zanamivir) have been the only recommended influenza\n\n\n  antiviral drugs because of widespread resistance to the adamantanes (amantadine, rimantadine) among influenza A (H3N2) virus strains. The\n\n\n  neuraminidase inhibitors have activity against influenza A and B viruses while the adamantanes have activity only against influenza A\n\n\n  viruses. In 2007-08, a significant increase in the prevalence of oseltamivir resistance was reported among influenza A (H1N1) viruses\n\n\n  worldwide. During the 2007-08 influenza season, 10.9% of H1N1 viruses tested in the U.S. were resistant to oseltamivir.\n\n\n<\/p>\n\n\n<p>\n\n\n  Influenza activity has been low thus far this season in the United States. As of December 19, 2008, a limited number of influenza viruses\n\n\n  isolated in the U.S. since October 1 have been available for antiviral resistance testing at CDC. Of the 50 H1N1 viruses tested to date\n\n\n  from 12 states, 98% were resistant to oseltamivir, and all were susceptible to zanamivir, amantadine and rimantadine. Preliminary data\n\n\n  indicate that oseltamivir-resistant influenza A (H1N1) viruses do not cause different or more severe symptoms compared to oseltamivir\n\n\n  sensitive influenza A (H1N1) viruses. Influenza A (H3N2) and B viruses remain susceptible to oseltamivir. The proportion of influenza A\n\n\n  (H1N1) viruses among all influenza A and B viruses that will circulate during the 2008-09 season cannot be predicted, and will likely\n\n\n  vary over the course of the season and among communities. Oseltamivir-resistant influenza A (H1N1) viruses are antigenically similar to\n\n\n  the influenza A (H1N1) virus strain represented in 2008-09 influenza vaccine, and CDC recommends that influenza vaccination efforts\n\n\n  continue as the primary method to prevent influenza.\n\n\n<\/p>\n\n\n<p>\n\n\n  Oseltamivir resistance among circulating influenza A (H1N1) virus strains presents challenges for the selection of antiviral medications\n\n\n  for treatment and chemoprophylaxis of influenza, and provides additional reasons for clinicians to test patients for influenza virus\n\n\n  infection and to consult surveillance data when evaluating persons with acute respiratory illnesses during influenza season. These\n\n\n  interim guidelines provide options for treatment or chemoprophylaxis of influenza in the United States if oseltamivir-resistant H1N1\n\n\n  viruses are circulating widely in a community or if the prevalence of oseltamivir resistant H1N1 viruses is uncertain.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Interim Recommendations\n\n\n<\/h4>\n\n\n<p>\n\n\n  Persons providing medical care for patients with suspected influenza or persons who are candidates for chemoprophylaxis against influenza\n\n\n  should consider the following guidance for assessing and treating patients during the 2008-09 influenza season (see guidance table at\n\n\n  http:\/\/www.cdc.gov\/flu\/professionals\/antivirals\/antiviraltable.htm):\n\n\n<\/p>\n\n\n<ol>\n\n\n  <li>Review state influenza virus surveillance data weekly during influenza season, to determine which types (A or B) and subtypes of\n\n\n  influenza A virus (H3N2 or H1N1) are currently circulating in Delaware. For some communities, surveillance data might not be available or\n\n\n  timely enough to provide information useful to clinicians.\n\n\n  <\/li>\n\n\n  <li>Consider use of influenza tests that can distinguish influenza A from influenza B.\n\n\n    <ol class=\"lower-alpha\">\n\n\n      <li>Patients testing positive for influenza B may be given either oseltamivir or zanamivir (no preference) if treatment is indicated.\n\n\n      <\/li>\n\n\n      <li>At this time, if a patient tests positive for influenza A, use of zanamivir should be considered if treatment is indicated.\n\n\n      Oseltamivir should be used alone only if recent local surveillance data indicate that circulating viruses are likely to be influenza\n\n\n      A (H3N2) or influenza B viruses. Combination treatment with oseltamivir and rimantadine is an acceptable alternative, and might be\n\n\n      necessary for patients that cannot receive zanamivir, (e.g., patient is <7 years old, has chronic underlying airways disease, or\n\n\n      cannot use the zanamivir inhalation device), or zanamivir is unavailable. Amantadine can be substituted for rimantadine if\n\n\n      rimantadine is unavailable.\n\n\n      <\/li>\n\n\n      <li>If a patient tests negative for influenza, consider treatment options based on local influenza activity and clinical impression\n\n\n      of the likelihood of influenza. Because rapid antigen tests may have low sensitivity, treatment should still be considered during\n\n\n      periods of high influenza activity for persons with respiratory symptoms consistent with influenza who test negative and have no\n\n\n      alternative diagnosis. Use of zanamivir should be considered if treatment is indicated. Combination treatment with oseltamivir and\n\n\n      rimantadine (substitute amantadine if rimantadine unavailable) is an acceptable alternative. Oseltamivir should be used alone only if\n\n\n      recent local surveillance data indicates that circulating viruses are likely to be influenza A(H3N2) or influenza B viruses.\n\n\n      <\/li>\n\n\n      <li>If available, confirmatory testing with a diagnostic test capable of distinguishing influenza caused by influenza A (H1N1) virus\n\n\n      from influenza caused by influenza A (H3N2) or influenza B virus can also be used to guide treatment. When treatment is indicated,\n\n\n      influenza A (H3N2) and influenza B virus infections should be treated with oseltamivir or zanamivir (no preference). Influenza A\n\n\n      (H1N1) virus infections should be treated with zanamivir or combination treatment with oseltamivir and rimantadine is an acceptable\n\n\n      alternative.\n\n\n      <\/li>\n\n\n    <\/ol>\n\n\n  <\/li>\n\n\n  <li>Persons who are candidates for chemoprophylaxis (e.g., residents in an assisted living facility during an influenza outbreak, or\n\n\n  persons who are at higher risk for influenza-related complications and have had recent household or other close contact with a person\n\n\n  with laboratory confirmed influenza) should be provided with medications most likely to be effective against the influenza virus that is\n\n\n  the cause of the outbreak, if known. Respiratory specimens from ill persons during institutional outbreaks should be obtained and sent\n\n\n  for testing to determine the type and subtype of influenza A viruses associated with the outbreak and to guide antiviral therapy\n\n\n  decisions.\u00a0 Persons whose need for chemoprophylaxis is due to potential exposure to a person with laboratory-confirmed influenza A\n\n\n  (H3N2) or influenza B should receive oseltamivir or zanamivir (no preference).\u00a0 Zanamivir should be used when persons require\n\n\n  chemoprophylaxis due to exposure to influenza A ( H1N1) virus. Rimantadine can be used if zanamivir use is contraindicated.\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<p>\n\n\n  Enhanced surveillance for influenza antiviral resistance is ongoing at CDC in collaboration with local and state health departments.\n\n\n  Clinicians should remain alert for additional changes in recommendations that might occur as the 2008&#8211;09 influenza season progresses.\n\n\n  Oseltamivir resistant influenza A (H1N1) viruses are antigenically similar to the influenza A(H1N1) viruses represented in the vaccine,\n\n\n  and vaccination should continue to be considered the primary prevention strategy regardless of oseltamivir sensitivity. Information on\n\n\n  antiviral resistance will be updated in weekly surveillance reports (available at <a href=\"http:\/\/www.cdc.gov\/flu\/weekly\/fluactivity.htm\">http:\/\/www.cdc.gov\/flu\/weekly\/fluactivity.htm<\/a>).\n\n\n<\/p>\n\n\n<p>\n\n\n  For more information on antiviral medications and additional considerations related to antiviral use during the 2008-09 influenza season,\n\n\n  call the Delaware Immunization Program at 1-800-282-8672 or visit <a href=\"http:\/\/www.cdc.gov\/flu\/professionals\/antivirals\/index.htm\">http:\/\/www.cdc.gov\/flu\/professionals\/antivirals\/index.htm<\/a>.\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #166 December 23, 2008 2:01 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10123","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10123","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10123"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10123\/revisions"}],"predecessor-version":[{"id":11299,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10123\/revisions\/11299"}],"up":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10123"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}