General Information

CDPH Health Alert Update

Please route this update to appropriate staff — medical staff director, infection control practitioner, risk manager, emergency department manager, pharmacy director, disaster coordinator, human resource director — within your hospital. If you have questions or need assistance, please contact Michele Coughlin, (916) 552-7672,; Cheri Hummel, (916) 552-7681,; or Roger Richter, (916) 552-7570,

The California Department of Public Health (CDPH) issued the attached Health Alert Update on July 22 for health care providers and clinicians. Note the name change to Pandemic (H1N1) 2009 from Novel Influenza A (H1N1) to be consistent with the World Health Organization nomenclature. All CAHAN-enrolled hospitals should have received this and all other related alerts.

The following information is a snapshot of the summary from the interim guidance on antiviral recommendations for Pandemic (H1N1) 2009 virus infection. According to CDPH, a complete revised guidance will be released soon. Please review the attached alert carefully for further details.

  • CDPH recommends the selective use of Oseltamivir or Zanamivir to reduce severe disease and mortality caused by the H1N1 virus infection while delaying development of drug resistance.
  • Antiviral treatment recommendations include, but are not limited to, the following:
    • Higher (double) doses and extended (up to 10 days) courses of treatment should be considered for patients:
      • Requiring intensive care; OR
      • At higher risk — Body Mass Index (BMI) ≥ 35 (very obese) — and either hospitalized or with pneumonia.
  • Antiviral chemoprophylaxis for up to 10 days after last exposure can be considered for:
    • Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an infectious patient, co-worker or household contact.  

Other items of importance are:

  • Persons at higher risk for severe H1N1 virus infection have:
    • Underlying medical conditions associated with severe seasonal influenza; OR
    • A BMI ≥ 35.
  • H1N1 lessons learned and clinician considerations:
    • Asthmatic patients with H1N1 infection may present with what appears to be an asthmatic exacerbation rather than ILI. 

CHA will continue to post Health Alert Updates to its new emergency preparedness website at However, we encourage all hospitals to enroll in their local and state health alerting systems (e.g., CAHAN).

It is important to note that information and guidance changes can occur at any time. This is a fluid environment and, therefore, hospitals and all health care providers must remain alert, vigilant and flexible to plan and respond accordingly. Additionally, hospitals should note the differences between guidance or recommendations and requirements or mandates. Local public health jurisdictions can modify state/federal guidance and set separate local recommendations. However, local public health cannot modify state regulations or requirements, which are established in law.