PUBLIC HEALTH FACTS BY FAX April 30, 2009 Skagit County Health Department Howard L. Leibrand, M. D. Health Officer "Always working for a safer and healthier Skagit County" 336-9380 (voice) 336-9401 (fax) Please copy and distribute this fax to each provider served by this fax number. Number of pages: SWINE-ORIGIN H1N1 INFLUENZA UPDATE April 30, 2009 Communication: As I have done in the past, I will use this method to keep you up to date on the public health aspects of the current pandemic situation. We at Skagit County Public Health participate in daily conference calls with several state-level agencies and with all of the health departments across the state. We also receive updates by fax, email and text messaging from CDC and Washington DOH. Pertinent information will be forward to you as available. The news media has also been a good source of up-to-date information. The following websites give current and concise updates as soon as available:
Current Status Update: The World Health Organization (WHO) has elevated the swine flu situation to Pandemic Phase 5, meaning a novel virus with sustained human to human transmission. The severity of disease in Mexico appears to be much less than initially thought with the number of deaths attributable to swine flu considerably decreased. There are now 109 confirmed cases in 11 states, and that number is climbing hourly. There are 10 probable cases in Washington, and many more cases being evaluated. Locally, we have 2 suspected cases with samples being evaluated at the Washington State Public Health Lab. As illness becomes more widespread, the importance of travel as a risk factor diminishes considerably.
Prevention: Encourage your patients to take everyday actions to stay healthy. The message for ALL of us is: “Cover your nose and mouth with a tissue or sleeve when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread that way. STAY HOME IF YOU GET SICK. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.” Prevention in Health Care Settings: These recommendations pertain to all hospitals, clinics/offices, nursing homes, and other health care facilities. Post all entrances to your facility (public and staff) with signs asking symptomatic patients and visitors to wash hands and wear masks and symptomatic staff to not report for work but to contact their human resources representative. Symptomatic patients should be isolated in a separate waiting room or taken immediately to a treatment room. Symptomatic visitors should be discouraged from visiting. Symptomatic patients must wear masks at all times. If the mask is removed for any reason, staff present must have an N95 respirator or better in place. If staff has been exposed without protection to someone who becomes a suspected,
probable or confirmed case, antiviral prophylaxis is recommended, along will a thorough review of infection control procedures at the facility. Evaluation and Testing: Influenza A testing should be done in the following situations:
1. Patients seen in acute care settings with influenza-like respiratory
symptoms (i.e., fever >100F or 37.8C PLUS cough and/or sore throat), AND close contact with a person with confirmed or probable swine flu, OR travel to a community with one or more confirmed cases of swine flu, OR residence in a community with one or more confirmed cases of swine flu should be tested for Influenza A.
2. Persons hospitalized with severe respiratory illness (i.e., fever >100F or
37.8C PLUS SOB, hypoxia, or radiographic evidence of pneumonia) that may be due to influenza.
3. Unexplained deaths in patients <50 years of age that appear due to
severe respiratory illness, respiratory failure or pneumonia.
If positive for influenza A, the patient is then considered a suspected case. The lab will forward the specimen to the State Lab. If the sample tests negative for the common Influenza A subtypes, the patient is then considered a probable case (unsubtypable). The sample is then sent to the CDC for specific testing for swine flu. Most of these are positive and become confirmed cases. State labs may have the ability to do this confirmatory test by next week. Antivirals: Minimal antiviral medications are currently available in this county, and are reserved for treatment of suspected swine flu cases. The Strategic National Stockpile (SNS) is currently distributing 25% of its antiviral supply along with Personal Protective Equipment (PPE). These should reach the local counties by early next week. Dispensing of these medications and items will be controlled by local public health. Further information will follow. Treatment recommendations: All suspected, probable, or confirmed cases of swine flu should be isolated in the homes or health care facilities as appropriate. Heavy emphasis should be given to hand washing and wearing appropriate masks/respirators. A treatment course of Tamiflu or Relenza should be given if available. Household contacts who are pregnant or otherwise high risk should be given a prophylactic course of Tamiflu if available. Contingency plans: Keep your organization healthy by heavy emphasis on prevention. Don’t allow your people to come to work sick, and have a plan in place to deal with increased absenteeism if this virus becomes more widespread. Our activity with the Medical Reserve Corps is ongoing, and will represent a source of extra help if needed.
Doing what we do every day to keep our community healthy!
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Administrative Appeals Tribunal DECISION AND REASONS FOR DECISION  AATA 639 ADMINISTRATIVE APPEALS TRIBUNAL No NT2005/7, NT2005/56 to 65 TAXATION APPEALS DIVISION ROCHE PRODUCTS PTY LIMITED Applicant COMMISSIONER OF TAXATION Respondent DECISION Tribunal Place Sydney Decision The decision of the Commissioner of Taxation is