Nevada changes flu test protocol

Only the sickest of the sick will now attract the undivided attention of public health officials when it comes to the swine flu.

In fact, swine flu confirmation tests will now "only be performed for hospitalized patients," according to a Southern Nevada Health District Bulletin sent to health care providers on Tuesday.

Physicians, the bulletin adds, no longer need to routinely test patients for the flu if they exhibit symptoms, nor should they submit specimens from non-hospital patients who test positive for a unique influenza A strain -- which requires further government lab testing for swine flu.

Why the new approach in identifying possible swine flu cases?

According to Dr. Ihsan Azzam, the state epidemiologist, health officials are now aware that the swine flu virus is circulating in the state, which he says was the purpose behind the enhanced surveillance or testing of possible cases by Nevada health care providers.

And what has largely been found, he said, is that the seven cases that have been confirmed so far are largely mild, usually involving people suffering from flu-like symptoms who get over them at home in a few days. Eight other probable cases, which have yet to be confirmed, are also described as mild.

Two new cases were confirmed in Carson City Thursday. A Carson City Health District official said the two newly reported cases of H1N1 Type A flu involve people under age 18 and that one is a student in Carson City.

Health District spokeswoman Cortney Bloomer said both patients had a mild form of the illness and have recovered. She said the school won't close.

"We have a clear understanding that the mild cases are comparable to the seasonal flu and can be treated as such," Azzam said. "What we need to have a better understanding of now is what makes the virus severe for some. We're encouraging providers now to focus on severe cases."

One of the state's top public health officials questions the change that Azzam said has been predicated by a new federal protocol.

Dr. L.D. Brown, director of the state public health laboratory, said: "I think we should keep doing what we've been doing ... I'm all in favor of waiting to see what happens with the numbers so we get a better idea of things."

Brown noted that most serious pandemics start off with a mild wave of cases in the spring and then "come back with a vengeance in the winter."

Azzam said the state is following what federal officials have talked about in daily conference calls. He said the government will soon stop the counting of new cases "in the aggregate" because "we know we have a lot of cases nationwide."

Officials with the Centers for Disease Control and Prevention in Atlanta did not return phone calls or e-mails Thursday on the government's new method of tracking swine flu cases.

The Southern Nevada Health District bulletin explained the issue this way to health care providers: "The CDC has recently refocused its goals on monitoring the severity of illness among those who acquire infection with the new virus. They have asked that states submit no more than 10 isolates per week, preferably from patients with severe disease or those hospitalized with an influenza-like illness, so they can monitor the virus for any mutations."

Though health officials have been sending its flu samples to the CDC, they said Wednesday that state labs in Reno and Las Vegas have been cleared to do the same testing.

Only one of Nevada's seven confirmed cases, a 39-year-old Clark County woman who initially was in critical condition, has been hospitalized for several days. Azzam said another Nevadan, who he would not identify, was hospitalized briefly "with a moderate case" of the flu.

Azzam said the state tested 500 samples sent by health care providers and about 90 samples turned out to be flu. About half of those were of the A strain that includes swine flu.

"We were very lucky that what we've seen across the nation is much milder than what we prepared for," Azzam said.

In fact, complications from seasonal flu end up killing 36,000 Americans each year. Another 200,000 are hospitalized.

Brian Labus, senior epidemiologist for the Southern Nevada Health District, said physicians should test for the seasonal flu at present as they have in the past. Those with serious respiratory illness or at high risk of complications should be tested, he said, in order for the doctor to make a proper clinical evaluation of treatment. This advice applies to mild cases of swine flu as well.

Labus said that very often doctors treat their patients with flu-like symptoms for the flu without a test. He also said that health officials are aware that most people don't seek care for the flu.

"What we want to really find out from the tests we do know is if there is some change in the virus that can make it more severe," he said.

The Associated Press contributed to this report. Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.