State H1N1 Information

Programs

H1N1 Clinical Testing Protocols

Of the fifty states and four territories with testing protocol on an official website, only six provide a direct link to the CDC's testing recommendations from May 13, 2009. The majority of state public health laboratories have restricted influenza subtype testing to several prioritized groups of patients or to specimens submitted from the state's network of sentinel surveillance providers.

The CDC updated its recommendations for testing suspected novel H1N1 specimens on September 29, 2009. In summary, testing should be considered for hospitalized patients with suspected influenza; patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts; and patients who died of an acute illness in which influenza was suspected. It is unclear at this point whether or how state guidance will conform to CDC's latest recommendations.

State public health laboratories differ fairly widely in their policies for accepting influenza A specimens. Many states prioritize patients who are hospitalized, deceased, or part of a suspected outbreak for H1N1 subtype testing. As of November 2009, fewer states were prioritizing state laboratory testing for specimens from pregnant women. Massachusetts recommends testing when test results will benefit the clinical treatment of the patient, and West Virginia is following CDC's testing recommendations issued in September 2009.

 

 
Alabama
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients, pregnant women, and a weekly fixed number of patients seen in designated surveillance practices.
Alaska
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients with ILI regardless of rapid influenza A test results, and specimens from outpatients with severe ILI who receive a negative influenza A rapid test.
American Samoa
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for updated recommendations on diagnostic testing.
Arizona
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients.
Arkansas
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for updated recommendations on diagnostic testing.
California
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from individuals with serious illness, including hospitalized patients and patients at high risk for complications.
Colorado
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for full updated recommendations on diagnostic testing.
Connecticut
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized with ILI and healthcare workers with ILI and a negative rapid influenza A test.
Delaware
H1N1 Clinical Testing Protocols
Summary: Recommends testing specimens from patients with febrile respiratory illness who 1) live in an area where human cases of H1N1 have been identified; 2) have traveled to an area where human cases of H1N1 have been identified; or 3) have been in contact with ill persons from these areas in the seven days prior to their illness onset.
District of Columbia
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who have been hospitalized with ILI for at least 48 hours, ante-mortem specimens from patients who have died with ILI, pregnant patients exhibiting ILI, and specimens from sentinel providers.
Florida
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI who have been hospitalized for severe or worsening symptoms.
Georgia
H1N1 Clinical Testing Protocols
Summary: Georgia's Public Health Laboratory is limiting testing to ILINet sentinel providers (maximum of 3 samples per week); participants in the Emerging Infections Program (27 hospitals); and patients with ILI who are hospitalized in the ICU only. (updated October 1)
Guam
H1N1 Clinical Testing Protocols
Summary: Notes that confirmation of novel influenza infection may be necessary for surveillance purposes and for special situations, e.g. severely ill patients, those with immune-compromising conditions, or who are pregnant or breast feeding, but does not specify whether that is Guam's specific policy.
 
Hawaii
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to: specimens collected by sentinel providers; specimens collected from patients with ILI who are severely ill and hospitalized; part of a health department disease outbreak investigation; have a history of travel outside the United States in the 10 days prior to illness onset; work in high-risk occupations, such as healthcare workers engaged in direct patient care; or are potentially at high risk for complications.
Idaho
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI who are hospitalized or patients with ILI who either work in a hospital setting, are pregnant, or are part of a possible outbreak.
Illinois
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from individuals who are hospitalized with ILI, recently deceased, or part of a suspected outbreak.
Indiana
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI seen by a sentinel provider, or from any death associated with ILI.
Iowa
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients with ILI.
Kansas
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who have respiratory illness (i.e., recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough, and fever or feverishness); AND who live in an area where cases of H1N1 have been identified, who have traveled to an area where cases of H1N1 have been identified, or have been in contact in the seven days prior to their illness onset with ill persons who reside in or have visited an area where cases of H1N1 have been identified.
Kentucky
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with acute febrile respiratory illness who are pregnant, hospitalized, or institutionalized in venues where previous cases have not been identified.
Louisiana
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients hospitalized with an ILI. The state laboratory will also test a sample of patients presenting to sentinel providers.
Maine
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized, patient who have died, and/or patients who are associated with a suspected outbreak.
Maryland
H1N1 Clinical Testing Protocols
Summary: The state laboratory is limiting testing to specimens from patients who are hospitalized, deceased, or part of a suspected outbreak. (updated October 19)
Massachusetts
H1N1 Clinical Testing Protocols
Summary: Recommends diagnostic testing only when the results will benefit the clinical management of a patient or where there is a clear public health benefit. Specimens should only be submitted to the state laboratory following the approval of a state health department epidemiologist.
Michigan
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized with severe ILI (i.e., ICU patients); patients with an ILI of an unusual presentation (e.g., encephalopathy, cardiac complications); pregnant women with severe ILI; outbreaks or clusters of ILI in congregate settings, as requested by local or state public health; and influenza-related deaths.
Minnesota
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI if they are hospitalized or deceased or have had contact with pigs in the seven days prior to onset of symptoms or during their illness.
Mississippi
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI who present to a sentinel provider and all patients who are hospitalized for treatment of ILI. The state laboratory will only accept a maximum of three samples per week from each sentinel provider.
Missouri
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens submitted by sentinel providers or specimens submitted as part of a suspected outbreak for epidemiological investigation purposes. The state laboratory is not accepting routine specimens for novel H1N1 influenza virus testing.
Montana
H1N1 Clinical Testing Protocols
Summary: Recommends that clinicians submit specimens for testing at their discretion when they want to confirm an influenza virus subtype.
Nebraska
H1N1 Clinical Testing Protocols
Summary: Recommends diagnostic testing for specimens from hospitalized patients with suspected influenza following testing through the hospital's in-house laboratory. The state laboratory will also test specimens obtained from sentinel providers.
Nevada
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for full updated recommendations on diagnostic testing.
New Hampshire
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients with ILI; healthcare workers with ILI in direct care patient settings; and patients suspected to be part of a cluster of undiagnosed respiratory illness in consultation with public health.
New Jersey
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens obtained from patients who have died with ILI, patients with ILI who require management in the ICU, and patients who are younger than 18 years and have been diagnosed with encephalopathy.
New Mexico
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to patients who are hospitalized or have died with ILI.
New York
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimen from patients who have been reported to the state or local health department and approved for testing. Testing is currently prioritized for patients who are hospitalized and/or part of a community or healthcare facility outbreak. In areas without widespread activity and in facilities with no cases among patients and/or staff, testing of HCWs with ILI should also continue to be prioritized. The state laboratory strongly recommends testing via commercially available tests for patients who are hospitalized with an acute febrile respiratory illness (i.e., ILI, fever and pneumonia, ARDS, or respiratory distress). These patients should also be reported to the local health department to assess the need for confirmatory testing at a public health laboratory.
North Carolina
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients with ILI who are hospitalized in the ICU, patients seen by sentinel providers, and patients who die with ILI.
North Dakota
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to patients with ILI who require hospitalization.
Northern Mariana Islands
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for updated recommendations on diagnostic testing.
Ohio
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized with ILI and have a negative rapid test. Ohio is no longer conducting surveillance testing on specimens that have tested positive on a rapid or RT-PCR test. Ohio is also no longer testing specimens from deceased patients with ILI.
Oklahoma
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to: patients who are hospitalized or deceased with suspected influenza; currently pregnant; health workers or employees involved in direct patient care; employees or residents or residential care facilities; or part of an outbreak when testing is approved by a state epidemiologist. The state laboratory will also test samples obtained from 18 viral respiratory illness surveillance sites and samples obtained from all hospitalized patients within the five-county enhanced surveillance catchment areas of Cherokee, Comanche, Garfield, Oklahoma, and Potonoc.
Oregon
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized with ILI and respiratory symptoms, following in-house testing.
Pennsylvania
H1N1 Clinical Testing Protocols
Summary: Encourages providers to consider the possibility of testing in patients with febrile respiratory illness but recommends that they consult their state or local health department about the feasibility of submitting a specimen for testing.
Puerto Rico
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens obtained from patients who present with fever and cough or sore throat.
Rhode Island
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from patients who are hospitalized with ILI, deaths due to ILI, pregnant women, institutional clusters of ILI as directed by epidemiology staff, selected healthcare workers, and patients with ILI who are seen by sentinel providers.
South Carolina
H1N1 Clinical Testing Protocols
Summary: Recommends diagnostic testing to specimens from the following priority groups: all hospitalized patients with ILI; patients who are dying or have died of ILI from whom ante-mortem and/or post-mortem specimens should be obtained; patients who are part of an outbreak or cluster of cases; patients with ILI who present to a sentinel provider; and selected other persons who may be considered of special interest because of carefully considered clinical, epidemiologic, or public health reasons.
South Dakota
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients with ILI; seriously ill patients who have risk factors such as pregnancy, breast feeding, or underlying medical conditions; patients that are part of a cluster investigation or other unusual circumstance; or patients who present to a sentinel provider, who may only submit a maximum of five samples a week.
Tennessee
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens obtained from sentinel providers, Emerging Infections Program influenza surveillance hospitals, and cases of public health significance, which require pre-approval.
Texas
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens obtained from: 1) patients hospitalized for at least 48 hours with influenza symptoms, plus either a severe illness, such as a lower-respiratory tract infection or pneumonia, and/or unusual presentation in children or people who are over 64 years and/or immunocompromised; 2) patients with ILI who have died; 3) individuals with ILI who are part of a critical public health investigation; and 4) patients who present to sentinel providers.
Utah
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to specimens from hospitalized patients and other cases that have been screened and authorized for outbreak characterization testing.
Vermont
H1N1 Clinical Testing Protocols
Summary: Recommends diagnostic testing for specimens from hospitalized patients with ILI who are being considered for antiviral treatment.
Virginia
H1N1 Clinical Testing Protocols
Summary: Directs users to CDC guidelines for updated recommendations on diagnostic testing.
Washington
H1N1 Clinical Testing Protocols
Summary: Restricts diagnostic testing to: specimens from deceased or critically ill patients (i.e., admitted to the ICU) with ILI; hospitalized patients who have tested positive for influenza on the rapid test; and, at the healthcare provider's discretion, non-hospitalized pregnant women who have tested positive for influenza on the rapid test.
West Virginia
H1N1 Clinical Testing Protocols
Summary: Follows CDC's September 2009 recommendations: hospitalized patients with suspected influenza; patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts; patients who died of an acute illness in which influenza was suspected.
 
Wisconsin
H1N1 Clinical Testing Protocols
Summary: Fee-exempt testing at the state laboratory is limited to specimens from pregnant patients, deceased patients, residents or staff of a residential or correctional facility, hospitalized patients, and cases that have received public health agency approval.
Wyoming
H1N1 Clinical Testing Protocols
Summary: Recommends diagnostic testing for specimens from patients who present to sentinel providers. Healthcare providers should conduct testing for influenza per their usual practice and report influenza cases to the Wyoming Department of Health.