HINI INFLUENZA

DON'T HAVE TO BE PANIC BUT'VE TO TAKE CARE

ABC GUIDELINES

Category A- mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and
vomiting
--No Oseltamivir required
--Symptomatic treatment
--Good supportive measures
 Plenty of warm nourishing oral fluids,
 Good food intake
 Complete rest
Category-B
(Bi) Category-A plus high grade fever and severe sore throat
        ---Home isolation
        ---Oseltamivir to be started as per clinical assessment;
(Bii) Category- Any mild ILI in people with co-morbidities
 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+.
        ----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
 · Breathlessness, chest pain, drowsiness, fall in blood pressure, haemoptysis, cyanosis
 · Children with ILI (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.
     -------Hospitalization stat
     -------Start Oseltamivir immediately, without waiting for test results
     -------Intensive supportive management is usually necessary.
Pregnancy is an extreme high risk category
Any Influenza Like Illness (ILI) in pregnancy (both antenatal and post natal) – suspect H1N1, START OSELTAMIVIR IMMEDIATELY
Early referral to appropriate centre to start Oseltamivir / If any delay in transit expected, start Oseltamivir, then refer.
Oseltamivir in pregnancy is considered sa

 H1N1 TESTING

ILI- Cat- A- No testing needed
ILI -Cat-B- No testing for Category-B (i) and (ii)
Cat-C- Test may be needed**, but do not wait for test results .
** (Sentinel type Testing now needs to be done only for epidemiological purposes, eg.- unusual in presentation, failure to respond even after 5 days extension of Oseltamivir therapy, institutional spread, etc)
If testing is indicated -
Contact your hospital Nodal MO, DSO / Nodal MO of District Hospital
Specimen required - 1 throat swab and 1 nasal swab, using Dacron swab, and immersed in VTM (Viral Transport Medium) tube, immediately put in cold chain/ refrigerated till dispatch at 2-8 deg C .
Testing centres – Three** authorized testing centres for Kerala,
1. Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram,
2.Virology Division, MCVR, KMC Hospital, Manipal, Karnataka State.
3. NIV Unit, Medical College, Alappuzha
Chemoprophylaxis to family, school and social contacts of a positive case-
 No mass contact prophylaxis advised
 For those with high risk Eg. pregnancy/ diabetes/ Asthma/immuno-suppressed/ very low or high age-- Start OD dose Oseltamivir x 10 days
 Others – assess category, if and when symptomatic, then treat as per ABC guidelines
Oseltamivir dosage schedule
 Dose for treatment is as follows:
 By Weight:
- For weight <15kg 30 mg BD for 5 days
- 15-23kg 45 mg BD for 5 days
- 24-<40kg 60 mg BD for 5 days
- >40kg 75 mg BD for 5 days
 For infants:
- < 3 months 12 mg BD for 5 days
- 3-5 months 20 mg BD for 5 days
- 6-11 months 25 mg BD for 5 days
- It is also available as syrup (12mg per ml )
- If needed dose & duration can be modified as per clinical condition.
- In case suspension is not in stock, the contents of the capsule can be divided and administered in powdered sugar, sugar syrup, or honey.
-
***Dose by weight for chemoprophylaxis (only in special circumstances-see section 2) is similar, except that it is Once daily, for 10 days