Infectious Disease and Foreign Travel Emergencies 163Pandemic Influenza
● A pandemic is a global outbreak of a new type of infection in susceptible
individuals, with rapid person-to-person spread and the potential to affect
millions.
● International travel is the main reason for the speed of pandemic spread, so
international travellers are thus represented among the first cases of a variant
of influenza A to be seen in any new location.
● H1N1 influenza 09 was the most common cause of human influenza in 2009,
and spread around the world causing additional deaths, especially in young
adults. Pregnant women and the morbidly obese were at particular risk.
● In 2010, H1N1 influenza 09 became the principal cause of seasonal influenza.
DIAGNOSIS1 Inf luenza is an acute illness with an abrupt onset and peak symptoms in the
first 24–48 h.
(i) These most commonly include sudden fever, chills, headache, dry
cough, sore throat and muscle aches.
(ii) Diarrhoea can be a presenting complaint.
2 Ask patients presenting with fever or respiratory symptoms specifically
about interstate and international travel, or about contact with anyone who
has an acute respiratory illness ideally at triage, before entering the ED.
(i) Check the status of the current ‘at-risk’ countries at http://
wwwnc.cdc.gov/travel/ or refer to local policy information
concerning global infection threats.
MANAGEMENT1 Place a suspected case of inf luenza in isolation, preferably a negative-
pressure room, and give him or her a surgical mask to wear.
2 All attending staff must wear a correctly fitted, high-filtration mask (N95),
long-sleeved gown, gloves, and full eye protection.
3 Inform the senior ED doctor, the local infectious disease physician, and
hospital infection control officer.
(i) Call the clinical microbiologist and take FBC, ELFTs, blood
cultures and 30 mL serology including for atypical pneumonia.
(ii) Send a nose/throat swab and arrange a chest X-ray:
(a) alert the radiographer to the infection risk.
(iii) A nasopharyngeal aspirate (NPA) has a higher risk to staff and is
not recommended.
4 Specialist consultation and local policy will determine further management.