California Prison Health Care Services Public Health Unit INFLUENZA QUARANTINE PROTOCOL– Revised 10/09

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California Prison Health Care ServicesPublic
Health Unit INFLUENZA QUARANTINE PROTOCOL
Revised 10/09

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Status of Influenza In CDCR and CA

• In CDCR, 20 of the 33 institutions have had
  significant ILI outbreaks since July 2009.
• 370 ILI cases reported between Jul 09 and
  09/23/09
• 88 of outbreaks from 17 institutions were
  confirmed for H1N1 Influenza 15 hospitalized
• CDCR ILI protocols have been very effective in
  preventing widespread transmission of ILI in
  prisons.
• In California (non prisons), 2698 H1N1 reported
  hospitalized, ICU, or death cases.
• Between Jul 09 to 09/25/09.
• Number of probable H1N1 in community is far
  greater.

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Current CDCR ILI Protocol

• Isolate suspect ILI case until 24 hours post
  fever and symptoms.
• Send Preliminary Outbreak Report to PH Unit.
• For initial ILI case and any ILI cases from a new
  part of the prison.
• Gather data using Influenza Case Form.
• Send daily line list to PHU when there are two or
  more suspect cases.
• Collect nasal swabs
• Only if two or more suspects per outbreak
  location or
• If inmate is hospitalized.
• Quarantine
• Open dorm or gym unit as soon as single ILI case
  is identified.
• Cell block unit (single or double cells) when two
  ILI cases identified within 2 weeks of each
  other.
• Maintain quarantine for 7 days, starting from
  date of last ILI in unit.
• Establish heightened surveillance of quarantined
  unit and nearby areas.

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Revised ILI Quarantine Protocol

• Quarantine when
• 5 or more ILI SUSPECTS are identified within a 2
  week period who are living in the same housing
  unit.
• With fewer than 5 ILI suspects, maintain
  heightened surveillance in housing unit but do
  not quarantine.
• Isolation no change in policy.
• All suspect ILI cases must be isolated in single
  cell or cohorted with other symptomatic inmates.
• Isolate until 24 hours post fever and symptoms.
• as of 10/1/09

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What ILI Protocols Do Not Change

• All other ILI Protocol elements remain the same,
  including
• Suspect ILI case reporting
• To PH Unit and Local Health Department
• Enhanced Surveillance
• Clinic nursing staff conduct daily inmate symptom
  review for each new outbreak location.
• Nasal swab protocol
• Isolation Procedure
• Isolate in Ad Seg, single cell, or in a
  designated isolation area
• Greater than 6 feet away from well inmates
  and/or
• Inmates are masked when required to be closer to
  other people.
• Once 5 suspect cases are identified within a two
  week period in the same housing unit, quarantine
  duration remains the same (i.e., 7 days from last
  ILI case).
• Submit daily line lists for outbreaks (2 or more
  cases)
• Include dates and housing unit on line list.

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Why Revise the Quarantine Protocol?

• Recommended by CDPH.
• In past 3-4 months when inmates were rapidly
  isolated, the rates of transmission in the
  quarantine areas have been low.
• Current evidence suggests that a less restrictive
  quarantine will be safe and not result in large
  outbreaks (could change!)
• PH Unit will closely monitor to determine if
  there is an uptick in large outbreaks after new
  protocol is implemented.
• Secondary gain Improve inmate morale/compliance
  with quarantine over duration of influenza season
  (6 months).
• Encourages ill inmates to seek medical attention
  promptly.

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PHN/ICN Leadership Responsibilities

• Continue regular surveillance, training, and flu
  prevention programs.
• Lead vaccination campaigns throughout
  Fall/Winter.
• Provide timely reports outbreak and line lists.
• Continue to work with leadership to identify
  effective isolation areas for sick inmates.
• Plan for alternative quarantine sites (outside of
  normal housing units) for possible mass pandemic
  surge.

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Questions