What is the management approach for an emerging virus infection?

Management Approach for Emerging Viral Infections

The management of emerging viral infections requires immediate implementation of strict isolation measures, appropriate personal protective equipment (PPE), and notification of public health authorities to prevent disease spread and reduce mortality.1, 2

Case Identification and Initial Assessment

Case Definition

• Suspect an emerging viral infection in patients with:
  • Fever (≥38°C) OR cough OR breathing difficulty
  • AND within 10 days before symptom onset:
    • Close contact with a probable/confirmed case
    • Travel to an area with recent local transmission
    • Exposure to laboratories handling viral isolates1

Initial Clinical Evaluation

• Assess for pneumonia-like presentation and disease severity
• Document travel history and exposure contacts
• Evaluate for risk factors associated with severe outcomes (diabetes, cardiopulmonary disease)1
• Monitor for typical symptoms: fever, fatigue, dry cough, dyspnea2

Infection Control Measures

Patient Isolation

1. Immediately give the patient a surgical mask to wear continuously1
2. Place patient in a negative pressure isolation room (preferred)1, 2
3. If negative pressure room unavailable, use a single room1
4. Consider transfer to a designated center with appropriate facilities1

Healthcare Worker Protection

• All healthcare workers must use appropriate PPE:1, 2
  • Gown (fluid-resistant)
  • Gloves
  • Eye protection (goggles or face shield)
  • Respiratory protection (N95 respirator or equivalent)
  • Strict hand hygiene before and after patient contact

Limiting Transmission

• Maintain a list of all staff who have contact with the patient1
• Restrict visitors to only next of kin/legal guardian1
• Staff should self-monitor for symptoms for 10 days after exposure1
• Avoid procedures that generate aerosols whenever possible1
• Maintain at least 1 meter distance from patient when possible2
• Ensure proper room ventilation2

Diagnostic Testing

Laboratory Specimens (with strict infection control)

1. Double-bag and label all specimens as biohazard1
2. Collect:
   • Expectorated sputum (if available)
   • Urine (20-30 ml)
   • Stool
   • EDTA blood (20 ml for PCR)
   • Acute serology (20 ml clotted blood)1

Avoid High-Risk Procedures

• Do not obtain nasopharyngeal aspirates (high aerosol generation risk)1

Additional Testing

• Chest X-ray
• Pulse oximetry
• Blood gases if oxygen saturation <92% on air
• Complete blood count, renal and liver function tests, electrolytes
• C-reactive protein, lactate dehydrogenase, creatinine kinase1

Treatment Approach

General Management

• Administer fluids and oxygen as required
• For suspected bacterial co-infection: intravenous antibiotics (e.g., co-amoxiclav 1.2g TDS or cefuroxime 1.5g TDS plus erythromycin 500mg QDS or clarithromycin 500mg BD)1

Oxygen Therapy

• Provide oxygen supplementation according to standard guidelines
• Avoid high-flow oxygen (>6 L/min) to reduce aerosol generation risk1

Antiviral Considerations

• For influenza-like illness, consider oseltamivir:
  • Treatment: 75mg twice daily for 5 days (adults)
  • Prophylaxis: 75mg once daily for at least 10 days after exposure3
  • Adjust dosing in renal impairment3

Critical Care Management

• Early consultation with critical care specialists for deteriorating patients
• Prepare for potential need for mechanical ventilation
• Implement enhanced infection control during aerosol-generating procedures1

Public Health Response

Notification and Reporting

• Immediately inform:
  • Hospital infection control representative
  • Local public health authorities
  • Regional designated infectious disease unit1
• Establish mechanisms for rapid alert of increased viral activity2

Contact Tracing

• Identify and monitor close contacts
• Consider prophylaxis for high-risk contacts when appropriate2, 3

Environmental Measures

• Frequent cleaning and disinfection of high-touch surfaces
• Use disinfectants containing 500 mg/L of chlorine2
• Reduce traffic in patient care areas2

Special Considerations

Healthcare Worker Safety

• Staff should not come to work if they develop fever1
• Seek advice from infection control and occupational health teams1
• Use proper donning and doffing procedures for PPE to avoid self-contamination2

Travel Precautions

• Take routine precautions when entering/exiting affected areas
• Avoid non-essential travel to affected regions2

Common Pitfalls to Avoid

• Delaying isolation of suspected cases
• Inadequate use of appropriate PPE
• Failure to notify public health authorities promptly
• Performing aerosol-generating procedures without proper precautions
• Neglecting to maintain a list of exposed healthcare workers
• Overlooking alternative diagnoses for pneumonia-like presentations1