Our state department of public health issued a bulletin for clinicians about discontinuing routine diagnostic testing by the State laboratory to confirm cases of the H1N1 (Swine) flu virus. This makes good sense because the H1N1 virus is so increasingly widespread, that laboratory confirmation is less critical to decisions regarding antiviral treatment and disease control. Instead, we can perform rapid testing in the office setting for the Influenza A virus, which if positive, presumes the presence of the H1N1 virus.

The MA Department of Public Health instead is only testing for the virus in rare circumstances. So what are those rare circumstances? Suspected H1N1 viral infection in a health care worker who works with extremely sick patients – for example, nurses who work in neo-natal intensive care units or ICUs etc.

Because these health care workers can potentially infect severely compromised patients, it makes sense to confirm the diagnosis.

The state lab will continue to test specimens from “sentinel sites” meaning areas that have not reported previous outbreaks. This is to provide information about disease surveillance and tracking for genetic mutations over time.

So when I had my suspected case of swine flu in the office recently, I swabbed the nasal mucosa of my patient to test for the presence of Influenza A.  The Influenza A virus is responsible for normal seasonal flu outbreaks that occur as well as the H1N1 virus.

Since this is not the season for the flu, the DPH told us that we could presume the diagnosis of  H1N1 (Swine flu) if the swab was positive for Influenza A.

As a reminder, the symptoms include fever, body aches/pains, sore throat, cough, runny nose and fatigue which generally comes on suddenly.

This time of year, if it sounds like the flu, it is the H1N1 (Swine) flu and treat accordingly.

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