• Patients with influenza-like illness (ILI)^*
• AND
• Those at high-risk for developing complications from influenza^**
  OR Those hospitalized with an influenza-like illness^*

^{*ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than influenza.}

^**Groups at higher risk for seasonal influenza complications include:

• Children less than 5 years old;
• Persons aged 65 years or older;
• Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infection;
• Pregnant women;
• Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
• Residents of nursing homes and other chronic-care facilities.

Additional Information
Continue to review guidelines that will be provided at www.idph.state.ia.us/h1n1 and at www.cdc.gov/h1n1flu.

Testing Instructions for Novel Influenza A (H1N1):

Tests: Posterior nasopharyngeal swab is the recommended test. Nasopharyngeal aspirate or wash will also be accepted. UHL will not charge for this test.

Collection: Use Dacron or rayon swabs with a flexible metal shaft swab or NP-flocked swab with flexible plastic shaft. Do not use calcium alginate or wooden-shafted swabs. Use M4 transport tube provided in kit or equivalent viral transport media. Place swabs in M4 transport medium, and do not remove. Do not send dry swabs. Refrigerate specimens at 2-8°C immediately after collection.

Test request form instructions: On the viral test request form, clearly document all clinical information, including signs and symptoms.

Shipping: Wrap the specimen in absorbent material, and place into a biohazard bag. Ship the specimen at cold 4 degrees C with ice (cool) packs. Use routine courier service to transport specimens to UHL or contact your healthcare network laboratory coordinator for more information. Online collection and shipment instructions, as well as a test request form are avaliable.

Please note that specimens submitted to UHL will be screened to determine whether patients meet the above criteria for testing. Tests that do not meet the criteria will not be tested.

Guidelines for Iowa Influenza Surveillance Network Sentinel Providers:

IDPH will begin conducting year-round influenza surveillance this year (2009) due to the recent outbreak of Novel Influenza A (H1N1). This decision is based on the CDC recommendation to implement a year-round seasonal influenza surveillance system. IDPH plans to ask Iowa Influenza Surveillance Network (IISN) participants to conduct year-round surveillance and reporting.

Thus patients seen by IISN sentinel providers with influenza-like illness* symptoms (regardless of hospitalization or risk factors) should have specimens taken and submitted for testing.