Novel and Variant Influenza A Viruses
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Information for Health Professionals on Influenza A Variant Viruses (H3N2v, H1N2v, H1N1v)
Specimen collection and testing
- Commercially available rapid influenza diagnostic tests may not detect H3N2v, H1N2v, or H1N1v in respiratory specimens.
- MDH is very interested in conducting RT-PCR testing for surveillance purposes on outpatients with illness compatible with influenza* who meet any of the following criteria:
- Recent (7 days or less) direct or in-direct contact with swine.
- Recent attendance at an agricultural fair where swine were present.
- Recent contact with a confirmed case of variant or swine influenza A infection (such as H3N2v, H1N2v, or H1N1v).
* Illness compatible with influenza may present as influenza-like illness (ILI):
fever ≥100°F plus cough and sore throat.
Note that influenza may not cause fever in all patients (especially in patients < 5 years of age, ≥ 65 years of age, or patients with suppression of their immune system).
For patients admitted with ILI or clinical suspicion of influenza without evidence of pneumonia or other lower respiratory disease – submit one upper respiratory specimen per patient.
- Nasopharyngeal swab is the preferred specimen
- Other acceptable specimens include nasal swab, nasal wash/aspirate, throat swab, or combined nasal swab with an oropharyngeal swab, and viral culture
- Place respiratory specimens into viral transport media (VTM; e.g., M4, M5, Universal Transport Media) for transport to MDH-PHL. Washes and aspirates may be collected in saline and placed into 1-3 milliliters viral transport media.
- Store and ship at refrigeration temperature.
- Freeze specimen, and ship frozen, if it will not reach MDH-PHL within 7 days.
- Swabs collected and/or transported in non-sterile containers, baggies, or without transport media (dry) will not be accepted.
- Ship at refrigeration temperature.
- New England Journal of Medicine: H1N1 Influenza A Disease - Information for Health Professionals
Refer to Collection of Nasopharyngeal Specimens with the Swab Technique video.
Please indicate "swine exposure" as appropriate.
Only a single Clinical Testing and Submission Form is required; however, you must use the correct version of the form, which is dependent on whether the patient is hospitalized or not.
NOTE: There is NO fee sticker required for influenza testing.
Non-Hospitalized Influenza Testing (Project #493)
Use this form for submitting specimens for influenza testing from non-hospitalized patients. Write project #493 in the upper right-hand corner of the form and indicate "swine exposure" as appropriate.
- Infectious Disease Laboratory Submission Form (PDF)
Printable and/or fillable. More information can be found on Forms for the Infectious Disease Laboratory
Hospitalized Patients Only (Project #1492)
Use this form for all specimens submitted from persons hospitalized with ILI or clinical suspicion of influenza. In order to allow for prompt testing of submitted specimens for project #1492, please be sure to fill out the form completely, especially information regarding hospitalization (date of admission, hospital of admission, and outcome) found on the lower right-hand corner of the form, and indicate "swine exposure" as appropriate.
- Hospitalized Influenza Submission Form Project 1492 (PDF)
- Influenza Form Guidance (PDF)
More information can be found on Forms for the Infectious Disease Laboratory
- Influenza Form Guidance (PDF)
Shipping to MDH-PHL
- Ship at refrigeration temperature.
- Use cold packs to keep specimens at 4 degrees C.
- Ship specimens to MDH-PHL by an overnight delivery service.
- NOTE: It is the responsibility of the submitting laboratory to determine the appropriate packaging and shipping for patient specimens and culture isolates.
- DOT HAZMAT regulations: PHMSA Regulations
- Ship to:
Minnesota Department of Health
Public Health Laboratory
Attn: Biological Accessioning
601 Robert St. N
St. Paul, Minnesota 55155-2531
Questions?
- For an MDH epidemiologist, call 651-201-5414 or 1-877-676-5414.
- During business hours you can call the Virology Supervisor at 651-201-5035.
Commercially available rapid influenza diagnostic tests may not detect H3N2v, H1N2v, or H1N1v in respiratory specimens.
- CDC: Evaluation of Rapid Influenza Diagnostic Tests for Influenza A (H3N2)v Virus Infections and Updated Case Count – United States, 2012 (PDF). CDC Morbidity and Mortality Weekly Report 2012. Early Release August 10, 2012.
Surveillance and reporting
- Reporting Influenza
In Minnesota, influenza is a reportable disease. - MDH is also conducting enhanced surveillance through established sentinel influenza surveillance sites.
More about seasonal and novel influenza A for Health professionals:
- Influenza Information for Health Professionals
- Information For Health Professionals on Novel Influenza A Viruses
Treatment
- Clinicians should consider antiviral treatment with oral oseltamivir or inhaled zanamivir in patients with suspected or confirmed variant or swine influenza virus infection.
- Antiviral treatment is most effective when started as soon as possible after influenza illness onset.
- Testing at the Minnesota Department of Health may take several days and the decision to treat should be based on clinical judgment.
Further information on diagnosis and treatment
CDC: Variant Influenza Information for Health Professionals and Laboratorians
Case definitions, infection control, guidance, and other resources.