RANDOLPH AIR FORCE BASE, Texas –
When two teenagers came to the Randolph Clinic on separate days more than two weeks ago with flu-like symptoms, a 12th Medical Group pediatric nurse practitioner let intuition be her guide.
Unusual circumstances prompted her to order throat cultures for the two 16-year-olds. About a week later, the Centers for Disease Control and Prevention confirmed the teenagers as the first two H1N1, or swine, influenza cases in Texas.
Swine flu is a respiratory disease commonly associated with pigs that is caused by type-A influenza.
"Their symptoms didn't fit the profile of a common cold or a bacterial infection," said Kathy Hagerman, the retired lieutenant colonel nurse practitioner who took the samples. "Since their fever was high for an extended period of time, and we were outside the normal flu season, I thought it best to take throat cultures from the two boys."
The 12th Medical Group quickly swung into action following confirmation of the two H1N1 flu cases April 23, which came on the heels of what was believed to be the initial cases in California and a wider outbreak in Mexico that generated widespread media attention and worldwide concern.
"We briefed the wing staff and ... did internal assessments for preparations to gear up for an increased number of patients," said Lt. Col. Gregory York, 12th MDG deputy commander. "Over the weekend, we had planning sessions on how to deal with it. At a meeting on Sunday we decided to break out our disease-containment plan that deals with influenza."
On Monday morning, with the clinic going to single-point entry control, 12th MDG staff wearing protective masks greeted clinic patients and inquired if they had flu-like symptoms. Those who answered "yes" were asked to don masks and were provided with sanitizing liquid for their hands before being isolated from other patients.
"We saw 70 to 75 patients with flu-like conditions on Monday and took 30 samples," Colonel York said. "The others didn't meet the criteria for possible influenza."
Clinic staff members reported taking 24 more cultures Tuesday from 46 patients with flu-like symptoms.
Meanwhile, 12th MDG leadership continued meeting with units on base and held briefings at the child development center, youth center and both Randolph Independent School District campuses.
"We're working diligently with wing leadership and public affairs to put out as much information as we can," Colonel York said.
Though campuses in the nearby Schertz-Cibolo-Universal City, Comal and New Braunfels Independent School Districts have been closed as a precautionary measure, Randolph Field ISD schools remained open as of Thursday.
"No positive cases have been confirmed in the Randolph schools," Colonel York said.
He also said no servicemembers at Randolph have tested positive for H1N1 influenza, but the clinic will continue its proactive stance as long as necessary.
"We have to figure out where this is going to go," Colonel York said. "We don't know where we are in its course."
Lt. Col. (Dr.) Andrew Moore, 12th MDG chief of medical staff, said cultures taken at Randolph are first sent to a lab at Brooks City-Base, where tests determine whether the virus is type-A or type-B influenza. Influenza A cultures are then tested at the CDC, where the subtype, such as H1N1, can be confirmed.
"We're in a unique situation," Dr. Moore said. "Randolph is the sentinel alarm for the rest of the country. People are looking at Randolph as a model for how to handle this kind of situation."
The 12th MDG's Public Health Flight is playing an important role in the mission by tracking the virus and helping to prevent its spread.
"We conduct epidemiological surveillance, checking to see if there is an increase of influenza in our population," said Master Sgt. Sheryl Green, Public Health Flight chief.
She said an epidemiological team from the School of Aerospace Medicine at Brooks is assisting the effort.
"What we're trying to do is break the chain of infection," Sergeant Green said. "We always do that, but this is on a much larger scale. We detect it, find it and try to stop it."
Colonel York offered common-sense guidance to help "break the chain."
"If you have flu-like symptoms, stay at home and take care of yourself," he said. "Stay out of social situations and gatherings. It's what is called social distancing."
Colonel York said people who display flu-like symptoms - fever, cough, sneezing, sore throat, stuffy nose, body aches and headache - for three to five days should seek medical help.
"Go see a doctor if you're not feeling better or the symptoms worsen," he said.
PRECAUTIONARY MEASURES YOU CAN TAKE
12th Medical Group officials encourage Randolph members and their families to follow these guidelines:
· Prevent the spread of viruses by washing your hands with warm water and soap or an alcohol-based gel after contact with a sick person or before eating
· Avoid touching your eyes and nose with fingers since these are the most common routes for viruses entering the body
· Avoid contact with people who are ill
· Sneeze or cough into a tissue or cover your mouth
· Use bleach-based cleaning agents or a bleach-based solution on contaminated surfaces to kill viruses and prevent the spread of viruses through indirect contact
· If you desire medical attention, go to a primary care manager or facility. Go to the nearest emergency facility or call 911 if you are severely ill
· Be especially careful with infants, small children, elderly, ill or those with a compromised immune system since they are more vulnerable to viral illnesses