BCCDC responds

Issue: BCMJ, vol. 51, No. 8, October 2009, Page 335 Letters
By: Danuta M. Skowronski, MD, FRCPC Travis Hottes, MSc,

A cardinal feature of influenza illness is its short incubation and sudden onset. For seasonal influenza viruses, the incubation period is generally estimated to be 1- to 4-days.[1] The 2009 swine-origin pandemic A/H1N1 (pH1N1) virus is considered a novel pathogen, but it is nevertheless an influenza virus and anticipated to share consistent epidemiologic characteristics. Published data estimating the specific incubation period for pH1N1 are limited but nevertheless consistent with this typical 1- to 4-day range, with some series suggesting an upper limit of 7 days.[2-4]

In light of these observations, the US Centers for Disease Control and Prevention,[5] European Centre for Disease Control,[6] and the World Health Organization[7] each currently cite an incubation period of 1 to 7 days for pH1N1, acknowledging up to 4 days is a more likely range. The Public Health Agency of Canada also initially advised of a 1- to-7 day incubation period but has recently revised its guidelines to specify 1 to 4 days as most likely.[8] Thus, even doubling the likely incubation period as a margin of error, most people may consider themselves “out of the woods” if still asymptomatic at 1 week following specific pH1N1 exposure.

—Danuta M. Skowronski, MD
—Travis Hottes, MSc
Influenza & Emerging Respiratory Pathogens Team
BC Centre for Disease Control

References

1. Lessler J, Reich NG, Brookmeyer R, et al. Incubation periods of acute respiratory viral infections: A systematic review. Lancet Infect Dis 2009;9:291-300.
2. Dawood FS, Jain S, Finelli L, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360: 2605-2615.
3. Jeannot AC, Hamoudi M, Bourayou N, et al. Premiers cas de transmission secondaire en France du nouveau virus grippal d’origine porcine A(H1N1)v. Médecine et maladies infectieuses 2009;doi:10.1016/j.medmal. 2009.06.014.
4. Odaira F, Takahashi H, Toyokawa T, et al. Assessment of secondary attack rate and effectiveness of antiviral prophylaxis among household contacts in an influenza A(H1N1)v outbreak in Kobe, Japan, May - June 2009. Eurosurveillance 2009;14(35).
5. US CDC. Interim guidance for clinicians on identifying and caring for patients with swine-origin influenza A(H1N1) virus infection. cdc.gov/h1n1flu/identifyingpatients.htm (accessed 15 September 2009).
6. European Centre for Disease Prevention and Control. ECDC Interim Risk Assessment: Influenza A(H1N1) 2009 Pandemic. 20 July 2009. ecdc.europa.eu/en/health topics/Documents/0908_Influenza_AH1N1_Risk_Assessment.pdf (accessed 15 September 2009).
7. World Health Organization. Transcript of virtual press conference with Gregory Hartl, WHO Spokesperson for Epidemic and Pandemic Diseases, and Dr. Keiji Fukuda, Assistant Director-General ad. Interim for Health Security and Environment, WHO. 04 May 2009. www.who.int/mediacentre/swineflu_presstranscript_2009_05_04.pdf (accessed 15 September 2009).
8. Public Health Agency of Canada. Individual and community based measures to help prevent transmission of influenza-like illness (ILI) in the community, including the pandemic influenza (H1N1) 2009 virus. 10 September 2009. phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps-info_health-sante-eng.php (accessed 15 September 2009).

Danuta M. Skowronski, MD, FRCPC, Travis Hottes, MSc,. BCCDC responds. BCMJ, Vol. 51, No. 8, October, 2009, Page(s) 335 - Letters.


Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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