H1NI Influenza

H1N1 Influenza- ABC Guidelines


Clinical features
‐ Fever,
‐ Upper respiratory symptoms
‐ Cough
‐ Sore throat.
‐ Head ache, body ache, fatigue diarrhea and vomiting have also been observed

Categorization guidelines

• Category- A- 

mild fever plus cough / sore throat with or without body ache, headache, diarrhoea andvomiting

• Category-B-

(Bi) Category-A+ high grade fever and severe sore throat
(Bii) Category-A+ one or more of the following
 Pregnant women
 Lung/ heart / liver/ kidney / neurological disease, blood   disorders/ diabetes/ cancer /HIVAIDS
 On long term steroids
 Children -- mild illness but with predisposing risk factors.
 Age 65 years+.

• Category-C

 · Breathlessness, chest pain, drowsiness, fall in blood pressure, haemoptysis, cyanosis
 · Children with influenza like illness with red flag signs
 .Somnolence, high/persistent fever, inability to feed well, convulsions,
dyspnoea/respiratory distress, etc).
 · Worsening of underlying chronic conditions.

Testing Recommendations

Cat- A- No testing needed
Cat-B- No testing for Category-B (i) and (ii)
Cat-C- Test, but do not wait for test results .


Specimen required- 1 throat swab and 1 nasal swab, using Dacron swab, and immersed inViralTransport Medium tube, immediately put in cold chain/ refrigerated till dispatch at 2-8deg C in thermocol box with i-2 ice packs


Despatch is recorded, and should be only through the DMO/DSO of the district. 
The only authorized testing centres for Kerala are Rajiv Gandhi Centre for Biotechnology,Thiruvananthapuram, and Virology Division, KMC Hospital, Manipal, Karnataka State. Specimens
directly sent by individuals/hospitals will not be accepted at either of these centres.

Management Recommendations

Category- A- No Oseltamivir
--Symptomatic treatment
---Good supportive measures
 Plenty of warm nourishing oral fluids,
 Good food intake
 Complete rest
--Monitor progress
--Reassess, at 24 to 48 hours
--Self isolation at home, and telephone follow up for the next 2-3 days
--Any suggestion of deterioration/ failure to improve?-- report in person stat.
Category-B
(i) home isolation
Oseltamivir may be needed;
(ii) --Start Oseltamivir immediately
--Self isolation at home, and telephone follow up for the next 2-3 days
--Any suggestion of deterioration/ failure to improve?-- report in person stat.
Category-C
Hospitalization immediately
Start Oseltamivir immediately, without waiting for test results
Intensive supportive management is usually necessary.

Pregnancy and H1N1

Exterme high risk category
Any Influenza Like Illness in a pregnant female – suspect H1N1.
Early referral to appropriate centre to start Oseltamivir /If any delay in transit expected, start
Oseltamivir, then refer.
Oseltamivir in pregnancy so far is considered safe
“Counseled prescription” should be given.


Community spread- MOHFW guidelines…


“If there is 25 or more epidemiologically linked suspect cases of Pandemic Influenza A considered to be having community spread”.
 No mass contact prophylaxis advised
 Others – assess category, if and when symptomatic, then treat as per ABC guidelines